Each year, the Centers for Medicare and Medicaid Services (CMS) issues the dollar amount that must be met in order to appeal to the Administrative Law Judge (ALJ). For calendar year 2026, that dollar amount is

The National Correct Coding Initiative (NCCI) Edits Version 32.0 are in effect for dates of service January 1, 2026 – March 31, 2026. NCCI edits are used in all outpatient therapy settings for original Medicare and Medicaid beneficiaries. In addition, some Medicare Advantage plans, commercial insurers, and workers compensation programs also utilize the NCCI edits. Gawenda Seminars & Consulting has created a NCCI Edit therapy specific reference sheet for both Medicare and Medicaid. These reference sheets will inform providers when modifier 59 is required on a CPT code on the claim form. In addition, the reference sheet will inform providers

The Centers for Medicare and Medicaid Services (CMS) has issued an updated teleahealth FAQ document. To access this document, log into your account and click

The Centers for Medicare and Medicaid Services (CMS) has announced the 2026 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2026. Lastly, I will discuss how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount. In this article, I will answer the following questions:

This 1.5-hour online course will provide participants with regulatory and payment changes that will impact outpatient physical, occupational and speech therapy services in calendar year 2027.

On October 31, 2025, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2026 Medicare Physician Fee Schedule (MPFS) final rule. This final rule does have regulatory and reimbursement implications for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings. In this article, I will provide my members with the payment amounts for calendar year 2026 for the more common CPT codes billed in outpatient physical, occupational and speech therapy compared to the 2025 payment rate for each CPT code. For my examples, I used the national payment averages for each CPT code.

The government shutdown has ended so what does this mean for outpatient therapy delivered via telehealth for Medicare beneficiaries. Here is the update:

On October 31, 2025, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2026 Medicare Physician Fee Schedule (MPFS) final rule. This final rule does have regulatory and reimbursement implications for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings. Does this final rule have tricks, treats, or both for outpatient therapy services. In this article, I will inform you of what CMS is finalizing on the following topics: