In what outpatient therapy settings is maintenance therapy a covered benefit under traditional Medicare? Does traditional Medicare cover maintenance therapy in a skilled nursing facility under Part A benefits? Does traditional Medicare cover maintenance therapy for a Medicare beneficiary receiving home health services under Part A benefits? If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, do those visits count towards their annual therapy threshold dollar amount? If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, do we need to apply the KX modifier to the CPT codes on the claim form if the Medicare beneficiary has exceeded their annual therapy threshold dollar amount? Can a physical therapist assistant (PTA ) or occupational therapy assistant (OTA) provide maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services? Does the Centers for Medicare and Medicaid Services have a web page dedicated to maintenance therapy? Does the Jimmo Settlement Agreement apply to Medicare Advantage plans? On the claim form, how will the Medicare Administrative Contractor (MAC) know whether the therapy is rehabilitative in nature or maintenance in nature? If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, do we need to apply the KX modifier to the CPT codes on the claim form if the Medicare beneficiary has exceeded their annual therapy cap? If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, do those visits count towards their annual therapy cap? If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, what CPT codes do I use to bill the Medicare program? What happens if the Medicare beneficiary does not have anyone to help them at home carry out the maintenance program? Can I continue to see the Medicare beneficiary and bill the Medicare program for the maintenance therapy services? Can an assistant carry out a maintenance program with the Medicare beneficiary and/or their family/caregiver? Who can establish and develop a maintenance therapy program? Is maintenance therapy covered in Comprehensive Outpatient Rehabilitation Facility (CORF) setting? In the inpatient rehabilitation facility (IRF) setting, must the patient be expected to return to their prior functional status and/or prior home situation? Is maintenance therapy covered in the inpatient rehabilitation facility (IRF) setting? What is the difference between rehabilitative therapy and maintenance therapy? Prior to the settlement of this lawsuit, did CMS have an “Improvement Standard” for outpatient therapy services? Why did the Medicare Advocacy Organization bring a lawsuit against CMS regarding outpatient therapy coverage issues?

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