This article was updated on July 23, 2020 due to a change in the expiration date of outpatient therapy services delivered via telehealth. See below for the updated answer on the expiration date of the Public Health Emergency due to COVID-19. As I hope you all know by now, the Centers for Medicare and Medicaid Services (CMS) has expanded who can provide and be reimbursed for services delivered via telehealth to include outpatient physical, occupational and speech therapy services provided not only by private practices, but also institutional providers. Now what everyone wants to know is this a temporary or

This article was updated on May 29, 2020. See below for answers that have been updated. The Centers for Medicare and Medicaid Services (CMS) has issued guidance regarding the billing of E-Visits and Telephone Services provided by physical therapists, occupational therapists and speech-language pathologists. In this article, I will provide you the information via a question and answer format. QuestionWhat is the update that CMS released and how does it pertain to the E-Visits and Telephone Services? Answer (Updated on May 26, 2020) QuestionWhat codes were added to the list of “sometimes therapy” services? Answer QuestionSince the above codes have

This article was updated on July 23, 2020 due to Secretary Azar extending the Public Health Emergency due to the COVID-19 pandemic. This article was updated on June 23, 2020 due to CMS clarifying if a practitioner can be out of the country and provide a telehealth visit to a Medicare beneficiary in a state where the practitioner is licensed in. See below for the question and the answer. This article was updated on May 27, 2020 due to the Centers for Medicare and Medicaid Services expanding telehealth coverage for outpatient therapy services to include institutional providers. Please see questions

On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) announced they were adding physical therapists, occupational therapists and speech-language pathologists as temporary providers of telehealth services during the Public Health Emergency due to the COVID-19 pandemic. Here is what we know so far. QuestionCan a physical therapist, occupational therapist or speech-language pathologist in private practice provide a telehealth visit and have it paid by the Medicare program? Answer Question – New Question May 6, 2020Can a physical therapist or occupational therapist employed by a physician-owned practice provide a telehealth visit to a Medicare Part B beneficiary and

National Correct Coding Initiative (NCCI) edits are updated quarterly by the Centers for Medicare and Medicaid Services (CMS) and Capital Bridge, CMS’ NCCI coding contractor. Updates occur on January 1, April 1, July 1, and October 1 of each calendar year. Typically, the January 1 update sees the most additions, deletions and revisions due to new, revised and deleted CPT codes taking effect on January 1 of the calendar year. Due to the COVID-19 Public Health Emergency as well as CMS’s expansion of telehealth services, CMS updated procedure-to-procedure (PTP) edits and Medically Unlikely Edits (MUEs) for Current Procedural Terminology (CPT)

Due to the coronavirus (COVID-19), I am receiving many questions regarding the ability for physical therapists, occupational therapists and speech-language pathologists to provide outpatient therapy services in a patient’s home and to have those services reimbursed by the Medicare program and private/commercial insurance carriers. See below for some of the common questions I receive and the answers to each question. This article was originally published on March 16, 2020, but I republished it today and added additional Q&As. QuestionDoes the Medicare program reimburse for outpatient therapy in a patient’s home? Answer QuestionWhat is considered a patient’s home? Answer QuestionWith the

Today, I am receiving emails and phone calls from providers around the country that believe the Medicare program covers telehealth services provided by a physical therapist, occupational therapist or a speech-language pathologist. I have even received emails from several providers stating they provided telehealth visits to Medicare beneficiaries, submitted the claim to their Medicare Administrative Contractor using place of service code 02 on the 1500-claim form and appended modifier 95 or modifier 95 and the GP modifier to the CPT code(s) on the claim form and were paid. I hate to tell you, but you were paid in error. As

On April 16, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Fiscal year (FY) 2021 proposed rule for facilities under the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). Highlights of the proposed rule include the following: In the FY 2021 IRF PPS proposed rule, CMS is proposing to allow non-physician practitioners to perform any of the IRF coverage service and documentation duties that are currently required to be performed by a rehabilitation physician, provided that the duties are within the non-physician practitioner’s scope of practice under applicable state law CMS is proposing to no longer require