billing

NCCI Edits and Major Changes

April 21, 2020 by Rick Gawenda 18 Comments

National Correct Coding Initiative (NCCI) edits are updated quarterly by the Centers for Medicare and Medicaid Services (CMS) and Capital Bridge, CMS’ NCCI coding contractor. Updates occur on January 1, April 1, July 1, and October 1 of each calendar year. Typically, the January 1 update sees the most additions, deletions and revisions due to new, revised and deleted CPT codes taking effect on January 1 of the calendar year.

Due to the COVID-19 Public Health Emergency as well as CMS’s expansion of telehealth services, CMS updated procedure-to-procedure (PTP) edits and Medically Unlikely Edits (MUEs) for Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, retroactive to January 1, 2020. This announcement was posted on April 8, 2020 on the CMS website.

There have been many significant changes (well over 150) to the PTP edits applicable to physical, occupational and speech therapy services with all of them retroactive to January 1, 2020. Many of the NCCI edits have been deleted, including those that became effective January 1, 2020.

I have updated NCCI Version 26.0 for dates of service January 1, 2020 – March 31, 2020 for both the private practice setting and non-private practice settings. In addition, NCCI Version 26.1 for dates of service April 1, 2020 – June 30, 2020 has been published on my website for my Gold Members. To access the NCCI edit reference sheet, click HERE.

Billing Telehealth Incident-to a Physician

April 9, 2020 by Rick Gawenda Leave a Comment

On March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule titled “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency“. In this interim final rule, CMS did add CPT codes that are typically billed by physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) as covered telehealth services; however, they did not add PTs, OTs and SLPs as telehealth providers.

This led many to ask why would CMS add these CPT codes to the list of covered therapy services if they did not add PTs, OTs and SLPs as telehealth providers? This is because the Medicare program allows physicians, physician assistants, nurse practitioners, and clinical nurse specialists who is licensed or certified by the state to furnish therapy services can bill the CPT codes that were added to the list of covered telehealth services.

A second question that arose was can a physical therapist or occupational therapist who is employed by a physician practice perform a telehealth visit and have that visit billed incident-to a physician. Right now, we do not know the answer to this question and we are seeking clarification from CMS on this question.

Watch for updates if additional information becomes available. For those of you that are a Gold Member to my website, thank you! We appreciate your business and loyalty.

Telehealth Billing Questions and Answers

April 1, 2020 by Rick Gawenda 27 Comments

Due to the COVID-19 pandemic, many providers of outpatient therapy services are implementing telehealth services to meet the needs of their patients. Since many have never provided telehealth services previously, they are uncertain how to do the billing. In addition, insurance carriers who are expanding telehealth coverage, either voluntarily or state mandated, may not have guidance for providers regarding the billing of outpatient therapy telehealth services. In this article, I will provide answers and/or guidance on some of the questions I have been receiving.

Question
Does the Medicare program pay for telehealth services provided by a physical therapist, occupational therapist or speech-language pathologist for outpatient physical, occupational and speech therapy services?

Answer – Updated March 31, 2020