With many states mandating insurance plans in their state expand telehealth services and reimbursement to include physical therapy (PT), occupational therapy (OT) and speech therapy (ST) as well as several insurances expanding telehealth services and reimbursement on their own, I am being asked what CPT code(s) do I use to bill for telehealth services for physical, occupational and/or speech therapy services. The answer is the one that you do not like. It is insurance carrier specific and you have to check with each insurance carrier and yes, this includes workers compensation. Codes that I am commonly seeing insurance companies mention

This week, I will provide 3 billing scenario’s that can be applicable to either outpatient physical therapy or outpatient occupational therapy services and provide the billing answer for Medicare beneficiaries and those insurance carriers that follow the Medicare Program billing rules (i.e. “8-minute rule) and will also provide the billing answer for those insurance carriers that do not follow the Medicare Program billing rules, rather, follow the definition of a substantial portion of a time-based CPT per the American Medical Association (AMA). Two articles that you may want to read prior to continuing on with this article are “What CPT

It has been awhile since I have written an article focused on outpatient speech therapy and billing. So this week, I thought I would provide answers to some of the more common questions I receive about billing for speech therapy services. The answers I provide are based on what the Medicare Part B program allows and these answers may or may not be applicable to Medicare Advantage plans, Medicaid, managed Medicaid plans, private/commercial insurance carriers, workers compensation and automobile carriers. Here are the questions I will answer in this article: Can you be paid for CPT codes 92507 and 92526

Due to a recent finding by the Office of the Inspector General (OIG) finding that the Medicare program improperly paid for Skilled Nursing Facility (SNF) services when the Medicare 3-Day inpatient hospital stay requirement was not met, the Centers for Medicare and Medicaid Services (CMS) has developed a Fact Sheet to explain the SNF 3-day rule billing as well as several other resources. To access the Fact Sheet and additional resources, click HERE.

This article was originally published on May 20, 2019. Information has been updated as of June 3, 2019. Please read below for further details. Changes are coming to UnitedHealthcare and billing for outpatient therapy services. Failure to be aware of this change will cause your claims not to be paid beginning this summer. UHC has announced they will begin requiring the application of the therapy specific

The Centers for Medicare and Medicaid Services (CMS) has released a new booklet where they describe common outpatient rehabilitation therapy services Comprehensive Error Rate Testing (CERT) Program errors, how the CMS calculates improper payment rates, the necessary documentation to support billed Medicare claims, and managing potential overpayments. Some of the more common CERT errors include: