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

The Medicare Payment Advisory Commission (MedPAC) has released a 3-page document providing data and Medicare spending for outpatient therapy in calendar year 2017. Here is a brief summary of the report. Distribution of Outpatient Therapy by Setting Skilled Nursing Facility: 37% PT in Private Practice: 34% Hospital: 16% ORF, CORF and HHA: 9% OT & SLP Private Practice: 3% Physician & Nonphysician Practitioner: 2% Keep in mind that PT in private practice can include physical therapists who practice in a physician-owned therapy practice, but are submitting claims under the NPI number of the treating physical therapist. Spending by Discipline In

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

Effective July 1, 2019, Anthem Blue Cross patients in several states will require preauthorization to receive outpatient physical, occupational and speech therapy services. This will be true not only for new patients beginning therapy on or after July 1, 2019, but also for current Anthem patients who are being seen now and will continue to be seen for therapy on or after July 1, 2019. The states where prior authorization will be required effective for dates of service on and after July 1, 2019 are: