Current News



New Jersey Governor Mandates Telehealth Coverage and Payment

New Jersey Governor Murphy announces Departmental Actions to Expand Access to Telehealth and Tele-Mental Health Services in Response to COVID-19. This includes physical therapists, occupational therapists and speech-language pathologists. Click HERE to read the announcement.

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COVID-19 and Telehealth Services

Due to the coronavirus (COVID-19), I am receiving many questions regarding telehealth and the ability for physical therapists, occupational therapists and speech-language pathologists to provide telehealth services and to have those services reimbursed by the Medicare program and private/commercial insurance carriers. See below for some of the common questions I receive and the answers as of March 13, 2020. QuestionWith the Centers of Medicare and Medicaid Services changing the rules and regulations for telehealth services due to the coronavirus (COVID-19), does this now mean physical therapists, occupational therapists and speech-language pathologists can now provide telehealth services to Medicare beneficiaries, bill

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Humana Resumes Prior Authorization for Outpatient Therapy

On December 18, 2017, Humana announced they would no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage. Unfortunately, nothing lasts forever. Effective with dates of service on and after I hope you found this article helpful and informative. Thank you for being a Gold Member!

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Billing CPT Codes 92611 and 74230 Same Day: Update

The Centers for Medicare and Medicaid Services (CMS) and Capital Bridge, LLC, who is the National Correct Coding Initiative (NCCI) contractor, has informed the American Speech-Language-Hearing Association (ASHA) that they will change the modifier indicator for when CPT codes 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording) and 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography) are billed on the same date of service by the same provider. CMS will now assign a modifier indicator ofI hope you found this article informative. Thank you for being a Gold Member!

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Prior Authorization Requirements for Florida

If you provide outpatient physical, occupational and/or speech therapy services in the state of Florida to patients who are covered by UnitedHealthcare Community Plan of Florida, you will want to read this article. Prior authorization requirements for Florida effective

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Speech Therapy Billing: Questions and Answers

It has been awhile since I have written an article focused on outpatient speech therapy and billing. So this week, I thought I would provide answers to some of the more common questions I receive about billing for speech therapy services. The answers I provide are based on what the Medicare Part B program allows and these answers may or may not be applicable to Medicare Advantage plans, Medicaid, managed Medicaid plans, private/commercial insurance carriers, workers compensation and automobile carriers. Here are the questions I will answer in this article: Can you be paid for CPT codes 92507 and 92526

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UHC Community Plan Adds 3 States to Prior Authorization

UnitedHealthcare (UHC) Community Plan is adding 3 states (in addition to the 4 previously announced) that will require prior authorization prior to initiating physical, occupational and/or speech therapy services. In addition, UHC Community Plan is adding site of service medical necessity reviews for all speech, occupational and physical therapy services provided in a hospital outpatient setting in 2 of the 3 states. The new impacted states are

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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

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