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05/09/22

Does CMS Limit Outpatient Therapy Units

Question A question I often receive is does the Centers for Medicare and Medicaid Services (CMS) limit the number of total units that can be billed per day by type of discipline (e.g., PT, OT, SLP)? Answer

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09/08/20

CMS Reinstates Therapy NCCI Edits

The Centers for Medicare and Medicaid Services (CMS) has reinstated many of the procedure-to-procedure (PTP) edits, known more commonly as the National Correct Coding Initiative (NCCI) edits, for physical therapy, occupational therapy, and speech therapy outpatient therapy services that they had deleted earlier this year. The reinstated NCCI edits were published by CMS on September 1, 2020 and become effective with dates of service beginning on October 1, 2020. CPT codes affected include, but are not limited to, the following: Biofeedback codes (CPT codes 90912 and 90913) Speech therapy evaluations (CPT codes 92521-92524) Speech therapy treatment and treatment of dysphagia

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08/24/20

How Does CMS Determine the Payment of a CPT Code

Two questions I am often asked is how does the Centers for Medicare and Medicaid (CMS) determine the payment for each CPT code and why is the same CPT code paid differently depending on where the practice or facility is located? In this article, I will answer how CMS determines the payment for each CPT code and why the same CPT code reimburses differently based on the location of your practice or organization. QuestionHow does CMS determine the payment for each CPT code? Answer QuestionWhat is included in the work relative value unit (RVU) of a CPT code? Answer QuestionWhat

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06/25/20

CMS Releases CY 2021 Home Health Proposed Rule

On June 25, 2020, the Centers for Medicare and Medicaid Services (CMS) released “Medicare and Medicaid Programs: CY 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Services Requirements“. Per the summary, “This proposed rule would update the home health prospective payment system(HH PPS) payment rates and wage index for calendar year (CY) 2021. This proposed rule alsoproposes to make permanent the changes to the home health regulations regarding the use oftechnology in providing services under the Medicare home health benefit as described in theMedicare and Medicaid Programs; Revisions in Response to

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03/27/20

President Trump Signs CARES Act into Law

This afternoon, March 27, 2020, President Trump signed the Coronavirus Aid, Relief and Economic Security (CARES) Act into law. The CARES Act has several important provisions related to therapy services. A few of them are as follows: Sec. 3703. Expanding Medicare Telehealth Flexibilities This section will broaden the authority of the Secretary of Health and Human Services to waive the telehealth requirements of section 1834(m) of the Social Security Act during the COVID-19 emergency period. This would enable Medicare beneficiaries to access telehealth, including in their home, from a broader range of providers, reducing COVID-19 exposure. To make it clear,

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07/29/19

CMS Releases Proposed Rule for Calendar Year 2020

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for calendar year (CY) 2020 for services paid under the Medicare Physician Fee Schedule (MPFS). This proposed rule does impact providers of outpatient physical, occupational and speech therapy services in all outpatient therapy settings that does include private practices, hospital outpatient departments (including Medicare beneficiaries under Observation status and in the Emergency Department and do not get admitted to the hospital), skilled nursing facilities, rehabilitation agencies, comprehensive outpatient rehabilitation facilities and home health agencies providing outpatient therapy in a Medicare beneficiaries home. Highlights of

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06/24/19

Application of Modifier 59 Changing on July 1st

For dates of service on and after July 1, 2019, the Centers for Medicare and Medicaid Services (CMS), as well as UnitedHealthcare (UHC), is changing which CPT code Modifier 59 must be appended to on the claim form in order for both the Column 1 and Column 2 CPT codes to be paid when provided on the same date of service. If you missed my webinar last week on NCCI edits and Modifier 59, click HERE to see the complete webinar description, objectives and to order the recorded version with handouts and Gawenda Seminars & Consulting NCCI edit reference sheet.

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