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03/21/22

CPT Codes That Require Direct One-on-One Contact

In this article, I will provide which CPT codes require the therapist or assistant have direct one-on-one patient contact in order to bill that CPT code to the patient for that visit. According to the American Medical Association, CPT 2022, Professional Edition, the following CPT codes require direct one-on-one patient contact for physical and occupational therapy services: I hope you found this article informative. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written

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03/14/22

Telehealth Under Medicare Extended Once PHE Ends

As many of you know, outpatient physical, occupational and speech therapy delivered via telehealth for traditional Medicare beneficiaries was due to expire once the public health emergency (PHE) is declared over. Well, that has now changed due to recent legislation that was signed into law. In this article, I will answer the following questions: When will the traditional Medicare program stop paying for outpatient physical, occupational and speech therapy delivered via telehealth? Why did this change occur? At this time, when does the PHE end? Where can I access this change incase I need the reference? Let’s begin! Question #1When

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03/07/22

Medicare Improper Payments as They Apply to Outpatient Therapy Services

The Improper Payments Elimination and Recovery Improvement Act (IPERIA) of 2012 requires the heads of Federal agencies, including the Department of Health and Human Services (HHS), to annually reviewprograms it administers to improve agency efforts to reduce and recover improper payments. Each November, the Department of Health and Human Services (HHS) publishes the improper payment rate in the Agency Financial Report. The Centers for Medicare and Medicaid Services (CMS) later publishes more detailed improper payment rate information in the form of the annual Medicare Fee-for-Service (FFS) Improper Payments Report and Appendices. This list contains reports produced by the Comprehensive Error

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03/07/22

UHC Revises Negative Pressure Wound Therapy Medical Policy

UnitedHealthcare (UHC) Commercial and UHC Oxford have revised their Negative Pressure Wound Therapy medical policy with an effective date of May 1, 2022. To access the revised policy,

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02/21/22

Group Therapy Frequently Asked Questions and Answers

CPT code 97150 (Group Therapy) remains one of the most confusing CPT codes for physical therapists, physical therapist assistants, occupational therapists, and occupational therapy assistants to understand. In this article, I will answer the following questions: Let’s Begin!

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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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