Palmetto GBA, Medicare Administrative Contractor for the states of Alabama, Georgia and Tennessee, has published their Part A and Part B Targeted Probe and Educate Active Medical Review List. If you are a non-private practice, Palmetto GBA is looking at CPT codes 97110, 97112 and 97140 when billed with and without a KX modifier. If you are a private practice, Palmetto GBA is looking at CPT codes 97110, 97112, 97140 and 97530 when billed without the KX modifier. Click HERE to view the complete list.

Palmetto GBA has announced that some skilled nursing facility (SNF) type of bills (TOB) 22X and 23X and Critical Access Hospital (CAH) TOB 85x with dates of service January 1 through April 11, 2021, processed prior to April 12, 2021, did not have the Multiple Procedure Payment Reduction (MPPR) applied on them. The system was updated on April 12, 2021, when the fix was installed. These TOBs with Revenue Code 042X, 043X or 044X present with more than 1 units or Revenue Code 042X, 043X or 044X present on more than one line with the same line item date of service, are

Palmetto has published an updated list of active medical reviews. Pertaining to outpatient therapy, 2 of the active medical reviews include CPT code 97110 (therapeutic exercise) and 97140 (manual therapy) provided in non-private practice settings. It’s important to document not just what the patient performed in therapy that visit, but what did the therapist or assistant do for the patient that visit that required the unique skills of a therapist, or an assistant under the direction and supervision of the therapist, to provide. Did the therapist or assistant provide verbal instruction and/or correction to the patient during the performance of

Palmetto GBA, Medicare Administrative Contractor (MAC) for Jurisdiction J which includes the states of Alabama, Georgia and Tennessee, currently has two active medical reviews for outpatient therapy services for non-private practice settings. The two reviews are focused on CPT code 97110 (therapeutic exercise) and CPT code 97140 (manual therapy). When the results of the review are posted, I will write an article on the findings.

Palmetto GBA, Medicare Administrative Contractor for the states of Alabama, Georgia, North Carolina, South Carolina, Tennessee, Virginia and West Virginia, have revised their physical therapy, occupational therapy and speech therapy local coverage determinations (LCD’s). The effective date for the revisions for all 3 LCD’s is January 1, 2019. To access the revised LCD’s, log into your Gold Member account and click on the following titles below