In calendar year (CY) 2020, there will be 6 new CPT codes applicable to outpatient therapy services. The AMA also released 3 new Level II HCPCS codes that may or may not be applicable to physical therapists, occupational therapists and/or speech-language pathologists. In addition, there are 5 CPT codes and 1 Level II code being deleted in 2020.
What are the new CPT codes for calendar year 2020 applicable to outpatient therapy services?
Will the Multiple Procedure Payment Reduction (MPPR) policy apply to the new CPT codes?
What are the three new Level II HCPCS codes that may be applicable to physical therapists, occupational therapists and/or speech-language pathologists?
What are the deleted CPT codes for calendar year 2020 applicable to outpatient therapy services?
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Can you tell me if the new dry needling codes are timed or untimed codes?
They are untimed. They are based on the number of muscles you are performing dry needling on.
Any suggestions on how do document dry needling time in a Medicare chart/flowsheet to keep it separate? If multiple covered codes are used in a session for a total of 30 minutes (ie: 97110 15 min, 97140 min) and then 15 minutes of dry needling is performed under cash pay (now a non-covered), how would you keep it “separate” to prevent thoughts of bundling it into other services and codes and upcoding/false claim? DN has to be documented in the chart per the state practice act. (Total Time: 30 minutes. Time-based: 30 minutes. Non-covered – 20561 Dry Needling 15 minutes ???). Being able to account for time and productivity is important. Thank you.
How each organization decides to document for services that are not payable by any insurance carrier is an organizational decision and not something I can address in this format. I would suggest you discuss with the person that you report to in your organization or contact your risk management and/or legal department.
Hi Rick–Does Medicare typically allow for biofeedback? We are using mostly for perineal/incontinence treatments. Thanks
CMS doe scover biofeedback for urinary incontinence after a failed trial of PME training is defined as no clinically significant improvement in
urinary incontinence after completing four weeks of an ordered plan of pelvic muscle
exercises to increase periurethral muscle strength. Read Section 30.1.1 of this link: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part1.pdf
Are there any codes that you would suggest to replace the 95831 code?
There are some insurance companies saying that the new Dry Needling CPT codes (20560 and 20561) are considered surgical codes therefore they must quote the patient surgical benefits. Are these codes considered surgical or procedural?
They may be saying that since they fall under the Surgery/Musculoskeltal System of the CPT Book. If you are asking me if I think dry needling is a surgical procedure, my answer is no since dry needling is within the scope of many PT practice acts and last I checked, PTs can’t do surgery.
Have you seen denials of the 97129 and 97130 codes? We have received a denial from Medicare and Wellmark BCBS of Iowa.
You would have to look at the denial reason code(s) to see why it was denied.
It was listed as investigational.
What was listed as investigational?
I am looking at CMS / Novitas coverage for 90912 and 90913. It states “the physician and / or the non physician practitioner (NP/APN or PA) must provide direct supervision. To me that says they must be in the room. Is this a correct interpretation.
CMS also seems to indicate a physician must do an initial diagnostic EMG before biofeedback training. Is this correct?
I see other codes such as 97110 can be billed with a modifier. Would this be in conjunction with 90912/90913 or must be a separate 15 minutes?