On July 13, 2023, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) proposed rule. This proposed rule does have regulatory and reimbursement implications for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings. In this article, I will inform you of what CMS is proposing on the following topics:

The public health emergency (PHE) ended at the end of the day on May 11, 2023. What providers want to know is will the Medicare program continue to reimburse for outpatient therapy services delivered via telehealth after the PHE and if yes, in which outpatient settings and for how long? Several updates have occurred since I published an article on this topic back on May 4, 2023. The article has been updated twice since that date due to new information from the Centers for Medicare and Medicaid Services (CMS). Click HERE to read this article that does contain the latest

This 2.5-hour webinar will teach participants what CPT code to bill dependent upon their intent and documentation in the medical record. The webinar will provide case scenarios to teach participants how to bill correctly to the Medicare program as well as non-Medicare insurance carriers.

This webinar will provide participants with information on NCCI Edits Version 28.2 that became effective with dates of service beginning on July 1, 2022 and lasting through September 30, 2022

Please join us as Gawenda Seminars & Consulting, Inc. presents “Understanding NCCI Edits and Modifier 59: Version 26.2” webinar conference on June 24, 2020 from 1:00PM – 2:00PM eastern daylight time. The Centers for Medicare and Medicaid Services (CMS) updates the National Correct Coding Initiative (NCCI) edits every quarter. This webinar will provide participants with information on NCCI Edits Version 26.2 that become effective on July 1, 2020. In addition, I will teach participants changes that occurred in April 2020 that went retroactive to either December 31, 2019 or January 1, 2020.  To register online with a credit card, purchase

Please join us as Gawenda Seminars & Consulting, Inc. presents “2022 Outpatient Therapy Regulatory and Payment Updates” webinar conference on December 9, 2021 from 1:00PM – 2:30PM eastern standard time. This webinar will teach participants the new payment changes for Medicare Part B outpatient therapy services for calendar year 2022 along with changes to supervision requirements of an assistant, the 2022 Medicare Part B deductible, 2022 therapy threshold dollar amount, the 15% payment reduction when services are provided in whole or in part by an assistant, an update on the current status of telehealth with traditional Medicare and commercial insurance

Cigna has updated their medical coverage policy for outpatient physical therapy services. The effective date for the revised policy is I hope you found this information helpful. Thank you for being a Gold Member!

If you are a Blue Cross Blue Shield (BCBS) provider in the state of Michigan and provide outpatient therapy services, you will want to read this article. eviCore Healthcare has made changes to the corePath therapy authorization model for initial authorization requests for new episodes of treatment. This change applies to: Physical therapy providers in categories B and C Occupational therapists in category B What Has Changed? To access a nice 6-page document that contains frequently asked questions (FAQs) regarding practitioner performance summary and provider category FAQs, click I hope you found this article helpful and informative. Thank you for being