A question I am often asked is how many 15-minute time-based units can I bill in an hour? Or phrased another way, I can only bill 4 15-minute time-based units in an hour, correct? The simple answer is that it’s possible to bill more than 4 15-minute time-based units in an hour, even if you had an all Medicare outpatient therapy population. In this article, I will provide examples of how it’s possible to bill more than 4 15-minute time-based units in an hour for both Medicare patients and commercial insurance patients just using one therapist or one therapist/therapy assistant

I am often asked if the time a student treats a Medicare patient for physical, occupational and/or speech therapy services, is that time billable to the Medicare program? In this article, I will answer this question as it applies to inpatient acute care, inpatient rehabilitation facilities, skilled nursing facilities providing Part A therapy services and outpatient therapy settings. QuestionIn the Inpatient Rehabilitation Facility (IRF) setting, do the minutes of therapy provided by the student therapist count towards the required 3-hours of therapy at least 5 days per week? Answer QuestionIn the inpatient hospital acute care setting, can therapy students treat

When a physical therapist, occupational therapist or speech-language pathologist in private practice enrolls in the Medicare program, how does the Centers for Medicare and Medicaid Services (CMS) determine the effective date of enrollment and what are the requirements for retrospective billing and how many days can you bill for services prior to the effective date of your enrollment? In this article, I will answer these questions. Question How is the effective date determined? Answer QuestionWhat are the retrospective billing requirements and limitations? Answer QuestionCan you give an example of the difference between Effective Date of Enrollment and Retrospective Billing Date?

QuestionFor physical therapy services submitted to an insurance carrier on a 1500-claim form, how do I bill for the services provided by a physical therapist assistant? Answer I hope you found this article helpful. Thank you for being a Gold Member!

QuestionFor occupational therapy services submitted to an insurance carrier on a 1500-claim form, how do I bill for the services provided by an occupational therapy assistant? Answer I hope you found this article helpful. Thank you for being a Gold Member!

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)

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,

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. QuestionDoes the Medicare program pay for telehealth services provided by a physical therapist, occupational therapist or