NC Medicaid Simplifies Authorization of Therapy for Adults
North Carolina Medicaid has recently simplified its PT/OT authorization rules for patients who are 21 and older. https://files.nc.gov/ncdma/documents/files/10-A_3.pdf All of the prior rules limiting the number of visits […]
The following discussion is intended to help PT/OT providers choose when using 97530 is appropriate with documentation examples.
The CPT definition of 97530 is “[t]herapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes […]
Which standardized tests are recommended for patients who are non-ambulatory?
The standardized assessment should support the treatment plan and demonstrate achievement of the goals. Listed below are standardized tests that can be used for low level functioning patients.
Sitting Balance Scale – This test assesses the […]
North Carolina Medicaid Therapy Visit Limits for 2018
The following is an update on NC Medicaid therapy visit limitations for patients over 20 years old. These limits are from DMA Clinical Coverage Policy No: 10A (amended 12/15/2017). Medicare Cap
Medicaid patients who are over […]
PTAs and COTAs will soon be able to treat Tricare patients.
A new law has been enacted instructing the Department of Defense to add PTAs and COTAs to its list of permitted providers. Please note that this […]
The following changes to the orthotic and prosthetic management codes will be effective as of January 1, 2018:
• Both 97760 and 97761 are revised so that they can only be used for the initial encounter. The new descriptions […]
Supervised Exercise Therapy Approved for Medicare Patients with PAD, Medicare Guidelines For Physical Therapy
CMS has recently concluded that supervised exercise therapy improves health outcomes for Medicare patients with intermittent claudication due to peripheral artery disease (PAD) and the this exercise therapy is at least […]
As we approach the latter months of this year, this is a reminder of how the Medicare therapy cap rules apply during 2017.
Regular Medicare Therapy Cap. The annual Medicare therapy cap is $1,980 for 2017. As in past years, the cap for physical and speech […]
June 2017
CMS has very specific documentation requirements that apply to typical off-the-shelf and custom orthotics and other “DME” supplied by orthopaedic groups and hand therapy practices. DME carriers are auditing claims and specifically requesting this documentation.
Whenever a Medicare provider supplies and bills for DMEPOS […]
The following is a detailed explanation of the “in-office ancillary services” exception in the Stark Rules.
Statutory Background
Section 1877 of the Social Security Act, which is commonly referred to as the “Stark Rules,” was enacted in 1989. As originally enacted, the Stark Rules […]
