In this article, I will answer the following questions regarding TRICARE and upcoming changes:

Beginning on January 1, 2022, Cohere will manage prior authorizations for outpatient therapy services for most Humana Commercial and Humana Medicare Advantage plans.

Aetna, Cigna and Humana have all announced changes to their respective policies related to the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits and the payment of a CPT code(s) that has had modifier 59 appended to it on the claim form. These positive changes would not have occurred without the advocacy of the American Physical Therapy Association (APTA). Aetna Aetna has informed Cigna According to Humana Humana has informed I hope you found this article and information helpful. Thank you for being a Gold Member!

Humana has released a revised telehealth policy for their commercial plans due to the COVID-19 public health emergency. In addition, Humana Medicare Advantage plans are applying the same coverage-related waivers to Original Medicare telehealth services that the Centers for Medicare & Medicaid Services (CMS) has announced in response to the COVID-19 PHE. To read this detailed revised telehealth policy, log into your Gold Member account and click I hope you found this article and Humana’s telehealth policy to be informative and helpful. Thank you for being a Gold Member!

With the Secretary of the Department of Health and Human Services extending the Public Health Emergency (PHE) due to the COVID-19 pandemic, many private practices as well as facilities and organizations want to know what does this mean for the extension of providing outpatient therapy services via telehealth. In this article, I will provide updates on outpatient therapy services delivered via telehealth for the traditional Medicare Part B program and some of the larger national insurance carriers. Medicare (Traditional) Aetna Anthem BCBS of Colorado Anthem BCBS of Connecticut Anthem BCBS of Georgia Anthem BCBS of Indiana Anthem BCBS of Kentucky

This article was updated on May 28, 2020 Humana will now cover telehealth services for outpatient therapy services provided by physical therapists, physical therapists assistants, occupational therapists, occupational therapy assistants and speech-language pathologists. Humana states they will always follow the Centers for Medicare and Medicaid Services (CMS) telehealth or state-specific requirements that apply to telehealth coverage for our insurance products. Since CMS now covers telehealth when provided by physical therapists, physical therapists assistants, occupational therapists, occupational therapy assistants and speech-language pathologists in all outpatient therapy settings (both private practice and institutional settings), at minimum, Humana will now cover the same.

On December 18, 2017, Humana announced they would no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage. Unfortunately, nothing lasts forever. Effective with dates of service on and after I hope you found this article helpful and informative. Thank you for being a Gold Member!

Humana has issued 2 new policies that have an impact on outpatient therapy services. Both policies apply to Humana Medicare Advantage plans and Humana Commercial plans. CQ/CO Modifier Effective with dates of service on and after Missed Appointments Humana’s Medicare Advantage and Commercial Payment Policies both allow a provider to bill I hope you enjoyed this article. Thank you for being a Gold Member!