Current News



Therapeutic Exercise vs Therapeutic Activities: What’s the Difference?

If you were to ask your clinical staff if they have their patients do functional activities for 15-30 minutes during a therapy visit, my experience as a consultant tells me 100% of them would say yes. Yet, if I were to review the percentage of 97530 units billed in a calendar month, my experience tells me that percentage is under 10% and many times, under 5%. Why is that? In my opinion, therapists and assistants do not fully understand what interventions are included within the therapeutic activities CPT code and how to document to support billing therapeutic activities and they

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Update on Evaluation and Therapeutic Activities Same Day

Breaking news from the Centers for Medicare and Medicaid Services (CMS) regarding the payment of a physical therapy evaluation and/or occupational therapy evaluation on the same day you bill therapeutic activities. Several professional organizations have received notice from Capital Bridge, LLC, National Correct Coding Initiative Contractor, announcing they will What About Group Therapy and an Evaluation on the Same Day? What About Manual Therapy and an Evaluation Same Day? I hope you found this information helpful. Thank you for being a Gold Member! 

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Billing Therapeutic Activities Same Day as an Evaluation

Effective with dates of service on and after January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will Question Is there a “work-around” to this issue? Answer Question Can I count the evaluation time under therapeutic activities? Answer Question Can I provide other treatments the same day as an evaluation? Answer Question Do these NCCI edits apply to all insurance carriers, including Medicare Advantage plans Answer Question Can any insurance carrier, Medicaid plan or Medicare Advantage plan implement the NCCI edits? Answer Question How do I know if an insurance carrier, Medicaid plan or Medicare Advantage plan has

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Significant Changes to NCCI Edits Effective January 1, 2020

Every quarter, the Centers for Medicare and Medicaid Services (CMS) updates the National Correct Coding Initiative (NCCI) edits. This occurs on January 1st, April 1st, July 1st and October 1st of every year. The biggest changes usually occur with the January 1st edition due to new and deleted CPT codes for the new calendar year now being in effect. Version 26.0 has been released by CMS. This version will be effective with dates of service beginning on January 1, 2020 through March 31, 2020. There are many additions and deletions to Version 26.0 that will have a significant impact on

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