Effective for dates of service on or after Oct. 1, 2018, the following procedure codes will require prior authorization for UnitedHealthcare Community Plan of Mississippi (Medicaid, CHIP Plans): Speech Therapy: CPT Code 92507

The American Physical Therapy Association partnered with the American Chiropractic Association and presented an application for a dry needling CPT code at the American Medical Association CPT Meeting in Boston, September 27-29. APTA will provide an update on the results of the meeting after the meeting information is made public. Watch for an updated article on my website once the information is made public.

A question I receive often from therapists in private practice is “I just hired a new physical therapist (PT), occupational therapist (OT) and/or speech-language pathologist (SLP) and they are not yet approved as a Medicare provider; can they see Medicare patient’s while waiting to become approved and if yes, how do I bill for their visits?” In this article, I will explain the 2 options private practices have when this situation occurs. Keep in mind that when I say Medicare, this is traditional Medicare Part B and does not include Medicare Advantage plans. Option #1

The Comparative Joint Replacement (CJR) program was implemented on April 1, 2016 and in the first year (which was only 8 months), the program saw average total payments decrease by 3.9% or $1,127 compared to hospitals not participating in the model according to a report prepared by The Lewin Group for the Centers for Medicare and Medicaid Services (CMS). The study analyzed results from 731 CJR participant hospitals and 841 hospitals not in the experiment, which lasted from April 1, 2016 to Dec. 31, 2016. However, in 2017, CMS scaled back the CJR program is now only mandatory in 34

Providers always want to know if they can treat family members who have Medicare as their insurance and submit the claims for those services to the Medicare program and receive reimbursement. Well, to answer that question, we must look at what the Centers for Medicare and Medicaid Services (CMS) has to say on this matter. The answer can be found in  

Automatic annual increases in Medicare payment for outpatient therapy services is coming to an end after 2019 unless you participate successfully in the Merit-Based Incentive Payment Program (MIPS). Due to the passage of the Medicare Access and Chip Reauthorization Act of 2015, providers of outpatient therapy services received an annual update of 0.5% from July 2015 through 2019. For calendar years 2020-2025, there will be no update to the conversion factor that CMS uses to determine the payment amount for each CPT code paid under the Medicare Physician Fee Schedule. For 2026 and beyond, providers who participate in alternative payment

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. The GA modifier is defined as waiver of liability statement on file. The GA modifier must be used when therapy providers want to indicate

Noridian Healthcare Solution, Medicare Administrative Contractor for the states of Alaska, Arizona, Idaho, Montana, Oregon, North Dakota, South Dakota, Utah, Washington, and Wyoming, has published a revised article providing clarification regarding the billing of CPT codes 29105, 29125, 29126, 29130, 29131, 97760, 97799 for the application of a splint when also billing the L code the same day. To access the article, log into your Gold account and click