When Does an Order for Therapy Expire

One of the most common questions I am asked via email and in-person during a seminar is “When does an order for therapy expire” or “How old can an order be before a patient starts therapy”? To answer this question, we must look in 3 places. The first is your  

Novitas Updates Modified Barium Swallow Study LCD

Novitas Solutions, Inc, Medicare Administrative Contractor in the states of Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Jersey, Oklahoma and Pennsylvania as well as the District of Columbia, has released a revised local coverage determination (LCD) on Modifier Barium Swallow Studies. The LCD provides covered indications where instrumental assessment of swallowing may be helpful as…

Can New PT and PTA Graduates Treat Medicare Patients

A question I often receive is can a new graduate physical therapist or graduate physical therapist assistant treat Medicare patients while they are waiting to take their national examination and have their services supervised by a licensed physical therapist (PT) or physical therapist assistant (PTA) and billed to the Medicare program? Does the Centers for…

UHC to Require Therapy Modifiers for Reimbursement

This article was originally published on May 20, 2019. Information has been updated as of June 3, 2019. Please read below for further details. Changes are coming to UnitedHealthcare and billing for outpatient therapy services. Failure to be aware of this change will cause your claims not to be paid beginning this summer. UHC has…

Distinguishing Between the GA, GX, GY and GZ Modifiers

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,…

How to Document Time in the Medical Record

Lately, I have been receiving questions regarding what must a therapist or an assistant document in regards to time for patients receiving outpatient therapy services under Medicare Part B. Does the Medicare program require time in and time out? Does the Medicare program require we document the minutes spent on each individual CPT code. In…

Outpatient Therapy Common CERT Errors

The Centers for Medicare and Medicaid Services (CMS) has released a new booklet where they describe common outpatient rehabilitation therapy services Comprehensive Error Rate Testing (CERT) Program errors, how the CMS calculates improper payment rates, the necessary documentation to support billed Medicare claims, and managing potential overpayments. Some of the more common CERT errors include:…

UnitedHealthcare Community Plan Therapy Changes

UnitedHealthcare (UHC) Community Plan will begin Site of Care Medical Necessity Reviews and are also revising their prior authorization requirements for occupational, physical and speech therapy services. Beginning with dates of service on and after  

Recovery Audit Program and Therapy Services

The Medicare Fee-For-Service Recovery Audit Program was initiated in 2009 to reduce improper Medicare payments to suppliers and providers enrolled in the Medicare program. Since its inception, the program has recouped more than $10 billion for the Medicare program. It should be to no ones surprise that therapy services have contributed to the more than…

Billing an Evaluation and CPT Code 97750 on the Same Day

A question I often receive is can I bill and be paid for an evaluation or reevaluation (CPT codes 97161-97168) and a physical performance test and measurement (CPT code 97750) when provided on the same date of service by the same discipline? To obtain the answer, we must refer to the