Due to the coronavirus (COVID-19), I am receiving many questions regarding telehealth and the ability for physical therapists, occupational therapists and speech-language pathologists to provide telehealth services and to have those services reimbursed by the Medicare program and private/commercial insurance carriers. See below for some of the common questions I receive and the answers as of March 13, 2020. QuestionWith the Centers of Medicare and Medicaid Services changing the rules and regulations for telehealth services due to the coronavirus (COVID-19), does this now mean physical therapists, occupational therapists and speech-language pathologists can now provide telehealth services to Medicare beneficiaries, bill

UnitedHealthcare Community plan has revised one clinical policy pertaining to cognitive rehabilitation, 3 coverage determination guidelines pertaining to outpatient physical, occupational and speech therapy services and 2 utilization review guidelines pertaining to outpatient physical, occupational and speech therapy services. The following policies have been revised with an effective date of April 1, 2020 except for Cognitive Rehabilitation which became effective March 1, 2020: I hope you found this article informative and will assist you treating and billing UnitedHealthcare Community Plan beneficiaries for dates of service on and after April 1, 2020. Thank you for being a Gold Member!

UnitedHealthcare Oxford has revised several of their clinical policies pertaining to outpatient physical, occupational and/or speech therapy services. The following policies have been revised with an effective date of April 1, 2020: I hope you found this article informative and will assist you treating and billing UnitedHealthcare Oxford beneficiaries for dates of service on and after April 1, 2020. Thank you for being a Gold Member!

UnitedHealthcare Commercial has updated their coverage determination guideline pertaining to Habilitative Services and Outpatient Rehabilitation Therapy with an effective date of April 1, 2020. In this updated coverage determination guideline, UHC lists certain CPT codes that are only payable as habilitative therapy services when they are billed with one of the habilitative diagnosis codes in the primary position on the claim. In addition, in this coverage determination guideline, UHC lists which ICD-10 diagnosis codes, when listed in the primary position on the claim form, qualify as habilitative therapy services only. In addition, UHC provides which CPT codes are payable for

UnitedHealthcare Medicare Advantage has updated their coverage summary for speech generating devices with an effective date of February 18, 2020. To access the updated clinical policy, click HERE. Thank you for being a Gold Member!

On February 20, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule revising certain aspects of the Comprehensive Care for Joint Replacement (CJR) model including the episode of care definition, the target price calculation, the reconciliation process, the beneficiary notice requirements and the appeals process. CMS is proposing to extend the CJR model for an additional three years, through Dec. 31, 2023, but only to hospitals in the 34 metropolitan statistical areas in which participation was mandatory. Hospitals participating in the 33 “voluntary” MSAs, as well as all low-volume and rural hospitals that have elected to

Two weeks, I wrote an article titled “Can I Double Book Medicare Patients“. If you have not had a chance to read this article, I would suggest you take a few minutes to read it as it will really help you in your practice and organization understand the rules and regulations regarding scheduling and billing of double booking Medicare patients. This article then led to other questions that I will address in this article. The last question will show you how it’s possible to bill 7 time-based units plus 2 untimed CPT codes within a one hour time period. QuestionCan

On December 18, 2017, Humana announced they would no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage. Unfortunately, nothing lasts forever. Effective with dates of service on and after I hope you found this article helpful and informative. Thank you for being a Gold Member!