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 […]
UHC Medicare Advantage plans will require prior authorization for outpatient PT and OT for DOS on and after September 1, 2024.
The following is a link to the UHC announcement: https://www.uhcprovider.com/en/resource-library/news/2024/outpatient-therapy-chiropractic-prior-auth.html?cid=em-providernews […]
The NC Department of Health and Human Services has modified its policy regarding prior authorization of PT/OT for patients who are 21 or over. Please note that this change will not affect authorizations for patients covered by managed Medicaid plans.
This modification is in Section 5.4 […]
About one year ago, UHC issued a policy requiring that daily notes include time in and out for commercial patients. (You should note that UHC Medicare Advantage plans follow Medicare documentation requirements.)
UHC has revised its policy for commercial patients so that time in and out is no […]
We help recruit dozens of physical therapists each year. In far too many cases, therapists are subject to agreements that restrict where they can work after termination of employment with their current practice. For example, a therapist may be prohibited from working within a 15-mile radius of […]
UHC has issued an updated PT/OT policy that applies to its commercial and exchange members and is effective as of July 1, 2023. This policy can be found at https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/habilitative-services-outpatient-rehabilitation-therapy […]
CMS’s policy for missed appointment charges can be found in the Medicare Claims Processing Manual, Chapter 1, Section 30.3.13.
CMS’s policy is to allow providers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries but also charge […]
Payment rates
Medicare pays for re-evaluations at a rate that is about 2X a timed treatment code. Commercial and work comp payment rates are generally in proportion to Medicare rates.
The Washington State legislation recently passed an amendment to the Physical Therapy Act allowing physical therapists (PTs) to provide dry needling (DR) on and after July 23, 2023. The requirements for providing DR are relatively burdensome. The following is a summary of the law which can be found […]
CMS has started to pay for remote therapeutic monitoring (RTM) by physical and occupational therapists. RTM allows for monitoring of HEP compliance, therapy response and pain level. So, Medicare will now pay therapists for remotely monitoring and managing a patient’s HEP.
CPT Codes. PTs and […]
The following is a summary of current NC PT Board position statements regarding clinical matters. The complete position statements can be found at https://www.ncptboard.org/app/LandingPages/ScopeOfPracticeHome.php
