Current News



Does Sequestration Reduction Apply to Medicare Advantage Plans

Due to COVID-19, the 2% sequestration reduction for traditional Medicare was placed on pause until April 1, 2022. Beginning with dates of service between April 1 – June 30, 2022, the sequestration reduction returned at 1% and then increases to 2% for dates of service on and after July 1, 2022. What therapy providers want to know is does the sequestration reduction also automatically apply to Medicare Advantage plans? The answer is

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Highmark Implements CQ/CO Modifier Payment Reduction

Highmark BCBS has implemented the CQ/CO therapist/therapy assistant modifier reduction. The reduction applies to the following states, Highmark plan(s) and claim forms:

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Highmark Requires Prior Authorization for Speech Therapy

Highmark BCBS has put out a reminder that the CPT codes listed below now require prior authorization for speech therapy since March 15, 2022. The codes are as follows:

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Making Amendments, Corrections and Addenda’s in Medical Records

Whether you document in an electronic medical record (EMR), on paper, or dictate your notes, most likely, you have made an error in your documentation and/or omitted documentation in the medical record for that treatment visit. When this occurs, the Centers for Medicare and Medicaid Services (CMS) has provided instructions on record keeping principles, whether you document on paper or in an EMR. Per CMS, documents submitted to MACs, CERT, Recovery Auditors, SMRC and UPICs, whether paper or EMR, containing amendments, corrections or addenda must:

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Does TRICARE Follow Medicare’s “8-Minute Rule”?

The Centers for Medicare and Medicaid Services (CMS) implemented what providers of outpatient therapy call “Medicare’s 8-minute rule” in 2000. There is a misconception that the “8-minute rule” applies automatically to all federal insurance carriers and Medicare Advantage plans. That is actually not true. Each federal insurance carrier and Medicare Advantage plan can determine if they want to apply Medicare’s “8-minute rule” for payment for outpatient therapy services or use the American Medical Associations’ (AMA) substantial portion methodology. In this article, I will provide the answer to TRICARE and do they follow Medicare’s “8-minute rule” or the AMA substantial portion

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UnitedHealthcare Medicare Advantage Updates Therapy Coverage Policy

UnitedHealthcare (UHC) Medicare Advantage has updated their OT, PT, and ST Coverage Policy. The effective date of the updated coverage policy is May 4, 2022. To access the updated policy, click

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AIM Specialty Health Clinical Guidelines for Outpatient Therapy Services

AIM Specialty Health will have revised outpatient rehabilitative and habilitative services guidelines that will impact outpatient physical, occupational and speech therapy services. In this article, I will answer the following questions:

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Common Questions and Answers Regarding Assistants

In this article, I will answer some of the more common and frequent questions I receive regarding physical therapist assistants (PTAs) and occupational therapy assistants (OTAs).

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