New physical therapy codes for 2017 were released yesterday by CMS as part of the Medicare Physician Fee Schedule Proposed Rule for 2017 (CMS-1654-P). The therapy community has long awaiting the anticipated changes to the current CPT coding structure. The proposed rule provides information on the new physical therapy and occupational therapy evaluation codes (we […]
Here we go again! Therapy manual medical review again! Just when the therapy community, particularly those in private practice, were thinking that CMS forgot about manual medical review of outpatient therapy over $3700 CMS opted a stealth move, the though an update to the therapy cap website. It represents a long-awaited announcement, but not a particularly welcome […]
There is no change in 2016 PQRS measures reporting for occupational therapy for claims based reporting. As the new year begins occupational therapists, much like physical therapists, may find themselves in one of three situations regarding PQRS reporting: 1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting […]
Time to get started to with 2016 PQRS measures for physical therapy! As the new year begins physical therapists may find themselves in one of three situations regarding PQRS reporting: 1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting was unsuccessful and therefore a 2% […]
The Medicare therapy cap in 2016 is set at $1960. The therapy cap for physical and speech-language pathology combined is set at $1960 and there is a separate $1960 therapy cap for occupational therapy. This represents an increase of $20 per cap over the 2015 amount of $1940. The increment is based upon a medical […]
The 2016 OIG Work Plan once again includes a review of physical therapists in private practice and is captioned as “Physical therapists—high use of outpatient physical therapy services”. Per the OIG Work Plan and physical therapists in private practice: We will review outpatient physical therapy services provided by independent therapists to determine whether they were […]
Therapists always seem to ask “does Medicare cover ionto?” There is a bit of urban legend that Medicare does not cover this constant attendance modality, where in fact there is not a National Coverage Determination (NCD) that speaks to the use of ionto. According to the clinical responsibility description of iontophoresis at SuperCoder: Iontophorehis (Ionto) is […]
I get calls and inquiries asking “what is a rehab agency”. Generally people have heard that a rehab agency may be a more profitable outpatient model than private practice, or that supervision rules for assistants are more favorable. Some outpatient providers have been told by managed care payors that certification as a rehab agency or CORF […]
It’s that time of the year when therapy providers are carefully reviewing the potential for therapy over the cap for each of their Medicare patients. Beneficiaries may need to exceed the therapy cap for several reasons: A single complicated episode of care. Multiple related episodes of care. Multiple unrelated episodes. Using both physical therapy and speech therapy in the […]
Therapy supervision rules differ by venue in terms of Medicare, and may differ by state jurisdiction for Medicaid. Tricare does not have therapist supervision rules for private practice, as therapy assistants are not allowed by Tricare Military policy. Medicare, Medicaid and Tricare supervision rules are payor rules. There are also practice rules for supervision noted in your physical […]
New Physical Therapy Codes for 2017
New physical therapy codes for 2017 were released yesterday by CMS as part of the Medicare Physician Fee Schedule Proposed Rule for 2017 (CMS-1654-P). The therapy community has long awaiting the anticipated changes to the current CPT coding structure. The proposed rule provides information on the new physical therapy and occupational therapy evaluation codes (we […]
Until recently outpatient therapy providers had a low expectation of an audit, much less an expectation of an investigation. Therapists in private practice have been on the radar of the Office ... Read More
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