Today, the Centers for Medicare and Medicaid Services released the 2017 proposed rule for services paid under the Medicare Physician Fee Schedule. This proposed rule includes the long awaited new evaluation and reevaluation codes for physical and occupational therapy services. The proposed rule provides the 3 new physical therapy evaluation codes, new physical therapy reevaluation code, 3 new occupational therapy evaluation codes and the new occupational therapy reevaluation. The proposed rule provides the long descriptor of each new code along with the components required in the documentation to support the selection of each code. The new codes along with their

The Centers for Disease Control and Prevention (CDC) has released Fiscal Year (FY) 2017 ICD-10-CM codes that will become effective for dates of service beginning on October 1, 2016 and lasting through September 30, 2017. There are 1974 new ICD-10-CM codes, 425 diagnosis codes with revised definitions, and 311 codes that were deleted. Regarding therapy services, there are additions, revisions, and/or deletions related to sequela of cerebrovascular disease and cognitive deficits, men and women’s health (i.e. pelvic health) related to incontinence, testicular pain and erectile dysfunction, and orthopedic conditions such as bunion, bunionette, pain in joints, temporomandibular joint (TMJ) disorders

I am often asked how to report Functional Limitation G-codes and PQRS codes on patient’s who began therapy with a commercial insurance (i.e. BCBS, Aetna, Cigna, UnitedHealthcare, etc.) as their primary insurance and during the therapy episode of care, Medicare becomes the primary payer. In this article, I will answer this question. In addition, check out our FAQs on Functional Limitation Reporting and 2016 PQRS. Regarding Functional Limitation Reporting, on the first visit that the Medicare program is the primary payer, the provider would need to

CPT code 97750 is a code that many providers of therapy services do not understand when to use this code, when not to use this code and what interventions are included under this code. I often receive questions regarding CPT code 97750 such as: When can I bill CPT code 97750? Can we use CPT code 97750 in place of a reevaluation if an insurance carrier does not pay for a reevaluation? Can we use this code for the time it takes us to take range of motion measurements and perform manual muscle testing? Can we bill this CPT code

Effective for dates of service on and after January 1, 2016, new HCPCS codes 92537 and 92538 for caloric testing replaced code 92543. These CY 2016 code changes were inadvertently left off of the Audiology Code List until March 31. As a result, some claims for audiologists’ services for codes 92537 and 92538 were unintentionally denied. Medicare Administrative Contractors will automatically reprocess these claims.

The Centers for Medicare and Medicaid Services (CMS) has updated the instructions for the medical review of skilled nursing facility (SNF) Prospective Payment System (PPS) bills. The updated instructions include the following: Skilled nursing facility qualifying inpatient stay Types of SNF PPS reviews Bill review requirements Bill review process including obtaining records and making a coverage dertermination To access the updated instructions, please click

The Centers for Medicare and Medicaid Services has issued a proposed rule updating the requirements that hospitals and critical access hospitals (CAHs) must meet to participate in Medicare and Medicaid. Formally called the Conditions of Participation, the proposed changes would modernize and revise the requirements to reflect current standards of practice and support improvements in quality of care by: Reducing readmissions; Reducing barriers to care; Reducing the incidence of hospital-acquired conditions (including healthcare-associated infections); Improving the use of antibiotics (including the potential for reduced antibiotic resistance); Addressing workforce shortage issues; and Improving patient protections To view the CMS Fact Sheet

Question We have a patient that is coming to us that received Speech Therapy in another facility which used his PT/Speech Medicare benefits to the point of the therapy cap dollar threshold and has since discharged him. He now has started coming to our clinic for shoulder rehab under his Medicare benefits; however, we are having to KX the charges so we can get paid and provide the necessary care to improve his ROM, strength, and function. Since we do not desire to use up ALL of his PT benefits (to the point of $3700 total) in case he should