Does the Medicare program pay for CPT code 97750 (physical performance test or measurement) the same day a provider also bills either a physical therapy (PT) evaluation, PT reevaluation, occupational therapy (OT) evaluation, or OT reevaluation CPT code? Of course, the answer is not as easy as a simple yes or a simple no. A certain situation must occur that will allow CPT code 97750 to be paid on the same day as a PT or OT evaluation or reevaluation CPT code. So you might ask, what is that situation? The Medicare program will pay for CPT code 97750 on

The Noridian Provider Outreach and Education (POE) staff is hosting a Modifier 59, National Correct Coding Initiative (NCCI) and Medically Unlikely Edit (MUE) webinar on June 21, 2018 at 2 p.m. Central Time. This session includes: Procedure-to-Procedure Edits Medically Unlikely Edits Modifier 59 NCCI Policy Manual Resources To sign up for this webinar, click HERE.

A question I often receive is can a chiropractor and/or a dentist sign an outpatient therapy plan of care for Medicare beneficiaries receiving outpatient physical, occupational and/or speech therapy services? The answer is

A question I get every so often is can a midwife sign a plan of care for a Medicare beneficiary attending outpatient therapy services. In addition, what professionals can sign an outpatient therapy plan of care? In this article, I will answer both of these questions. Midwifery education programs leading to the certified nurse midwife (CNM) and certified midwife (CM) credentials involve graduate education. Most programs require a Bachelors Degree for entry, but some will accept Registered Nurses (RNs) without a Bachelors Degree, providing a bridge program to a Bachelor of Science in Nursing (BSN) prior to the midwifery portion

UnitedHealthcare Oxford has revised their policy on electrical stimulation for the treatment of pain and muscle rehabilitation with an effective date of June 1, 2018. The revised policy discusses functional electrical stimulation (FES), neuromuscular electrical stimulation (NMES), interferential therapy (IFT) and microcurrent electrical nerve stimulation (MENS), just to name a few. The revised policy states when the various forms of electrical stimulation are and are not considered medically necessary. To access the revised policy, log into your Gold account or become a Gold Member and then click

UnitedHealthcare (UHC) has updated their coverage determination guidelines for their commercial plans for their members requiring speech language pathology services. The effective date for the revised guideline is April 1, 2018. To access the updated guideline, click

Do you have questions about the appeals process for Medicare denied claims? Check out these FAQS from First Coast Service Options.

The Centers for Medicare and Medicaid Services (CMS) seeks to develop and implement a Medicare demonstration project, which CMS believes will help assist in developing improved procedures for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies (HHA) providing services to Medicare beneficiaries. This revised demonstration would help assist in developing improved procedures for the identification, investigation, and prosecution of potential Medicare fraud. The demonstration would help make sure that payments for home health services are appropriate through either pre-claim or postpayment review, thereby working towards the prevention and identification of potential fraud, waste, and abuse;