2020 Annual Update to the Therapy Code List

The Centers for Medicare and Medicaid Services (CMS) has released the annual update that provides the list of codes that sometimes or always describe therapy services. Providers of therapy services need to be aware of this list and the annual updates as this list will tell providers which CPT codes the Multiple Procedure Payment Reduction…

What are the New CPT Codes for 2020

In calendar year (CY) 2020, there will be 6 new CPT codes applicable to outpatient therapy services. The AMA also released 3 new Level II HCPCS codes that may or may not be applicable to physical therapists, occupational therapists and/or speech-language pathologists. In addition, there are 5 CPT codes and 1 Level II code being…

Medicare 2020 Deductibles and Premiums Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the 2020 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2020 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon…

Important Medicare Supplement Plan Changes for 2020

Big changes are coming in calendar year 2020 for Medicare beneficiaries who purchase Medicare Supplement plans (known as Medigap). The changes are a result of the Medicare Access and CHIP Reauthorization Act (MACRA) that will change Medicare Supplement plans in all states, and this becomes effective January 1, 2020. Who will this change impact in…

Will CMS Pay for Dry Needling in 2020

On January 1, 2020, there will be 2 new CPT codes to report needle insertion(s) (i.e. dry needling) for qualified healthcare professionals, such as physical therapists, who provide dry needling where allowed by state law and state practice act. Now, just because we have the new CPT codes that describe dry needling does not mean…

CMS Releases 2020 Final Rule for Medicare Services

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS) and the Merit-Based Incentive Payment System (MIPS) program for calendar year (CY) 2020. Highlights of the final rule include, but are not limited to, the following: 2020 Medicare Conversion…

CMS Releases 2020 Home Health Final Rule

On October 31, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Home Health Agencies for calendar year 2020. Highlights of the final rule include: CMS projects that aggregate Medicare payments to HHAs in CY 2020 will increase by 1.3 percent, or $250 million CMS will allow physical therapist assistants…

BCBS of Minnesota Reviewing for Medical Necessity

On June 3, 2019, Blue Cross and Blue Shield (BCBS) of Minnesota removed the prior authorization (PA) requirements for outpatient therapies, including physical, occupational, and speech therapy, and chiropractic services. Self-Insured Groups may have benefits that require a PA for outpatient therapy or chiropractic services. These services may be managed as a PA or a…

UnitedHealthcare Medicare Advantage Plan Changes

Since January 1, 2019, facilities that provide post-acute care inpatient services have been required to request prior authorization and receive a pre-service determination before UnitedHealthcare (UHC) Medicare Advantage Plan members can be admitted to a post-acute care facility or a post-acute care bed in one of the following types of facilities: Acute Inpatient Rehabilitation Skilled…

Medicare Spending for Outpatient Therapy in 2017

The Medicare Payment Advisory Commission (MedPAC) has released a 3-page document providing data and Medicare spending for outpatient therapy in calendar year 2017. Here is a brief summary of the report. Distribution of Outpatient Therapy by Setting Skilled Nursing Facility: 37% PT in Private Practice: 34% Hospital: 16% ORF, CORF and HHA: 9% OT &…