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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.  Wee also include information on Medicare appeals, Advanced Beneficiary Notice of Noncoverage (ABNs), the Merit-Based Incentive Payment System (MIPS), enrollment,  National Correct Coding Initiative (NCCI), and home health. 

Medicare Forum - Open forum for members and non-members to ask questions about Medicare therapy services.


Guide to the New PTA/OTA Modifiers

  • Who must use the new modifiers
  • Determining when to use the modifiers
  • How to use the modifiers with timed codes
  • How to use the modifiers with untimed codes
  • Treatment Notes

2020 Annual Update to the Therapy Code List 

Medicare Outpatient Physical and Occupational Therapy Services

  • Criteria for Outpatient Rehabilitation Services
  • Documentation Requirements for Therapy Services
  • Assistants, Aides, and Students
  • Coverage of Specific Modalities and Therapeutic Procedures
  • National Coverage Determinations for Therapy Services
  • KX Modifier
  • Targeted Medical Review Process
  • Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services

    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
    • Level 1: Redetermination
    • Level 2: Reconsideration
    • Level 3: Administrative Law Judge (ALJ) Hearing
    • Level 4: Appeals Council Review
    • Level 5: Judicial Review
    • Medicare Advantage Appeals


    Medicare Enrollment


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


    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

    Merit-Based Incentive Payment System (MIPS)

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

    National Correct Coding Initiative 

    • Policy for Physical Medicine and Rehabilitation - January 1, 2020
    • PTP Hospital Edits (For therapists)
    • PTP Practitioner Edits (If therapy services are performed by a physician)
    • Guides

    Home Health Therapy Services 


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