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

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

Per the Nebraska (NE) Physical Therapy Association, Blue Cross Blue Shield (BCBS) of Nebraska has made the decision to adjust their telehealth policy to cover Physical, Speech and Occupational therapy services . BCBS NE will accept telehealth charges from any credentialed provider with no video component required during this pandemic urgency period. An announcement will be place on our Happening Now section of our webpage later this today. Here is the link to our Happening Now section that will be updated: https://www.nebraskablue.com/Providers/Alerts-and-Updates/Happening-Now A provider may bill using E&M codes, therapy codes or telehealth codes and must use the modifier 95 and

Previously, I wrote an article explaining how much time of a time-based CPT code must be provided in order to bill that CPT code to an insurance carrier as well as explaining the difference between Medicare’s “8-minute rule” and the American Medical Association (AMA) definition of substantial when billing a time-based CPT code. This article then led people to ask me if I can double book and/or overlap Medicare patients receiving outpatient therapy services. I’m going to answer this question once and for all and the answer will not only apply to outpatient therapy services paid under Medicare Part B benefits, but

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

The American Medical Association (AMA) has released the calendar year (CY) 2020 CPT codes and there are at least 6 new CPT codes and 6 deleted CPT codes that will impact physical therapists, occupational therapists and/or speech-language pathologists in CY 2020. The new CPT codes will become effective with dates of service on and after January 1, 2020 and be valid for dates of service up to an including December 31, 2020. In addition, the Centers for Medicare and Medicaid Services (CMS) is proposing to change 2 existing CPT codes to an active status meaning that CMS will assign work

It’s a new year and this means we have some deleted CPT codes that are no longer available for physical therapists (PT’s), occupational therapists (OT’s) and/or speech-language pathologists (SLP’s) to use in calendar year 2019. CPT codes, description, and material are copyright 2018 American Medical Association. CPT is a trademark of the American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. The 2019 deleted CPT codes applicable to PT’s, OT’s and SLP’s are:  

A question I often receive is what CPT codes does the so called “8-minute rule” apply to? Does it apply to just the 15-minute time-based CPT codes or does it also apply to the 1-hour time-based CPT codes as well as the untimed, supervised modality CPT codes and untimed evaluation CPT codes? The “8-minute rule” applies to all CPT codes