The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) Edits Version 24.0. Version 24.0 will be valid for dates of service beginning January 1, 2018 and ending March 31, 2018. Version 24.0 has some significant additions due to changes in CPT codes 97760 and 97761, the addition of CPT codes 97127 and 97763 and the deletion of CPT codes 29582, 29583 and 97532. In addition, there are changes to the edits for CPT codes 97750 and 97755 when billed on the same day as a physical or occupational therapy evaluation or reevaluation. Lastly,

The Centers for Medicare and Medicaid Services (CMS) has defined the CPT codes most commonly utilized by providers of outpatient physical and occupational therapy as well as speech-language pathologists as either “always therapy” codes or “sometimes therapy” codes. In this article, I will explain the following: The difference between “always therapy” and “sometimes therapy” codes Which CPT codes are “always therapy” codes Which CPT codes are “sometimes therapy” codes Which CPT codes does the Multiple Procedure Payment Reduction policy apply to Which CPT codes count towards the annual therapy cap dollar threshold What is the between an “always therapy” code and

On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS). This final rule impacts providers and suppliers of outpatient physical and occupational therapy services as well as speech-language pathology services. This would include outpatient therapy services provided in the following settings: Private Practice Skilled Nursing Facility Part B Therapy Comprehensive Outpatient Rehabilitation Facility Rehabilitation Agency Home Health Doing Part B in the Home Hospital Outpatient Departments Highlights of the final rule include: 2018 annual therapy cap dollar threshold and manual medical review process New

The 2018 CPT codes have been officially released by the American Medical Association (AMA) and there are several changes that will impact outpatient physical and occupational therapy services. CPT codes, description, and material are copyright 2017 AMA. CPT is a trademark of the AMA. 2018 CPT code changes impact the following CPT codes:  Multi-layer compression system CPT codes 29582 and 29583 Orthotic and management training (CPT code 97760) Prosthetic management and training (CPT code 97761) Orthotic/prosthetic checkout (CPT Code 97762) Development of cognitive skills (CPT code 97532) Lets begin with the multi-layer compression system CPT codes. For dates of service

On July 12, 2017, the Centers for Medicare and Medicaid Services released the 2018 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). This would include outpatient therapy services provided in the following settings: Private Practice Skilled Nursing Facility Comprehensive Outpatient Rehabilitation Facility Rehabilitation Agency Home Health Doing Part B in the Home Hospital Outpatient Departments Highlights of the final rule include: 2018 Conversion Factor (used in determining payment for each CPT code) Discussion of new, revised and deleted CPT codes for 2018 that will impact outpatient therapy Updates to the work relative value unit (RVU) for

Functional Limitation Reporting (FLR) (i.e. G-codes) has been required for dates of service on and after July 1, 2013 for Medicare beneficiaries receiving outpatient therapy services being billed under their Part B Medicare benefits. I still receive many questions when G-codes have to be reported on the claim form. Many of the questions I receive concern if a therapist only bills an L code for an orthosis during the patients initial visit, do I need to report G-codes? Another question I receive is are G-codes required if on the first visit, I only bill CPT code 97542 for a wheelchair

With the implementation of the new physical and occupational therapy evaluation codes with dates of service on and after January 1, 2017, I am receiving many questions what do I think is the proper billing when a patient is referred to either physical therapy or occupational therapy for the purpose of an orthosis. In this article, I will answer this question from 2 perspectives. I will first address when a patient is referred for a one-time visit for an orthosis and secondly, provide the answer for when a full evaluation is required to develop the appropriate treatment plan in addition

In last weeks article, I discussed two options for the billing of an orthosis to the insurance carrier, including the Medicare program. Those options were either the applicable L code for the orthosis or CPT code 97760 (orthotic management and training) for patient’s under an outpatient therapy plan of care. In this weeks article, I will discuss what practice settings can bill L codes to the Medicare program for orthotics provided under an outpatient physical or occupational therapy plan of care without requiring a durable medical equipment (DME) supplier number, which practice settings do require a DME supplier number to