Current News

News

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

Read More
05/04/22

NCCI Edits and Modifier 59: Version 28.2

This webinar will provide participants with information on NCCI Edits Version 28.2 that became effective with dates of service beginning on July 1, 2022 and lasting through September 30, 2022

Read More
03/14/22

Telehealth Under Medicare Extended Once PHE Ends

As many of you know, outpatient physical, occupational and speech therapy delivered via telehealth for traditional Medicare beneficiaries was due to expire once the public health emergency (PHE) is declared over. Well, that has now changed due to recent legislation that was signed into law. In this article, I will answer the following questions: When will the traditional Medicare program stop paying for outpatient physical, occupational and speech therapy delivered via telehealth? Why did this change occur? At this time, when does the PHE end? Where can I access this change incase I need the reference? Let’s begin! Question #1When

Read More
02/03/22

Dry Needling and Medicare: February 2022 Update

For those physical therapists (PTs) that perform dry needling on Medicare beneficiaries, they understand that the Medicare program does not reimburse PTs for dry needling when billing CPT codes 20560 and 20561. What has been confusing is must the PT provider issue a mandatory advance beneficiary notice of noncoverage (ABN) to the Medicare beneficiary or is the ABN an optional ABN to provide to the Medicare beneficiary? This question has now apparently been answered by the Centers for Medicare and Medicaid Services (CMS). According to clarification received by

Read More
11/22/21

NCCI Edits and Modifier 59: Version 28.0

Please join us as Gawenda Seminars & Consulting, Inc. presents “Understanding NCCI Edits and Modifier 59: Version 26.2” webinar conference on June 24, 2020 from 1:00PM – 2:00PM eastern daylight time. The Centers for Medicare and Medicaid Services (CMS) updates the National Correct Coding Initiative (NCCI) edits every quarter. This webinar will provide participants with information on NCCI Edits Version 26.2 that become effective on July 1, 2020. In addition, I will teach participants changes that occurred in April 2020 that went retroactive to either December 31, 2019 or January 1, 2020.  To register online with a credit card, purchase

Read More
11/09/21

2022 Outpatient Therapy Regulatory and Payment Updates

Please join us as Gawenda Seminars & Consulting, Inc. presents “2022 Outpatient Therapy Regulatory and Payment Updates” webinar conference on December 9, 2021 from 1:00PM – 2:30PM eastern standard time. This webinar will teach participants the new payment changes for Medicare Part B outpatient therapy services for calendar year 2022 along with changes to supervision requirements of an assistant, the 2022 Medicare Part B deductible, 2022 therapy threshold dollar amount, the 15% payment reduction when services are provided in whole or in part by an assistant, an update on the current status of telehealth with traditional Medicare and commercial insurance

Read More
07/26/21

Hospice and Outpatient Therapy

Lately, I have been receiving questions via email and on various social media platforms concerning providing outpatient therapy services to a Medicare beneficiary who is in hospice. What people want to know is does the Medicare program pay a therapy provider separately for outpatient therapy services that they provide to a Medicare beneficiary who is in hospice? Let me answer this question for you as well as several other questions related to this topic. Question Does the Medicare program pay a therapy provider for outpatient therapy services that they provided to a Medicare beneficiary who is in hospice? Answer Question

Read More
06/14/21

What is Considered a Patient’s Home

More and more physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) are establishing private practices that focus on seeing patients in their home for outpatient therapy services. The Centers for Medicare and Medicaid Services (CMS) does allow PTs, OTs, and SLPs to treat Medicare beneficiaries in their home as outpatients and pays for those services under the Medicare Physician Fee Schedule just as CMS would pay if the Medicare beneficiary went to a private practice or other outpatient therapy setting (except for a critical access hospital who is reimbursed on a cost-ratio basis). However, what is considered a

Read More