It may sound like something out of a sci-fi movie, but hyperbaric oxygen (HBO) therapy is real. It involves breathing pure oxygen in a pressurized room or tube, and it has long been used to treat decompression sickness from scuba diving. More recently, physicians have found it useful to treat other conditions. Medicare Coverage under […] AAPC Knowledge Center
Hi! I just read something that stated that the Medicare therapy caps were REPEALED when President Trump signed the budget extension bill (through March 23rd) last week. Can anyone give me any information on this? Does it take effect immediately? And is it permanent, or might it change when we get a permanent budget signed into law? Thanks for your help!
Good Morning, Does anyone have any information on billing for Functional Restoration Programs in New York? I believe the program is for chronic pain where surgery is not an option -Are PT’s allowed to do this? What CPT codes are used? Any help is appreciated! Thanks
I work for a pediatric therapy clinic. We have a new patient scheduled for speech therapy, who is transferring from another clinic (not affiliated with ours). They did the initial eval in June. Can we bill a new eval, since the patient is new to us?
CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing. Several Medicare legislative provisions affecting health care providers and beneficiaries recently expired, including exceptions to the outpatient therapy caps, the Medicare physician work geographic adjustment floor, add-on payments for ambulance services and home health rural services, payments for low volume hospitals, and payments for Medicare dependent hospitals. CMS is implementing these payment policies as required under current law.
For a short period of time beginning on January 1, 2018, CMS took steps to limit the impact on Medicare beneficiaries by holding claims affected by the therapy caps exceptions process expiration. Only therapy claims containing the KX modifier were held; claims submitted with the KX modifier indicate that the cap has been met but the service meets the exception criteria for payment consideration. During this short period of time, claims that were submitted without the KX modifier were paid if the beneficiary had not exceeded the cap but were denied if the beneficiary exceeded the cap.
Starting January 25, 2018, CMS will immediately release for processing held therapy claims with the KX modifier with dates of receipt beginning from January 1-10, 2018. Then, starting January 31, 2018, CMS will release for processing the held claims one day at a time based on the date the claim was received, i.e., on a first-in, first-out basis. At the same time, CMS will hold all newly received therapy claims with the KX modifier and implement a “rolling hold” of 20 days of claims to help minimize the number of claims requiring reprocessing and minimize the impact on beneficiaries if legislation regarding therapy caps is enacted. For example, on January 31, 2018, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 11. Similarly, on February 1, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 12, and so on.
Reaffirm your knowledge of ICD-10-CM codes and the more specific E/M PT/OT codes introduced in 2017. Coding for physical and occupational therapy (PT and OT) requires an understanding of ICD-10-CM guidelines, and a firm knowledge on how to bill units of timed and untimed therapy CPT® codes. ICD-10 Considerations In therapy encounters, there is often […] AAPC Knowledge Center
Is anyone having any issues with Aetna Medicare reimbursing for G0283. We keep getting denials and they are stating that it is due to the LCD 35222 stating that the DX is not covered and we have used several DX that should be covered. When we look up LCD 35222 it doesn’t give us much information.