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Posting Date: 02/17/2022
Introduction to Outpatient OT and PT Services
Outpatient OT and PT Services Billing Guide Introduction to Outpatient OT and PT Services Therapy services are a covered benefit in Sections 1861(g), 1861(p), and 1861(ll) of the Act. Therapy services may also be provided incident to the [...]
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Posting Date: 02/08/2022
KX Modifier Threshold
KX Modifier Threshold The Bipartisan Budget Act of 2018 repealed application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold above which claims must include the KX modifier as a confirmation that [...]
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Posting Date: 02/17/2022
Annual Update to the Therapy Code List
Annual Update to the Therapy Code List Annual CRs update the list of codes that are described as “sometimes” or “always” therapy services. This will include additions, changes and deletions to the therapy code list. The current and previous [...]
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Posting Date: 02/17/2022
Targeted Medical Review
Targeted Medical Review CMS knows in certain circumstances you may need to treat a patient whose condition exceeds the KX modifier threshold amounts. This is always based on the medical necessity of the patient. If this is the case, you must [...]
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Posting Date: 02/17/2022
Functional Reporting - Using the G Codes
Functional Reporting ‒ Using the G Codes Effective for dates of service on and after 1/1/2019, the functional reporting requirements of reporting the functional limitation nonpayable HCPCS G-codes and severity modifiers on claims for therapy [...]
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Posting Date: 02/17/2022
What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy
What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy The ABN is a notice given to the Medicare patient before services are rendered when you believe Medicare may deny services. These may be for medical [...]
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Posting Date: 02/17/2022
Maintenance Programs
Outpatient OT and PT Services Billing Guide Maintenance Programs Skilled therapy services that do not meet the criteria for rehabilitative therapy may be covered in certain circumstances as maintenance therapy under a maintenance program. [...]
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Posting Date: 02/17/2022
Multiple Procedure Payment Reduction
Multiple Procedure Payment Reduction Medicare applied MPPR to the PE payment of select therapy services paid under the physician fee schedule or paid at the physician fee schedule rate. Currently, the reduction is 50 percent for therapy [...]
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Posting Date: 02/17/2022
The National Correct Coding Initiative
Outpatient OT and PT Services Billing Guide The National Correct Coding Initiative The purpose of the NCCI Procedure-to-Procedure (PTP) edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one [...]
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Posting Date: 02/17/2022
Recovery Auditor
Recovery Auditor The mission of the Recovery Audit Program is to detect and correct past improper payments made on health care claims for services provided to Medicare beneficiaries. The goal is to help CMS and the MACs implement actions that [...]
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Posting Date: 02/17/2022
Common Billing Errors and Remittance Message
Common Billing Errors and Remittance Message Remittance Remark Code Listing: X12 Message Narrative 119 Benefit maximum for this time period or occurrence has been met. 18 Duplicate claim/service. [...]
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Posting Date: 02/17/2022
Medical Review Therapy Documentation Checklist for Additional Development Request Letters
Medical Review Therapy Documentation Checklist for Additional Development Request Letters Refer to the checklist below when preparing your documentation in response to an ADR: Doctor’s orders Certifications/recertifications Initial [...]
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Posting Date: 02/17/2022
Related Content
Outpatient OT and PT Services Billing Guide Related Content Therapy Services American Physical Therapy Association (APTA) American Occupational Therapy Association (AOTA) Reviewed 10/07/2024
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Posting Date: 10/22/2021
Counting Units for Therapy Codes
Counting Units for Therapy Codes Counting units for therapy services can be complicated; therefore, we are providing guidance. First, you must understand the difference between timed codes and untimed codes in order to determine how to [...]
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Posting Date: 01/25/2024
Caregiver Training Services
Caregiver Training Services Effective 1/1/2024, payment will be made when practitioners train caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan. A caregiver is defined as a [...]
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Posting Date: 02/17/2022
Outpatient Occupational and Physical Therapy Coverage
Outpatient OT and PT Services Billing Guide Outpatient Occupational and Physical Therapy Coverage Table of Contents CMS References LCDs and Billing and Coding Articles CMS MLN Matters® Certifying Physician/NPP Therapy Plan of [...]
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Posting Date: 01/25/2024
2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring
2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring As of 1/1/2024, physical and occupational therapists in private practice may provide general supervision of their therapy assistants when they don’t personally furnish [...]
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Posting Date: 02/17/2022
Common Questions and Answers
Outpatient OT and PT Services Billing Guide Common Questions and Answers Can a PTA treat a Medicare B patient in an outpatient setting with direct supervision by the physical therapist? Answer: Yes, however PTAs are limited in the [...]
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Posting Date: 10/07/2024
Medicare Physician Fee Schedule Database
Medicare offers several tools to help providers bill their services. Many questions you have can be answered by learning how to access and use the Medicare Physician Fee Schedule Database. We hope you'll join us for an overview of this database.
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Posting Date: 10/07/2024
Availability of the Essential Medicines Shortage List for the Recently Finalized Separate IPPS Payment for Establishing and Maintaining Access
Availability of the Essential Medicines Shortage List for the Recently Finalized Separate IPPS Payment for Establishing and Maintaining Access On Thursday, 8/1/2024, CMS issued the FY 2025 Medicare Hospital IPPS and LTCH PPS final rule. [...]
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