There are many modifiers providers of therapy services are use to adding to CPT codes on the claim forms. Common modifiers include the KX modifier, 59-modifier and therapy specific modifiers of GN, GO and GP. But do you know the following modifiers and when to use them: GA, GX, GY and GZ? In this article, I will discuss when to use these modifiers on a CPT code on the claim form for therapy services. In addition, if you have additional questions on when to issue an advance beneficiary notice of non-coverage (ABN) form to a Medicare beneficiary, check out my

Lately, I have been receiving questions regarding what must a therapist or an 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 as well as Medicare Advantage plans, Medicaid, private/commercial insurance carriers and workers compensation carriers. For outpatient therapy services provided under Medicare

The Centers for Medicare and Medicaid Services (CMS) has released a new booklet where they describe common outpatient rehabilitation therapy services Comprehensive Error Rate Testing (CERT) Program errors, how the CMS calculates improper payment rates, the necessary documentation to support billed Medicare claims, and managing potential overpayments. Some of the more common CERT errors include:  

UnitedHealthcare (UHC) Community Plan will begin Site of Care Medical Necessity Reviews and are also revising their prior authorization requirements for occupational, physical and speech therapy services. Beginning with dates of service on and after  

The Medicare Fee-For-Service Recovery Audit Program was initiated in 2009 to reduce improper Medicare payments to suppliers and providers enrolled in the Medicare program. Since its inception, the program has recouped more than $10 billion for the Medicare program. It should be to no ones surprise that therapy services have contributed to the more than $10 billion recouped. Current approved topics pertaining to therapy include: 0138-SNF-Consolidated Billing for Therapies 0124-Part B Therapies in a Hospital Setting 0073-Inpatient Rehabilitation Facility Stays: Meeting Requirements to be Considered Reasonable and Necessary To access the complete list of approved topics, click HERE. Proposed topics

A question I often receive is can I bill and be paid for an evaluation or reevaluation (CPT codes 97161-97168) and a physical performance test and measurement (CPT code 97750) when provided on the same date of service by the same discipline? To obtain the answer, we must refer to the

Last week, the Office of the Inspector General (OIG) published 3 enforcement actions involving physical therapy. I will provide a brief summary of the 3 enforcement actions and a link to each action. In the first enforcement action, physical therapist Hatem Behiry was found guilty of participating in a $30 million scheme to defraud Medicare and the New York State Medicaid Program. Per the OIG report, Hatem Behiry “pretended to provide physical therapy to many of those same patients, most of whom were receiving cash kickbacks for coming to the Clinics”. In addition, BEHIRY “also prepared and oversaw the preparation

UnitedHealthcare has revised the following 2 Coverage Determination Guidelines with an effective date of February 1, 2019: Speech Language Pathology Services Habilitative Services and Outpatient Rehabilitation Services In addition, UnitedHealthcare updated their Cognitive Rehabilitation Medical Policy with an effective date of November 1, 2018. To access the guidelines and medical policies, log into your Gold Member account and click