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MEDICARE WILL PAY FOR E-VISITS BY PHYSICAL AND OCCUPATIONAL THERAPISTS

March 18, 2020
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March 2020

On
March 17, 2020, CMS issued guidance stating that Medicare will pay for PT/OT
e-visits. (This CMS guidance can be found at https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.)

This
CMS guidance explains that there […]

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New KV and J5 Medicare Modifiers for Off-the-Shelf Back and Knee Braces

April 27, 2021
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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 […]

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Cigna Updates Its PT Coverage Policy

April 7, 2021
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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 […]

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2021 Outpatient PT/OT Modifiers

January 21, 2021
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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 […]

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When to Charge for a PT/OT Re-evaluation

December 7, 2020
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We often receive questioned as to when a re-evaluation is necessary (and billable). Therapists are understandably uncertain as to when a re-evaluation can be billed because of conflicting terminology and confusion with “reassessment” requirements in PT and OT Acts.

To determine if and when a re […]

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Fall Prevention Awareness Week

September 8, 2020
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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 […]

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TRICARE POLICIES RE PAYMENT FOR TENS AND DRY NEEDLING

June 3, 2020
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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 […]

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New Tricare PTA/COTA Payment and Other Policies April 2020

April 28, 2020
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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 […]

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HOW TO EVALUATE AND TREAT PT PATIENTS VIA TELEHEALTH

April 16, 2020
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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 […]

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GETTING PAID FOR PT/OT TELEHEALTH AND E-VISITS

April 7, 2020
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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 […]

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TRICARE WILL START PAYING FOR PTA AND COTA SERVICES March 2020

March 18, 2020
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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 […]

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