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04/20/20

TRICARE Now Paying for Services Provided By an Assistant

On March 16, 2020, the Department of Defense issued the long awaited Final Rule titled “TRICARE; Addition of Physical Therapist Assistants and Occupational Therapy Assistants as TRICARE-Authorized Providers” with an effective date of April 16, 2020. This means that beginning with dates of services on and after April 16, 2020, a physical therapist assistant (PTA) and occupational therapy assistant (OTA) are now considered a TRICARE-Authorized Provider. I originally wrote about this change in an article I published on March 16, 2020 for my Gold Members. On April 15, 2020, the American Physical Therapy Association (APTA) published an article discussing the

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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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11/01/19

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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08/19/19

CMS to Require New Modifiers in Calendar Year 2020

Effective with dates of service beginning on and after January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will require 2 new modifiers be appended to CPT codes on the claim form when those services are provided “in whole” or “in part” by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). To make matters worse, beginning with dates of service on and after January 1, 2022, services that contain one of the two modifiers appended to them on the claim form will be paid at 85% of the normal rate of the Medicare allowed amount

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07/29/19

CMS Releases Proposed Rule for Calendar Year 2020

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for calendar year (CY) 2020 for services paid under the Medicare Physician Fee Schedule (MPFS). This proposed rule does impact providers of outpatient physical, occupational and speech therapy services in all outpatient therapy settings that does include private practices, hospital outpatient departments (including Medicare beneficiaries under Observation status and in the Emergency Department and do not get admitted to the hospital), skilled nursing facilities, rehabilitation agencies, comprehensive outpatient rehabilitation facilities and home health agencies providing outpatient therapy in a Medicare beneficiaries home. Highlights of

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03/18/19

How to Bill for Services Provided By a PTA or OTA

A question I often receive is how do I bill for services provided to a Medicare or non-Medicare beneficiary that were provided by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). The answer to the question depends upon your practice setting. In a private practice setting (you submit claims on a 1500-claim form to the insurance carrier), the services of a PTA or OTA are billed

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04/23/18

Supervision Requirements of an Occupational Therapy Assistant

Question: Under Medicare Part B, what are the supervision requirements of an occupational therapy assistant in the private practice setting and non-private practice setting (i.e. hospital, skilled nursing facility, rehab agency, CORF)? Answer:

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07/25/16

Supervision Requirements of Assistants in the Non-Private Practice Setting

Question: Under Medicare Part B, what are the supervision requirements of a physical therapist assistant (PTA) and occupational therapy assistant (OTA) in the non-private practice setting (i.e. hospital, skilled nursing facility, rehab agency, CORF)? Answer:

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