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09/25/19

IRF Provider Preview Reports Now Available

The Centers for Medicare and Medicaid Services (CMS) has announced that the Inpatient Rehabilitation Facility (IRF) Provider Preview Reports have been updated and are now available. Per CMS, “the data contained within the Preview Reports is based on quality data submitted by IRFs between Quarter 2 – 2018 and Quarter 1 – 2019 and reflects what will be published on IRF Compare during the December 2019 refresh of the website”. Providers will have until October 11, 2019 to review their data and can request CMS review of their data during the preview period if they believe the quality measure scores

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09/23/19

Speech Therapy Billing: Questions and Answers

It has been awhile since I have written an article focused on outpatient speech therapy and billing. So this week, I thought I would provide answers to some of the more common questions I receive about billing for speech therapy services. The answers I provide are based on what the Medicare Part B program allows and these answers may or may not be applicable to Medicare Advantage plans, Medicaid, managed Medicaid plans, private/commercial insurance carriers, workers compensation and automobile carriers. Here are the questions I will answer in this article: Can you be paid for CPT codes 92507 and 92526

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09/16/19

Work Hardening CPT Codes: Must I Be One-on-One With the Patient

A question I am often asked is must the therapist or assistant be one-on-one when providing work hardening or conditioning to a patient? There are 2 CPT codes that describe work hardening/conditioning used by physical and occupational therapists. The codes and descriptors are as follows: CPT code 97545 – Work hardening/conditioning; initial 2 hours CPT code 97546 – Work hardening/conditioning; each additional hour Now lets answer the question “Do CPT codes 97545 and 97546 require direct one-on-one contact”? Although these codes appear under the 97110 – 97546 heading of Therapeutic Procedures, these services do

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09/09/19

Texas Physical Therapists Get Direct Access

On May 23, 2019, House Bill (HB) 29 passed the Texas Senate and on June 14, 2019, Governor signed the bill into law. HB 29 will provide Texas residents the ability to have Direct Access for physical therapy services with an effective date of September 1, 2019. Highlights of HB 29 and Direct Access include: A physical therapist may treat a patient for an injury or condition in a manner described by Section 453.005 without a referral if the physical therapist:  

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09/04/19

UHC Delays Implementation of Therapy Specific Modifiers

UnitedHealthcare (UHC) has announced they have delayed the implementation of therapy specific modifiers (GN, GO, GP) to allow providers more time to adjust to changes in the submission of “Always Therapy” procedure codes to include the CMS required therapy modifiers. UHC has provided no new effective date at this time. This requirements was supposed to originally be effective with dates of service on and after July 1, 2019, but in June 2019, UHC further delayed the start of this new requirement until September 1, 2019. To read the latest on this issue straight from UHC, click I hope you enjoyed

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09/03/19

AMA Releases Calendar Year 2020 CPT Codes

The American Medical Association (AMA) has released the calendar year (CY) 2020 CPT codes and there are at least 6 new CPT codes and 6 deleted CPT codes that will impact physical therapists, occupational therapists and/or speech-language pathologists in CY 2020. The new CPT codes will become effective with dates of service on and after January 1, 2020 and be valid for dates of service up to an including December 31, 2020. In addition, the Centers for Medicare and Medicaid Services (CMS) is proposing to change 2 existing CPT codes to an active status meaning that CMS will assign work

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08/26/19

UHC Community Plan Adds 3 States to Prior Authorization

UnitedHealthcare (UHC) Community Plan is adding 3 states (in addition to the 4 previously announced) that will require prior authorization prior to initiating physical, occupational and/or speech therapy services. In addition, UHC Community Plan is adding site of service medical necessity reviews for all speech, occupational and physical therapy services provided in a hospital outpatient setting in 2 of the 3 states. The new impacted states are

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08/19/19

CMS to Require New Modifiers in Calendar Year 2020

Effective with dates of service beginning on and after January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will require 2 new modifiers be appended to CPT codes on the claim form when those services are provided “in whole” or “in part” by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). To make matters worse, beginning with dates of service on and after January 1, 2022, services that contain one of the two modifiers appended to them on the claim form will be paid at 85% of the normal rate of the Medicare allowed amount

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