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12/09/19

When Should I Use the New PTA and OTA Modifiers

Beginning with dates of service on and after January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will require providers of outpatient physical therapy and occupational therapy services to append a modifier to CPT code(s) on the claim form when that service was provided in whole or in part by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). Click HERE to access my answers to some of the more frequently asked questions on the new PTA and OTA modifiers. In this article, I will provide 14 scenarios and the answer how to correctly bill for

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11/25/19

2020 Annual Update to the Therapy Code List

The Centers for Medicare and Medicaid Services (CMS) has released the annual update that provides the list of codes that sometimes or always describe therapy services. Providers of therapy services need to be aware of this list and the annual updates as this list will tell providers which CPT codes the Multiple Procedure Payment Reduction (MPPR) policy does and does not apply to. Question Which CPT codes does the MPPR policy apply to? Answer Question Which CPT codes does the MPPR policy not apply to? Answer Question What’s the difference between an “always therapy” and “sometimes therapy” CPT code? Answer

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11/11/19

Medicare 2020 Deductibles and Premiums Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the 2020 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2020 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon was the deductible met before or after they received outpatient physical, occupational and/or speech therapy services. Question What is the 2020 Medicare Part B deductible? Answer Question How does the Part B deductible impact the annual therapy threshold dollar amount? Answer Question What is the

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11/11/19

Important Medicare Supplement Plan Changes for 2020

Big changes are coming in calendar year 2020 for Medicare beneficiaries who purchase Medicare Supplement plans (known as Medigap). The changes are a result of the Medicare Access and CHIP Reauthorization Act (MACRA) that will change Medicare Supplement plans in all states, and this becomes effective January 1, 2020. Who will this change impact in calendar year 2020? The changes will effect ONLY newly eligible Medicare beneficiaries. Newly eligible is defined as “people who are 65 years of age or become first eligible for Medicare because of age, disability or end-stage renal sickness on or after January 1, 2020”. Why

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11/04/19

Will CMS Pay for Dry Needling in 2020

On January 1, 2020, there will be 2 new CPT codes to report needle insertion(s) (i.e. dry needling) for qualified healthcare professionals, such as physical therapists, who provide dry needling where allowed by state law and state practice act. Now, just because we have the new CPT codes that describe dry needling does not mean the Medicare program and other insurance carriers have to pay for them. In this article, I will provide the 2 new CPT codes and also tell you if the Medicare program is going to pay for the codes. The 2 new CPT codes that describe

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11/01/19

CMS Releases 2020 Final Rule for Medicare Services

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS) and the Merit-Based Incentive Payment System (MIPS) program for calendar year (CY) 2020. Highlights of the final rule include, but are not limited to, the following: 2020 Medicare Conversion Factor 2020 Annual Therapy Threshold Dollar Amount Dry Needling CPT Codes CO/CQ Documentation Requirements New PTA and OTA Modifiers Effective January 1, 2020 Discipline Specific Therapy Modifiers (GO and GN) Biofeedback CPT Codes Cognitive Function Interventions Negative Pressure Wound Therapy Here we go! 2020 Conversion

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09/30/19

Can I Charge a Medicare Patient a Cancel or No Show Fee

A question I often receive is can I bill a Medicare beneficiary who is under an outpatient therapy plan of care a cancel or no show fee (missed appointment fee)? The answer may surprise you. According to the Centers for Medicare and Medicaid Services (CMS), Medicare Claims

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09/09/19

Texas Physical Therapists Get Direct Access

On May 23, 2019, House Bill (HB) 29 passed the Texas Senate and on June 14, 2019, Governor signed the bill into law. HB 29 will provide Texas residents the ability to have Direct Access for physical therapy services with an effective date of September 1, 2019. Highlights of HB 29 and Direct Access include: A physical therapist may treat a patient for an injury or condition in a manner described by Section 453.005 without a referral if the physical therapist:  

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