The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2021 Proposed Rule for services paid under the Medicare Physician Fee Schedule (MPFS). This would include outpatient physical, occupational and speech therapy services provided in all settings (private practice (both therapist-owned and physician-owned, skilled nursing facilities doing Part B, comprehensive outpatient rehabilitation facilities, rehabilitation agencies, home health agencies providing Part B therapy services in the home and hospital outpatient therapy departments). This proposed rule would not apply to outpatient therapy services provided by critical access hospitals (CAHs) since CAHs are not reimbursed under the MPFS. Highlights

With the Centers for Medicare and Medicaid Services (CMS) expansion of telehealth services as well as their Hospital Without Walls initiative, many hospitals are confused on the differences between providing outpatient physical, occupational and speech therapy services remotely versus via telehealth and how to complete the UB-04 claim form. I published an article on June 18, 2020 explaining the differences between the two and how to do the billing for each type of service. Now, CMS has provided additional clarification on providing outpatient physical, occupational and speech therapy services remotely versus via telehealth and explains how to do the billing

With the Secretary of the Department of Health and Human Services extending the Public Health Emergency (PHE) due to the COVID-19 pandemic, many private practices as well as facilities and organizations want to know what does this mean for the extension of providing outpatient therapy services via telehealth. In this article, I will provide updates on outpatient therapy services delivered via telehealth for the traditional Medicare Part B program and some of the larger national insurance carriers. Medicare (Traditional) Aetna Anthem BCBS of Colorado Anthem BCBS of Connecticut Anthem BCBS of Georgia Anthem BCBS of Indiana Anthem BCBS of Kentucky

Cigna has extended the expiration date for outpatient therapy services delivered via telehealth. The new expiration date is I hope you found this information informative and valuable to your practice or organization. Thank you for being a Gold Member!

UnitedHealthcare has provided updates on outpatient physical, occupational and speech therapy services delivered via telehealth. Telehealth for Medicare Advantage Telehealth for Individual and Fully Insured Group Market Virtual Check-Ins and E-Visits for Medicare Advantage Virtual Check-Ins for Individual and Fully Insured Group Market E-Visits for Individual and Fully Insured Group Market In addition to all of the above important information, click and read all about outpatient physical, occupational and speech therapy services delivered via telehealth. I hope you found this article informative. Thank you for being a Gold Member!

Health Net Federal Services, LLC (HNFS), who is the TRICARE West Region Contractor, has provided an update on what place of service (POS) code to use on the 1500-claim form when providing a telehealth visit. HNFS is now asking providers to use the POS that represents In addition, HNFS has provided an update on reimbursement and resubmission of claims. By using an incorrect POS code, the provider may have been or will be reimbursed at the facility CHAMPUS Maximum Allowable Charge (CMAC) rate, rather than a non-facility CMAC. If you provided telemedicine services from a non-facility setting, you may submit

QuestionFor occupational therapy services submitted to an insurance carrier on a 1500-claim form, how do I bill for the services provided by an occupational therapy assistant? Answer I hope you found this article helpful. Thank you for being a Gold Member!

The Centers for Medicare and Medicaid Services (CMS) has announced they will accept interstate license compacts for Physical Therapy, Occupational Therapy and Speech Language Therapy as valid, full licenses for the purposes of meeting CMS’ federal license requirements. A physical therapist, occupational therapist or speech-language pathologist working under the authorization of a compact must meet both the licensure requirements outlined in the primary state of residence and thoseestablished by the compact laws adopted by the legislatures of the interstate compact states. CMS states that the Medicare Administrative Contractors (MACs) will accept CMS-855 enrollment applications from providers reporting an interstate license