On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS). This would include outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except for a critical access hospital. Highlights of the final rule include, but […]
QuestionI often have patients who are under an outpatient therapy plan of care who had surgery and present during an evaluation or follow-up visit and the physician has asked me to remove the patients sutures. What is the most appropriate CPT code to bill for this service so that I am reimbursed by the insurance […]
QuestionIn my state, my Medicare Administrative Contractor (MAC) does not pay for iontophoresis as they consider it investigational and experimental. If I have a traditional Medicare patient that receives 35 minutes of 1 on 1 time that is billed out as therapeutic exercise, but also received iontophoresis that took 5 minutes of skilled one-on-tine to […]
I am often asked if the time a student treats a Medicare patient for physical, occupational and/or speech therapy services, is that time billable to the Medicare program? In this article, I will answer this question as it applies to inpatient acute care, inpatient rehabilitation facilities, skilled nursing facilities providing Part A therapy services and […]
The Centers for Medicare and Medicaid Services (CMS) has announced the 2021 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2021 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon […]
On September 8, 2020, the American Medical Association released CPT code 99072 and this code became effective immediately. I have previously published 2 articles on this CPT code. The first was on September 22, 2020 titled “CPT Code 99072: Can Therapists Bill This Code“? and the second was published on October 12, 2020 and titled […]
The Centers for Medicare and Medicaid Services has published updated data concerning the 2019 Merit-Based Incentive Payment System (MIPS) Performance Period results that will impact your calendar year 2021 Medicare payments for outpatient therapy services. Many MIPS eligible professionals who successfully participated in MIPS in 2019 and scored 30 or more points will be disappointed […]
TRICARE has provided updated information regarding their low back pain (LBP) and physical therapy demonstration scheduled to begin on January 1, 2021. Updated information includes the following: Demonstration goals and evaluation Policy and beneficiary eligibility ICD-10-CM Diagnosis codes applicable to demonstration Exclusions to the demonstration Under Policy and Beneficiary Eligibility, TRICARE states the following: I […]
Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States.