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11/26/18

Dry Needling CPT Codes Coming in 2020

During the weekend of September 28, 2018, the CPT Editorial Panel held their meeting where the American Physical Therapy Association, in collaboration with the Chiropractic Association, submitted an application for the addition of 2 CPT codes for dry needling/trigger point acupuncture. The CPT Editorial Panel did accept the addition of codes

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11/26/18

Patient Driven Payment Model for SNFs

Beginning on October 1, 2019, the Centers for Medicare and Medicaid Service (CMS) will begin using the Patient Driven Payment Model (PDPM) for classifying skilled nursing facility patients in a covered Part A stay. CMS has created a website with information for providers to prepare and learn for this important payment change effective October 1, 2019. This new website includes information on the following: Concurrent and Group Therapy Limit MDS Changes Interrupted Stay Policy PDPM Classification Variable per diem Adjustment PDPM Frequently Asked Questions PDPM Classification Walkthrough To access this valuable information, click

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11/19/18

Students Treating in the IRF Setting

Last week, the Centers for Medicare and Medicaid Services (CMS) held a conference call on the Inpatient Rehabilitation Facility (IRF) Payment and Coverage Policies. During the phone call, the presenter stated that according to hospital conditions of participation that IRFs must meet, students do not have a role in providing therapy or therapy minutes to patients, even under direct supervision of the licensed therapist. The presenter cited

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11/19/18

TRICARE Update for 2019

On December 12, 2017, President Trump signed the National Defense Authorization Act (NDAA) into law. One important piece of legislation included in the NDAA directs the Department of Defense (DOD) to add physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) to the TRICARE program as an eligible provider of therapy services. So, does this mean in 2019 that PTAs and OTAs can now treat TRICARE beneficiaries and have their services billed to and paid by the TRICARE program? Even though the NDAA is now law, the DOD must now make the change to add PTAs and OTAs as eligible

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11/19/18

Do Physicians Need to Sign Discharge Reports

A question I have been receiving lately is must a physician sign a therapists discharge report for Medicare beneficiaries receiving outpatient therapy services? In addition, must a physician sign a therapists discharge report for patients who have a commercial insurance or are being seen under workers compensation? The answer for Medicare Part B outpatient therapy services is

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11/13/18

Cigna Government Services to Begin TPE on PT and OT

In October 2018, Cigna Government Services (CGS), Medicare Administrative Contractor for the states of Kentucky and Ohio, will begin the CGS Targeted Probe and Education (TPE) program and will begin review of claims associated with physical and occupational therapies provided in the private practice setting, both therapist owned and physician owned. CPT codes initially under review will include: 97110- Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 97112-Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 97113-Aquatic therapy with therapeutic exercises

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11/12/18

Does Medicare Recognize Direct Access

Lately, I have been receiving questions regarding the Medicare program and does the Centers for Medicare and Medicaid Services (CMS) recognize and pay for direct access for outpatient therapy services. In CMS Publication 100-02, Chapter 15, Section 220.1.1, CMS states “Although there is no Medicare requirement for an order, when documented in the medical record, an order provides evidence that the patient both needs therapy services and is under the care of a physician”. So does this mean the Medicare program recognizes and pays for Direct Access since a physician order is not required? The answer is

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11/01/18

CMS Issues Final Rule for Services Paid Under the MPFS & MIPS for PT and OT

On November 1, 2018, the Centers for Medicare and Medicaid Services (CMS) issued the 2019 final rule for services paid under the Medicare Physician Fee Schedule (outpatient PT, OT and SLP services) as well as the Merit-Based Incentive Payment System (MIPS) for physical therapists, occupational therapists and speech-language pathologists in private practice. Highlights of the Final Rule include: 2019 Conversion Factor 2019 Therapy Threshold Dollar Amount 2019 Targeted Medical Review Dollar Amount Functional Limitation Reporting for 2019 New Modifiers to Distinguish Services Provided by a PTA or OTA “In Whole or In Part” Defined of a PTA or OTA Service

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