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05/13/19

Billing an Evaluation and CPT Code 97750 on the Same Day

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

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05/13/19

OIG Cases Involving Physical Therapy and Physical Therapists

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

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05/09/19

UnitedHealthcare Commercial Therapy Policies

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

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05/06/19

Double Booking Medicare Patients: Is This Allowed

Last week, 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

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05/02/19

Noridian to Host Free Outpatient Therapy Webinar

Noridian Healthcare Solutions will be hosting a free 30-minute webinar on May 21, 2019 at 1:00pm CT to discuss outpatient therapy certifications and recertifications. The webinar will include: Overview What is a Certification When to recertify Signatures Common Errors Resources For additional information and to register, click HERE.

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04/29/19

What is Substantial of a Time-Based CPT Code

For those of us that treat Medicare beneficiaries for outpatient physical, occupational and/or speech-language pathology services, we all understand that the Medicare program utilizes what as come to be known as the “8-minute rule” when determining how many time-based units can be billed during an outpatient therapy visit. But what about non-Medicare insurance carriers that do not utilize the “8-minute rule”? How do we determine how much time of a time-based CPT code must be provided in order to bill that CPT code to an insurance carrier that does not follow the Medicare “8-minute rule”? In this article, I will

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04/29/19

Novitas Revises PT and OT LCD

Novitas Solutions, Inc., Medicare Administrative Contractor (MAC) for the states of Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Mexico, New Jersey, Oklahoma, Pennsylvania, and Texas as well as the District of Columbia, has issued a revised physical therapy and occupational therapy local coverage determination (LCD) with an effective date of April 18, 2019. The LCD lists the most common CPT codes utilized by physical and occupational therapists and provides indications when the CPT code would be applicable to bill and supportive documentation requirements. To access the LCD, log into your Gold Member account and click

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04/26/19

Palmeto Active Medical Reviews

Palmetto GBA, Medicare Administrative Contractor (MAC) for Jurisdiction J which includes the states of Alabama, Georgia and Tennessee, currently has two active medical reviews for outpatient therapy services for non-private practice settings. The two reviews are focused on CPT code 97110 (therapeutic exercise) and CPT code 97140 (manual therapy). When the results of the review are posted, I will write an article on the findings.

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