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02/03/22

UnitedHealthcare February 2022 Updates

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02/03/22

Dry Needling and Medicare: February 2022 Update

For those physical therapists (PTs) that perform dry needling on Medicare beneficiaries, they understand that the Medicare program does not reimburse PTs for dry needling when billing CPT codes 20560 and 20561. What has been confusing is must the PT provider issue a mandatory advance beneficiary notice of noncoverage (ABN) to the Medicare beneficiary or is the ABN an optional ABN to provide to the Medicare beneficiary? This question has now apparently been answered by the Centers for Medicare and Medicaid Services (CMS). According to clarification received by

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01/31/22

What are Modifiers 96 and 97?

Effective for dates of service on and after January 1, 2018, there were 2 new modifiers that providers may be required to use with some insurance carriers, such as Affordable Care Act (ACA) compliant plans, to distinguish whether the service provided was rehabilitative in nature or habilitative in nature. As we are now 4 years into the use of these new modifiers, we are starting to see some insurance carriers require the use of either Modifier 96 or 97 to be appended to the CPT code(s) on the claim form in addition to any other required modifiers. Let’s begin!

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01/31/22

Do Physicians Need to Sign Discharge Reports

A question I have been receiving lately is must a physician sign a therapists discharge report for Medicare beneficiaries receiving outpatient therapy services? In addition, must a physician sign a therapists discharge report for patients who have a commercial insurance or are being seen under workers compensation? The answer for Medicare Part B outpatient therapy services is

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01/25/22

UHC Oxford Revises MPPR Policy

UnitedHealthcare (UHC) Oxford has revised their Multiple Therapy Procedure Reduction (MTPR) reimbursement policy with an effective date of December 1, 2021. In this policy, UHC Oxford lists the practice expense (PE) relative value unit (RVU) of each applicable CPT code so therapy providers will know which CPT code has the highest PE RVU and thereby will know the first unit of that code will not have their PE RVU decreased by 50%. Providers will then know which other CPT codes billed that day will have their PE RVU decreased by 50%. To access the revised policy, click

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01/24/22

Changes to amount in controversy (AIC) for appeals in 2022

The Centers for Medicare and Medicaid Services (CMS) has published the amount in controversy (AIC) for calendar year (CY) 2022 to appeal claims to the Administrative Law Judge (ALJ) level and/or Federal District Court level.

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01/17/22

SCOTUS Decides on CMS and OSHA Vaccine Mandates

On January 13, 2022, the Supreme Court of the United States (SCOTUS) decided the fate of the Centers for Medicare and Medicaid (CMS) vaccine mandate as well as the Occupational Safety and Health Administration (OSHA) vaccine mandate. In this article, I will provide answers to the following questions: Let’s Begin!

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01/14/22

Public Health Emergency: January 2022 Update

On January 14, 2022, Secretary of Health and Human Services Xavier Becerra renewed the Public Health Emergency (PHE) due to COVID-19. The new expiration date of the PHE is the end of the day on April 15, 2022. Regarding what does this mean for the Medicare program continuing to pay for telehealth if provided by a physical therapist, physical therapist assistant, occupational therapist, occupational therapy assistant and speech-language pathologist, click HERE and read the first question and answer.

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