The following only applies if your physician or PT/OT practice is providing off-the-shelf back or knee braces.
Original Medicare patients who live in or travel to a competitive bidding area (CBA) and are prescribed off-the-shelf (OTS) back braces or OTS knee […]
CIGNA has issued an updated PT/OT coverage policy which can be found at:
https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_Future/CPG135_Physical_Therapy.pdf
This policy provides that CIGNA will not pay for:
Infrared
Vaso
Work hardening
H-Wave
Dry needling
Taping
Laser
This policy also […]
2021 Outpatient PT/OT Modifiers
The table below shows which PT/OT modifiers are required by specific payers for 2021. For example, traditional Medicare requires the KX, GP, GO, CQ and CO modifiers while UHC only requires the GP and GO modifiers.
The threshold for the […]
Fall Prevention Awareness Week
Falls fundamentally alter the shape
and nature of an older person’s life. Among older adults, falls are the leading
cause of hospital admissions for trauma and death from injury. Notably, there
are two aspects of falls that strike intimidatingly in the […]
June 3, 2020
Tricare
has recently made the following announcements regarding its TENS and dry
needling payment policies.
TENS
Effective
June 1, 2020, TRICARE will no longer cover transcutaneous electrical nerve
stimulation (TENS) for the treatment of acute, subacute, and chronic low back
pain (LBP). Health […]
TRICARE has published its new policies regarding payment for
PTA/COTA services and related matters.
The PTA policy can be found at : https://manuals.health.mil/pages/DisplayManualHtmlFile/TP15/62/AsOf/TP15/C11S3_16.html
The COTA policy, which is a mirror of the PTA policy, can be
found […]
Questions and Answers
The following are questions
submitted in connection with the April 2 webinar titled “How to Evaluate and
Treat PT Patients via Telehealth” with answers.
What are the ranges for self-pay telehealth
sessions? $50-$125
per session; pricing should reflect value […]
Questions and Answers
The following are questions
submitted in connection with the April 2 webinar titled “Getting Paid for PT/OT
Telehealth and E-Visits” with answers.
I am at a hospital-based outpatient therapy
clinic at a critical access hospital. Is there […]
On March 17, 2020, the Department
of Defense published final regulations stating that TRICARE will start paying
for PTA and COTA services for dates of service on and after April 17, 2020.
TRICARE will be following
Medicare supervision rules. So, a physical therapist needs to be in the […]
Physical
and occupational therapists are included in the types of providers required to
participate in CMS’s Quality Payment Program and report Merit-Based Incentive Payment
System (“MIPS”) measures.
The
following FAQs address how inclusion of PTs and OTs for the 2020 reporting year
impacts physician groups and […]
