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!

The Centers for Medicare and Medicaid Services (CMS) and Capital Bridge, LLC, who is the National Correct Coding Initiative (NCCI) contractor, has informed the American Speech-Language-Hearing Association (ASHA) that they will change the modifier indicator for when CPT codes 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording) and 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography) are billed on the same date of service by the same provider. CMS will now assign a modifier indicator ofI hope you found this article informative. Thank you for being a Gold Member!

The Centers for Medicare and Medicaid Services has released a MLN Matters article that provides information on the continuing role of therapy under the newly implemented home health prospective payment system (HH PPS) case-mix adjustment methodology, named the Patient-Driven Groupings Model (PDGM), for home health periods of care starting on and after January 1, 2020. To access the article, click HERE. I hope you fond this article helpful.

Since in calendar year 2020, the Centers for Medicare and Medicaid Services has decided that the new 2 dry needling CPT codes are non-covered, physical therapists want to know if there are other CPT codes that could possibly be billed instead and be paid by the Medicare program and other insurance carriers if performing needle insertion. QuestionIf I provide electrical stimulation through the needles, can I bill for this as unattended electrical stimulation or manual electrical stimulation? AnswerThe simple and straightforward answer is For additional information on dry needling, read “Will CMS Pay for Dry Needling in 2020” and also

Previously, I wrote an article explaining how much time of a time-based CPT code must be provided in order to bill that CPT code to an insurance carrier as well as explaining the difference between Medicare’s “8-minute rule” and the American Medical Association (AMA) definition of substantial when billing a time-based CPT code. This article then led people to ask me if I can double book and/or overlap Medicare patients receiving outpatient therapy services. I’m going to answer this question once and for all and the answer will not only apply to outpatient therapy services paid under Medicare Part B benefits, but

UnitedHealthcare (UHC) has announced they will implement the National Correct Coding Initiative (NCCI) edits to outpatient physical, occupational and speech therapy services effective with dates of service on and after I hope you found this article informative and will assist you in notifying your staff, billing company or billing department about this upcoming change that will impact your payment for outpatient therapy services if unaware of this change. Thank you for being a Gold Member!

UnitedHealthcare (UHC) has updated their Multiple Therapy Procedure Therapy Reduction policy for physical, occupational and speech-language pathology therapy services provided in the private practice setting. To access the revised policy, click HERE. This policy applies to UHC Commercial Plans. I hope you enjoyed this free article.

AIM Specialty Health has announced the launch dates for the AIM Rehabilitative program for Anthem’s Commercial Membership and Anthem’s Medicare Advantage Membership. This announcement impacts 2 states for Anthem’s Commercial Membership and 16 states for Anthem’s Medicare Advantage Membership. The AIM Rehabilitative program for Anthem’s Commercial Membership will relaunch April 1, 2020 for the states of The AIM Rehabilitative program for Anthem’s Medicare Advantage membership will launch April 1, 2020 and will impact the following states: I hope you found this article helpful. Thank you for being a Gold Member!