Medicare’s 2019 physician fee schedule changes affecting PT/OT include:
• KX Modifier: Although the therapy cap was repealed as of 1/1/18, the KX modifier is still required. For 2019, the KX modifier will need to be added to claims above $2 […]
Medicare’s 2019 physician fee schedule changes affecting PT/OT include:
• KX Modifier: Although the therapy cap was repealed as of 1/1/18, the KX modifier is still required. For 2019, the KX modifier will need to be added to claims above $2 […]
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 […]
The U. S. Office of Inspector General just released a report on Medicare PT claims. (Link to OIG Report) The purpose of the OIG’s review was to determine the extent of PT claims that do not comply with Medicare requirements. This review covered claims from July 1 […]
The two most important PT/OT documentation requirements are demonstrating that care is (1) medically necessary and (2) skilled.
Care is regarded as “skilled” only if it is at a level of complexity and sophistication that requires the services of a therapist or an assistant supervised by a […]
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 […]
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