Due to the Bipartisan Budget Act of 2018, the Centers for Medicare and Medicaid Services (CMS) implemented the CQ and CO modifiers to be appended to CPT codes on the claim form when those services are provided in whole or in part by a physical therapist assistant (PTA) and occupational therapy assistant (OTA), respectively. This […]
Aetna, Cigna and Humana have all announced changes to their respective policies related to the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits and the payment of a CPT code(s) that has had modifier 59 appended to it on the claim form. These positive changes would not have occurred without the advocacy of the American […]
UnitedHealthcare (UHC) has announced a commercial reimbursement policy update for outpatient physical, occupational and speech therapy services provided in facility settings. This would include any setting that submits claims to UHC on a UB-04 claim form. This policy update will impact UHC Commercial Plans as well as UHC Oxford Health Plans. The new Outpatient Rehabilitation […]
A question I received today and thought was worthwhile to post and answer for my Gold Members relates to student supervision requirements in the outpatient therapy setting. Due to COVID-19, the Centers for Medicare and Medicaid Services (CMS) has eased the supervision requirements of a physical therapist assistant (PTA) by the physical therapist (PT) and […]
Humana has released a revised telehealth policy for their commercial plans due to the COVID-19 public health emergency. In addition, Humana Medicare Advantage plans are applying the same coverage-related waivers to Original Medicare telehealth services that the Centers for Medicare & Medicaid Services (CMS) has announced in response to the COVID-19 PHE. To read this […]
One of the most common topics I provide consulting services to my clients on is in regards to how to bill for an evaluation for an orthosis. Unfortunately, there is not just one answer as my answer will depend on at least 2 factors; what is your practice setting and what insurance does your patient […]
I am receiving many questions regarding what is the proper billing when a patient is referred to either outpatient physical therapy or occupational therapy for the purpose of an orthosis. In this article, I will answer this question from 2 perspectives. I will first address when a patient is referred for a one-time visit for […]
QuestionWhat are CPT codes 98960 – 98962? Answer QuestionWho can report these codes to the Medicare program or other insurance carriers? Answer QuestionDoes the Medicare program pay for CPT codes 98960 – 98962? Answer QuestionDo commercial and private insurance carriers pay for CPT codes 98960 – 98962? Answer I hope you found this article informative. […]
Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States.