Current News



Does CMS Limit Outpatient Therapy Units

Question A question I often receive is does the Centers for Medicare and Medicaid Services (CMS) limit the number of total units that can be billed per day by type of discipline (e.g., PT, OT, SLP)? Answer

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Does TRICARE Pay for Telehealth for Outpatient Therapy?

QuestionDoes TRICARE pay for telehealth services for outpatient physical, occupational and/or speech therapy services? Answer QuestionWhat CPT code(s) do I use to bill for telehealth for TRICARE beneficiaries? AnswerThe TRICARE Policy Manual is not clear on what code(s) to use for telehealth services. Your first option is to contact TRICARE. Per the TRICARE Policy Manual, April 2015, Change 60 (March 13, 2020), Chapter 7, Medicine, Section, it states the following: “When billing for synchronous telemedicine services, providers will use CPT or HCPCS codes with a GT modifier for distant site and Q3014 for originating site to distinguish telemedicine services. In addition,

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Louisiana Medicaid to Cover Telehealth for Therapy Services

In a memorandum dated March 17, 2020, the state of Louisiana, Louisiana Department of Health, Bureau of Health Services Financing, announced “Effective for dates of service on or after March 17, 2020, and for the duration of the COVID-19 emergency, Louisiana Medicaid encourages and will reimburse the use of telehealth, when appropriate, for rendering physical therapy, occupational therapy, and speech therapy to members. Telehealth can facilitate the continuation or establishment of these services while complying with the need for social distancing”. To read the entire memorandum, click This is a tremendous opportunity for therapists in the state of Louisiana and

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UnitedHealthcare Oxford Updates Several Therapy Policies

UnitedHealthcare Oxford has revised several of their clinical policies pertaining to outpatient physical, occupational and/or speech therapy services. The following policies have been revised with an effective date of April 1, 2020: I hope you found this article informative and will assist you treating and billing UnitedHealthcare Oxford beneficiaries for dates of service on and after April 1, 2020. Thank you for being a Gold Member!

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Therapy Under the Home Health Patient-Driven Groupings Model

The Centers for Medicare and Medicaid Services has released a MLN Matters article that provides information on the continuing role of therapy under the newly implemented home health prospective payment system (HH PPS) case-mix adjustment methodology, named the Patient-Driven Groupings Model (PDGM), for home health periods of care starting on and after January 1, 2020. To access the article, click HERE. I hope you fond this article helpful.

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When Should I Use the New PTA and OTA Modifiers

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

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2020 Annual Update to the Therapy Code List

The Centers for Medicare and Medicaid Services (CMS) has released the annual update that provides the list of codes that sometimes or always describe therapy services. Providers of therapy services need to be aware of this list and the annual updates as this list will tell providers which CPT codes the Multiple Procedure Payment Reduction (MPPR) policy does and does not apply to. Question Which CPT codes does the MPPR policy apply to? Answer Question Which CPT codes does the MPPR policy not apply to? Answer Question What’s the difference between an “always therapy” and “sometimes therapy” CPT code? Answer

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BCBS of Minnesota Reviewing for Medical Necessity

On June 3, 2019, Blue Cross and Blue Shield (BCBS) of Minnesota removed the prior authorization (PA) requirements for outpatient therapies, including physical, occupational, and speech therapy, and chiropractic services. Self-Insured Groups may have benefits that require a PA for outpatient therapy or chiropractic services. These services may be managed as a PA or a retrospective review. While the above is good news, with the removal of the PA, BCBS of Minnesota will be conducting medical necessity review of services. The number of visits outlined below provides an example of when Blue Cross would typically begin reviewing therapies for medical

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