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Disclaimer

The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Medicare

Welcome to Therapy Comply's Medicare page.  Here we have detailed information on the coverage of physical and occupational therapy services under the Medicare program.  We also include information on Medicare appeals, Advanced Beneficiary Notice of Noncoverage (ABNs), the Merit-Based Incentive Payment System (MIPS), enrollment,  and home health. 

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Outpatient Physical and Occupational Therapy Services

  • Criteria for Outpatient Rehabilitation Services
  • Assistants, Aides, and Students
  • CQ and CO Modifiers
  • Billing and Coding

Telehealth (Covid-19)

  • Codes Allowed for Telehealth
  • Rules for Medicare Telehealth
  • Documentation

Medicare Enrollment

  • Occupational Therapists in Private Practice
  • Physical Therapists in Private Practice
  • Site Visits for Physical Therapy Practices
  • Effective Enrollment Date and Retroactive Billing

Medicare Appeals

  • Levels of Appeals and Time Limits for Filing
  • Good Cause for Late Filing
  • Decisions Subject to Appeal
  • Who may File an Appeal
  • Representatives - Representing your patient
  • Levels of Appeals
  • Medicare Advantage Appeals

Merit-Based Incentive Payment System (MIPS)

  • Eligibility Criteria
  • Quality Measures of PT and OT
  • Improvement Activities 

Documentation Requirements for Therapy Services
    • General Documentation Requirements
    • Evaluations and Re-Evaluations
    • Plan of Care
    • Certification and Re-certification of the Treatment Plan
    • Progress Reports 
    • Treatment Notes 
    • Discharge Note 
    • Medicare Signature Requirements 
    • Audit Charts

Specific Therapy Services

  • National Coverage Determinations
  • Therapeutic Procedures
  • Modalities
  • Casting and Strapping
  • Speech Therapy Services

Practice Settings

  • Private Practice
  • Home Health
  • Outpatient Rehab
  • Inpatient Rehab
  • CORFs
  • Skilled Nursing Facilities
  • Hospitals

Advanced Beneficiary Notice of Noncoverage (ABN)

  • ABN Form and Instructions
  • ABN Preparation Requirements
  • ABN Notice and Delivery
  • Triggering Events
  • When it is Mandatory to Issue an ABN
  • When it is Voluntary to Issue an ABN
  • Issuing the ABN
  • Routine Notice Prohibitions and Exceptions
  • ABN Modifiers


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