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10/03/22

Are CHAMPVA and TRICARE the Same?

I am often asked if TRICARE and CHAMPVA are the same. In this article, I will answer the following questions concerning these 2 programs:

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09/12/22

Understanding the Biofeedback CPT Codes

In this article, I will provide answers to the following questions regarding the biofeedback CPT codes:

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09/07/22

BCBS of Michigan to Implement MPPR

Update as of September 8, 2022 at 12:00pm ET BCBS of MI has placed the MPPR implementation on hold. This information was not placed in the August or September 2022 editions of the “The Record”, but has been confirmed by multiple sources. I will provide updated information and resources when available. BCBS of Michigan has announced they will align with the Centers for Medicare and Medicaid Services and implement the multiple procedure payment reduction (MPPR) policy for outpatient physical, occupational and speech therapy services. This MPPR reduction will impact BCBS commercial members. The effective date of the MPPR implementation is

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09/07/22

Wellmark BC Updates Therapy ICD-10 Coding Guidelines

Wellmark BCBS has provided updated guidance on the use of the 7th character of ICD-10-CM codes when billed by physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs). Wellmark has identified that PTs, OTs and SLPs have been using the 7th character incorrectly and due to this, Wellmark has implemented a new claim code edit. The new claim edit will

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09/05/22

Does Medicare Reimburse for Driving Evaluations?

A question I often receive is does the Centers for Medicare and Medicaid Services (CMS) reimburse for driving evaluations when provided by a physical or occupational therapist? In this article, I will answer the following questions:

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08/29/22

Cigna to Implement Payment Reduction When Services are Billed with CQ/CO Modifier

Cigna has announced they will be implementing the 15% payment reduction when services are rendered in whole or in part by a physical therapist assistant or an occupational therapy assistant. CPT codes billed with the CQ or CO modifier appended to them on the claim form will have their reimbursement decreased by 15% beginning on

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08/29/22

Cigna Will Not Reimburse for More Than 4 Units

Cigna has announced a new payment policy that has implications for outpatient physical and occupational therapy services. Effective with dates of services on and after

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08/25/22

Remote Therapeutic Monitoring Comments

On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). Comments are due by 5:00pm on September 6, 2022. One part of the proposed rule that has a significant impact on physical and occupational therapists involves remote therapeutic monitoring (RTM). It is critical that CMS receives thousands of comments from physical and occupational therapists regarding the proposed RTM changes for CY 2023. I have drafted a 5-page customizable comment letter in a Word document that you can copy, paste and

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