Today, January 29, 2018, is the day Part A providers in the states of Alabama, Georgia, and Tennessee transition from Cahaba to Palmetto GBA as their Medicare Administrative Contractor. Part A providers include skilled nursing facilities, rehabilitation agencies, comprehensive outpatient rehabilitation facilities, and hospitals. This would include both Part A and Part B benefits provided to Medicare beneficiaries by these types of providers. This would include outpatient therapy services such as physical therapy, occupational therapy and speech therapy. Private practices in these states will transition to Palmetto GBA on February 26, 2018. For additional information, click HERE.
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Since the change to Palmetto, we have had denial on payment of eval codes with reason “patient seen by us in last 3 years.”
I assume you are speaking about either the PT or OT evaluation CPT codes. If yes, then you need to contact Palmetto as that is an error on their end. You may also want to contact APTA and AOTA.
Since the change to Palmetto, we have begun to have our estim unattended codes denied. Some stating LCD codes needed. We have confirmed the LCD codes are valid and attached to the claims. Any insight?
You would need to contact Palmetto as perhaps it’s a system error on their side. You can also contact APTA at email@example.com