I often receive the following questions regarding massage and manual therapy: What is the description of massage and manual therapy? Does the Medicare program pay for massage and manual therapy? What is the difference between massage and manual therapy? What is the difference in payment between massage and manual therapy? Do private insurance carriers pay for massage (CPT Code 97124) In this article, I will answer the above 5 questions. According to the American Medical Association (AMA), CPT 2018 Professional Edition, the descriptions for massage and manual therapy are as follows:

The Centers for Medicare and Medicaid Services has issued guidance to the Medicare Administrative Contractors (MACs) how to reprocess outpatient therapy claims that were previously denied before the passage of the Bipartisan Budget Act of 2018 or were denied after the passage of the Bipartisan Budget Act of 2018 even though the KX modifier was appended to services that had been delivered above $2010 in calendar year 2018. In addition, some MACs will have to reprocess therapy claims due to changes in the Work Geographic Price Cost Index (GPCI) floor. This means that some providers in some states will see

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the Centers for Medicare and Medicaid Services (CMS) to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status. Beginning in April 2018, CMS will start mailing the new Medicare cards with the MBI to all people with Medicare in phases by geographic location.CMS plans to have a transition period where providers can use either the HICN or

Effective May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) to cover Supervised Exercise Therapy (SET) for beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic Peripheral Artery Disease (PAD). SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest. SET has been recommended as the initial treatment for patients suffering from IC, the most common symptom experienced by people with PAD. CMS issued the NCD to cover SET for beneficiaries with IC for the treatment of symptomatic PAD. Up to 36 sessions

Since passage of the 2018 Bipartisan Budget Act of 2018 that repealed the therapy cap for outpatient therapy services, I have been receiving many questions about the application of the KX modifier for services that exceed either $2010 or $3000 physical therapy and speech therapy combined in 2018 or a separate $2010 or $3000 for occupational therapy. Most of the questions center around should I provide the Medicare beneficiary with an advance beneficiary notice of noncoverage (ABN)  when they exceed either $2010 or $3000 in calendar year 2018? In this article, I will answer the following questions: If the therapy

I receive many questions at my in-person seminars and via email that begin something like “I know we can’t have 2 Medicare patient’s being treated at the same time, but how about 2 patient’s with private insurance”? Or, “I know I need to be one-on-one with Medicare patient’s, but that does not apply to patient’s with private insurance, right”? Lastly, “I know if I have 2 Medicare patient’s in my facility for one hour during the same time period, I have to split the time between them, but if the 2 patient’s had private insurance, I could bill each for

Humana has announced 8 payment changes effective March 1, 2018 that will impact providers of outpatient physical, occupational and speech therapy services. While Humana states the effective date is March 1, 2018, it appears that the changes may have already been implemented with dates of service on and after January 1, 2018. Effective with dates of service on and after March 1, 2018, Humana will no longer pay for the following CPT codes:

The Centers for Medicare and Medicaid Services (CMS) has issued clarifying instructions for conducting medical review of Inpatient Rehabilitation Facility (IRF) claims when reviewing the requirements for the intensive level of rehabilitation therapy services. The instructions state the Medicare Administrative Contractors, Supplemental Medical Review Contractor, Recovery Audit Contractors and the Comprehensive Error Rate Testing contractor shall not make absolute claim denials based solely on a threshold of therapy time not being met. When the current industry standard of generally 3 hours of therapy (physical therapy, occupational therapy, speech-language pathology, or prosthetics/orthotics) per day at least 5 days per week or