Occupational Therapy

With the Centers for Medicare and Medicaid Services (CMS) adding physical therapists, occupational therapists and speech-language pathologists as temporary providers of telehealth services, I have been receiving many questions regarding the provision and billing of outpatient therapy services delivered via telehealth. Below, please find the questions and answers to some of the most common questions I receive. If you do not see the question and answer you are looking for, please send me an email with your question and if appropriate and applicable to this article, I will add it.

Question
In what settings will the Medicare program pay for outpatient therapy delivered via telehealth?

Answer

Question
Are hospital-based therapy departments able to provide and be paid for outpatient therapy services delivered via telehealth by the Medicare program?

Answer

Question
If I did an outpatient therapy visit via telehealth with a Medicare Part B beneficiary prior to April 30, 2020 and had them pay me cash, must I now refund the Medicare beneficiary and submit the claim to my Medicare Administrative Contractor (MAC)?

Answer

Question
If I am an institutional provider (hospital outpatient therapy department, rehab agency, etc.) and I did a telehealth visit with a Medicare Part B beneficiary, submitted the claim to my Medicare Administrative Contractor (MAC) as a telehealth visit and was paid, what should I do with the payment?

Answer

Question
If I have a mobile therapy practice where I see Medicare beneficiaries in their home for outpatient therapy services, am I able to provide telehealth services under the Medicare program?

Answer

Question
We are an outpatient company and have clinics established inside of assisted living facilities. What setting is that considered?

Answer

Question
Is a Medicare certified outpatient rehabilitation facility (rehabilitation agency) considered a private practice?

Answer

Question
Does the Medicare program pay the same rate for outpatient therapy services as they do for an in-person outpatient therapy visit?

Answer

Question
Does the payment amount for an outpatient therapy visit delivered via telehealth count towards the annual therapy threshold dollar amount?

Answer

Question
Does the multiple procedure payment reduction policy apply to outpatient therapy services delivered via telehealth?

Answer

Question
Does the Medicare program pay for an evaluation performed via telehealth?

Answer

Question
What CPT codes does the Medicare program pay for when providing a telehealth visit?

Answer

Question
When billing the Medicare program, can you only bill 1 CPT code per visit?

Answer

Question
Does the Medicare program pay for a swallow evaluation (CPT code 92610) and treatment of swallowing dysfunction (CPT code 92526) if delivered via telehealth?

Answer

Question
Does the Medicare program pay for CPT codes 97129 and 97130 (Therapeutic interventions that focus on cognitive function)?

Answer

Question
What are the documentation requirements when seeing a Medicare beneficiary for outpatient therapy services delivered via telehealth?

Answer

Question
Is there a limit to the number of telehealth visits I can provide to a Medicare beneficiary, either weekly or during the episode of care?

Answer

Question
Can a Medicare patient have a combination of in-person visits and telehealth visits during an episode of care?

Answer

Question
For Medicare Part B telehealth services, what place of service code do I use on the 1500-claim form?

Answer

Question
When submitting claims to my Medicare Administrative Contractor for outpatient therapy services delivered via telehealth, what modifier(s) are required to be appended to each CPT code on the claim form?

Answer

Question
Must the modifiers be appended to each CPT code in a particular order?

Answer

Question
Must I be licensed in the state where the patient is located during the telehealth visit?

Answer

Question
If a Medicare beneficiary usually resides in the state where I practice and I am licensed in, but for a temporary basis, has gone to live with family in another state where I am not licensed, can I do a telehealth visit with that Medicare beneficiary and submit the claim to my Medicare Administrative Contractor?

Answer

Question
If a Medicare beneficiary does not have a computer, laptop or android phone capable of audio/visual communication, can a I call the Medicare beneficiary on their land-line phone and bill it as a telehealth visit?

Answer

Question
Can you explain the difference between a telehealth visit and an E-Visit?

Answer

I hope you found this article helpful. If you have a question regarding Medicare and telehealth that did not appear in this article, please email it to me at info@gawendaseminars.com and perhaps I’ll add it to this article. Thank you for being a Gold Member!