In this week’s article, I wanted to answer some of the most commonly asked questions I receive concerning the Medicare therapy threshold (formerly, the Medicare therapy cap), the KX modifier, claims exceeding $3,000 in a calendar year and when to and when not to use an advance beneficiary notice of noncoverage (ABN) for Medicare beneficiaries who exceed the annual therapy threshold and $3,000 in a calendar year. In this article, I will answer the following questions: 1. Why is it called the therapy threshold and not the therapy cap? 2. Why must I still use the KX modifier? 3. Will

In this week’s article, I wanted to answer some of the most commonly asked questions I receive concerning the Medicare therapy threshold (formerly, the Medicare therapy cap), the KX modifier, claims exceeding $3,000 in a calendar year and when to and when not to use an advance beneficiary notice of noncoverage (ABN) for Medicare beneficiaries who exceed the annual therapy threshold and $3,000 in a calendar year. In this article, I will answer the following questions: 1. Why is it called the therapy threshold and not the therapy cap? 2. Why must I still use the KX modifier? 3. Will

A question I have been receiving often lately is can the time a therapy student or therapy assistant student is treating an outpatient receiving physical therapy, occupational therapy, and/or speech therapy be billed to the insurance carrier since the student is under the direct supervision of the therapist or assistant (if the student is a therapy assistant student)? As you can imagine, there are several answers to this question. The answers are yes, no, maybe so and depends. Lets talk first about Medicare beneficiaries receiving outpatient physical, occupational and/or speech therapy services (i.e. paid under Medicare Part B benefits). Does

First Coast Service Options, Inc. has revised their local coverage determination (LCD) for major joint replacement (hip and knee). The revision removes diagnosis codes M96.65, T84.020A, T84.020D, T84.020S, T84.021A, T84.021D, T84.021S, Z89.621, and Z89.622, that were included in the “ICD-10 Codes that Support Medical Necessity/Group 2 Codes:/Total Knee Arthroplasty” section of the LCD in error. The LCD revision is effective for claims processed on or after October 1, 2018, for services rendered on or after March 2, 2016. To access the revised LCD, click HERE.

Wisconsin Physician Services, Medicare Administrative Contractor for the states of Iowa, Kansas, Missouri and Nebraska, has announced they will begin a new Targeted Probe & Educate topic for private practices in the before mentioned states. The topic will focus on CPT code 97110, therapeutic exercise to improve strength and endurance, range of motion and flexibility. For additional information, click HERE.

The Centers for Medicare and Medicaid Services (CMS) has announced the 2019 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2019 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon was the deductible met before or after they received outpatient physical, occupational and/or speech therapy services. Lets begin with the 2019 Part B deductible and monthly premiums. In 2019, the Part B deductible will be

The Centers for Medicare and Medicaid Services (CMS) has released data that provides important premium and cost sharing information for Medicare health and drug plans offered in 2019. According to the CMS Fact Sheet: Enrollment in Medicare Advantage is projected to be at an all-time high in 2019 with 22.6 million Medicare beneficiaries. This represents a projected 2.4 million (11.5 percent) increase from 20.2 million in 2018. Based on projected enrollment, 36.7% of Medicare beneficiaries will be enrolled in Medicare Advantage in 2019. Medicare Advantage premiums, on average, have steadily declined since 2015 from the actual average premium of $32.91.

Last week, I published an article titled “How to Bill Medicare for a Therapist Not Yet Credentialed“. This article then led to readers asking must physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) in private practice enroll in the Medicare program if they want to treat Medicare beneficiaries? The answer is yes. PTs, OTs and SLPs in private practice must enroll in the Medicare program if they want to treat Medicare beneficiaries for services that would be covered by the Medicare program. In addition, once they enroll in the Medicare program, PTs, OTs and SLPs in private practices