Palmetto Denying CPT Code 97140

There was a payment issue with Palmetto GBA, Medicare Administrative Contractor for the states of North Carolina, South Carolina, Virginia and West Virginia, with the billing of CPT code 97140, manual therapy. Palmetto was denying payment for manual therapy (97140) unless it was billed with ICD-9 codes 457.0 (postmasectomy lymphedema syndrome), 457.1 (other lymphedema), and…

Can I Use the KX Modifier Above $3700?

I am often asked by therapists, office managers, biller’s, billing companies, etc., if the application of the KX modifier is allowed for Medicare beneficiaries who have exceeded $3700 physical and speech therapy combined in a calendar year or a separate $3700 for occupational therapy in a calendar year. Providers of therapy services are under the…

How to Complete the ABN Form

The past 2 weeks, I wrote on 2 primary reasons why a provider may have to issue an advance beneficiary notice of noncoverage (ABN) to a Medicare beneficiary receiving outpatient therapy services. In this week’s article, I am going to teach providers how to complete the ABN form and provide examples of completed ABN forms.…