On January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) will no longer require the use of the GT modifier on professional claims for telehealth services. Use of the telehealth POS code 02 certifies that the service meets the telehealth requirements. Click HERE for the CMS transmittal.
On December 12, 2017, President Trump signed the National Defense Authorization Act (NDAA) into law. One important piece of legislation included in the NDAA directs the Department of Defense (DOD) to add physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) to the TRICARE program as an eligible provider of therapy services.
Even though the NDAA is now law, the DOD must now make the change to add PTAs and OTAs as eligible providers of therapy services. The DOD must also establish, in regulations, requirements for the supervision of PTAs and OTAs. Until this is completed, PTAs and OTAs are still unable to treat TRICARE beneficiaries and bill for those services.
Further information on TRICARE will be posted as it becomes available.
The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) Edits Version 24.0. Version 24.0 will be valid for dates of service beginning January 1, 2018 and ending March 31, 2018. Version 24.0 has some significant additions due to changes in CPT codes 97760 and 97761, the addition of CPT codes 97127 and 97763 and the deletion of CPT codes 29582, 29583 and 97532. In addition, there are changes to the edits for CPT codes 97750 and 97755 when billed on the same day as a physical or occupational therapy evaluation or reevaluation. Lastly, I have added many new NCCI edits for the speech therapy evaluation and treatment codes.
To access the Gawenda Seminars & Consulting NCCI Version 24.0 reference sheet for therapy services, click HERE.
It’s not only important that you not only use this reference sheet to assist you to determine when modifier 59 is required to be appended to a CPT code on the claim form, but you need to read the NCCI Policy Manual for Medicare Services. This manual gives additional guidance on NCCI edits, proper billing of CPT codes and the correct use of modifier 59. Some examples of instructions in this manual include the following:
- Gives instructions what equipment must be used to bill CPT code 92597 (Evaluation for voice prosthetic device)
- Gives instructions on speech-language pathologists (SLPs) billing CPT codes 97110, 97112, 97127, 97150 and 97530 on the same day they are billing CPT codes 92507, 92508 and/or 92526.
- Gives instructions on SLPs billing unattended electrical stimulation (G0283) on the same day as CPT code 92526 for dysphagia and swallowing disorders.
- Discusses billing of more than one physical therapy evaluation code or more than one occupational therapy evaluation code on the same date of service.
- Discusses if the same practitioner, who is both a physical therapist and occupational therapist, performs a physical therapy and occupational therapy evaluation on the same day on the same patient.
- Discusses how to bill for physical and/or occupational therapy when performed at the same encounter as cardiac rehabilitation services or pulmonary rehabilitation services.
- Discusses the billing of CPT code 97750 (physical performance test or measurement) and CPT code 97755 ( assistive technology assessment) when performed on the same day as a physical and/or occupational therapy evaluation or reevaluation.
This list is not all inclusive. To access the NCCI Policy Manual for Medicare Services, click HERE.
This Gawenda Seminars & Consulting reference sheet is updated quarterly and is a Gold Member benefit that pays for itself by teaching our members what codes can and can’t be billed on the same date of service, when a CPT code needs modifier 59 appended to it and when modifier 59 is not allowed. The CPT code(s) in column 2 is considered a component of the CPT code in column 1. It is the CPT code in column 2, when provided on the same day as the CPT code in column 1, that requires modifier 59 appended to it on the claim form, if allowed, in order to be paid on the same date of service as the CPT code in column 1.
I hope you enjoyed this article. If you are currently a Gold Member, thank you! If not, this reference sheet, Current News articles, Insurance Links and FAQs on many topics such as the ABN, Maintenance Therapy, L Codes for Orthotics, Progress Reports, Reevaluations, and Therapy Cap will pay for your membership in no time. For additional information on Gold Membership and to join, click HERE.
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that makes significant changes to the Comparative Joint Replacement (CJR) model beginning on January 1, 2018. In addition, this rule finalizes the CMS proposal to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) Incentive Payment Model. The EPMs that have now been canceled include acute myocardial infarction, coronary artery bypass graft and surgical hip/femur fracture treatment episodes of care.
Beginning January 1, 2018, the CJR model will be mandatory in 34 metropolitan statistical areas (MSAs) instead of the current 67 MSAs. For the remaining 33 MSAs, hospitals will be able to choose whether or not they want to participate in CJR in 2018. In addition, CMS is finalizing their proposal that rural hospitals (as defined at § 510.2 as of January 31, 2018) and low volume hospitals, defined as hospitals with fewer than 20 episodes in the historical baseline period used to create the Program Year 1 target prices, in the 34 mandatory participation MSAs are not required to participate in the model, but may opt-in to the CJR model.
CMS is finalizing their proposal to offer a single opt-in period from January 1, 2018 – January 31, 2018 for hospitals not in the mandatory 34 MSAs and for rural hospitals and low volume hospitals in the mandatory 34 MSAs. Hospitals that opt-in during this time period will have an election effective date of February 1, 2018. If hospitals not in the mandatory 34 MSAs and for rural hospitals and low volume hospitals in the mandatory 34 MSAs do not opt-in by January 31, 2018 at 11:59pm EST, their participation in the CJR model will automatically terminate as of February 1, 2018.
To see the CJR mandatory participation MSAs and voluntary MSAs, click
A question I receive is can a speech-language pathologist (SLP) bill CPT code 92507 (treatment of speech, language, voice, communication, and/or auditory processing disorder, individual) or CPT code 92508 (treatment of speech, language, voice, communication, and/or auditory processing disorder, group) on the same day they also bill CPT code 97532 (development of cognitive skills to improve attention, memory)? To simplify the question, can an SLP bill 92507 and/or 92508 and 97532 on the same day for a patient who has Medicare as their insurance? The answer might surprise you!
According to the National Correct Coding Initiative (NCCI)
Lately, I have been receiving questions regarding what must a therapist or assistant document in regards to time for patients receiving outpatient therapy services under Medicare Part B. Does the Medicare program require time in and time out? Does the Medicare program require we document the minutes spent on each individual CPT code. In this article, I will answer what the Medicare program does and does not require in terms of documentation of time for each therapy visit. The answer below applies to traditional Medicare Part B only and not to Medicare Advantage plans, Medicaid, and private insurance carriers.
For outpatient therapy services provided under Medicare Part B, the required elements for documentation of time are: