Search
Generic filters
Exact matches only
Search in title
Search in content
Search in excerpt

What are the New Documentation Requirements CMS is Proposing

CMS is proposing a new documentation requirement effective with dates of service on and after January 1, 2020 to support the application or non-application of the CQ/CO modifier for each service furnished that day. In the proposed rule, CMS provides the following examples:

This content is for Gold Members only. Please log in above or Register

Lets now take a look at some case scenarios and see when and when not the CQ/CO modifiers would be required per the proposed rule Also, keep in mind that the scenarios could change when the final rule is released in early November 2019.

Evaluations and Reevaluations

This content is for Gold Members only. Please log in above or Register

When Multiple Units of the Same 15-Minute Time-Based CPT Code are Billed

Many times, providers of outpatient therapy services bill multiple units of the same 15-minute CPT code for services rendered to a Medicare beneficiary. I will provide several examples of how the CQ/CO modifier will or will not apply. I will use therapeutic exercise (CPT code 97110) for my examples. In addition, this is where the CMS interpretation of service will cause financial issues for providers of outpatient physical and occupational therapy.

This content is for Gold Members only. Please log in above or Register

When Different 15-Minute Time-Based CPT Codes are Provided

I will provide several examples when the PT/OT and PTA/OTA are providing different interventions and procedures to a Medicare beneficiary that are described by different CPT codes.

This content is for Gold Members only. Please log in above or Register

Group Therapy (CPT Code 97150)

I will provide several examples when the PT/OT and PTA/OTA are providing group therapy in which a Medicare beneficiary is a participant.

This content is for Gold Members only. Please log in above or Register

To access the proposed rule regarding the PTA/OTA modifiers, click

This content is for Gold Members only. Please log in above or Register

I hope you found this article helpful. Thank you for being a Gold Member!

 

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 the proposed rule include:

  • Proposing to revise the regulations at §§ 410.59 and 410.60 discussing the annual therapy threshold, use of the KX modifier, and the targeted medical review threshold
  • CQ/CO Modifiers to be appended to CPT codes for services provided in whole or in part by a PTA or OTA
  • To add a requirement that the treatment notes explain, via a short phrase or statement, the application or non-application of the CQ/CO modifier for each service furnished that day
  • PTA and OTA Payment Changes in 2022
  • New CPT codes for trigger point dry needling
  • New Biofeedback CPT codes
  • New Health and Behavioral Assessment and Intervention CPT codes
  • Discussing the 2 new Cognitive Function Intervention CPT codes
  • Work relative value unit (RVU) for CPT codes 97597 and 97598
  • Proposing an Active Status for CPT codes 97607 and 97608
  • Proposing a work RVU of 0.40 for CPT code 97610
  • Online Digital Evaluation Service HCPCS Level II Codes
  • 2020 Medicare Physician Fee Schedule Conversion Factor
  • 2020 MIPS Program

Revising Regulations at §§ 410.59 and 410.60

This content is for Gold Members only. Please log in above or Register

CQ and CO Modifiers

This content is for Gold Members only. Please log in above or Register

de minimis Standard for CQ and CO Modifiers

This content is for Gold Members only. Please log in above or Register

Documentation Requirements to Support Use of or Non-use of CQ/CO Modifiers

This content is for Gold Members only. Please log in above or Register

PTA and OTA Payment Changes in 2022

This content is for Gold Members only. Please log in above or Register

New CPT Codes for Trigger Point Dry Needling

This content is for Gold Members only. Please log in above or Register

Biofeedback CPT codes

This content is for Gold Members only. Please log in above or Register

New Health and Behavioral Assessment and Intervention CPT Codes

This content is for Gold Members only. Please log in above or Register

Cognitive Function Intervention CPT Codes

This content is for Gold Members only. Please log in above or Register

CPT Codes 97597 and 97598

This content is for Gold Members only. Please log in above or Register

CPT Codes 97607 and 97608

This content is for Gold Members only. Please log in above or Register

CPT Code 97610

This content is for Gold Members only. Please log in above or Register

Online Digital Evaluation Service

This content is for Gold Members only. Please log in above or Register

When you see the letter “X” in a new CPT code, this “X” will be replaced by the actual number that is in the CPT code once the American Medical Association (AMA) releases the 2020 CPT codes in early September. The same is true with the letters “NPP” in the 3 new HCPCS codes described above. These letters will be replaced by numbers once the AMA releases the 2020 CPT codes in early September.

2020 Medicare Physician Fee Schedule Conversion Factor

This content is for Gold Members only. Please log in above or Register

MIPS 2020

This content is for Gold Members only. Please log in above or Register

I hope you found this article informative. To access the proposed rule, click

This content is for Gold Members only. Please log in above or Register

Thank you for being a Gold Member!

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

This content is for Gold Members only. Please log in above or Register