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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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Site Updates

  • California Medicaid Outpatient Therapy Guidelines

    28 Jan 2022 10:17 AM | Zachary Edgar (Administrator)

    Guidelines for California's Medicaid coverage of physical, occupational and speech therapy services.  Including coverage, limitations, prescription requirements, prior authorization and documentation.  If the client is enrolled in a managed care plan some of the rules may be different.  If you need additional assistance please email us at info@therapycomply.com.

    Physical Therapy

    • Eligible Providers
    • Prescription Requirements
    • Covered Services
    • Prior Authorization
    • Claim Information

    PT Codes and Rates

    Speech Therapy

    • Eligible Providers
    • Coverage
    • Written Referral Requirements
    • Initial and Six-Month Evaluations
    • Required Professional Experience Services

    SLP Codes and Rates

    Occupational Therapy

    • Eligible Providers
    • Limitations
    • Prescription Requirement
    • Initial and Six-Month Evaluations
    • Claims

    OT Codes and Rates


  • Compliance Policies and Procedures

    19 Jan 2022 11:04 AM | Zachary Edgar (Administrator)

    We have recently added a number of new sample policies and procedures that can be easily adapted to any therapy practice.

    Visit at our Compliance Page. 

  • Tricare for PT/OT/SLP

    4 Jan 2022 9:05 AM | Zachary Edgar (Administrator)

    Tricare coverage of physical, occupational, and speech therapy.

    Provider Enrollment

    • Network and Non-Network Providers
    • Participating and Non-Participating Providers

    Billing

    • Claims
    • Directly Billing the Patient
    • Appeals

    Physical Therapy

    • CPT Codes Covered
    • Description
    • Coverage Criteria
    • Services Not Covered

    Physical Therapy Assistants

    • Qualifications
    • Scope of Practice
    • Supervision
    • Reimbursement
    • CQ Modifier
    • Services Not Covered

    Specific Services

    • Biofeedback
    • NMES Devices
    • Dry Needling
    • Negative Pressure Wound Therapy

      General Rehabilitation

      • Medical Necessity
      • Covered Services
      • Maintenance Programs
      • Rehabilitative Programs
      • Services Not Covered

      Telehealth

      Occupational Therapy

      • Covered Codes
      • Description
      • Prescription
      • Services Not Covered

      Occupational Therapy Assistants

      • Qualifications
      • Scope of Practice
      • Supervision
      • Reimbursement
      • CO Modifier
      • Services Not Covered

      Speech Therapy

      • Covered CPT Codes
      • Description of Services
      • Criteria for Coverage
      • Services Not Covered

      Prosthetics and Orthotics

      • Orthoses Splints and Braces
      • Prosthetic Devices and Supplies


      • January 2022 NCCI Edits for Outpatient Facilities

        27 Dec 2021 12:49 PM | Zachary Edgar (Administrator)

        PT/OT Evaluations and Re-evaluations

        • PT Eval; low complexity
        • PT Eval; med complexity
        • PT Eval; high complexity
        • PT Reevaluation
        • OT Eval; low complexity
        • OT Eval; med complexity
        • OT Eval; high complexity
        • OT Reevaluation

        Therapeutic Procedures

        • Therapeutic Exercise
        • Neuromuscular Reeducation
        • Aquatic Therapy
        • Gait Training
        • Massage Therapy
        • Therapeutic Intervention; 15 min
        • Therapeutic Intervention; add 15 min
        • Physical Medicine Procedure
        • Manual Therapy
        • Group Therapy
        • Therapeutic Activities
        • Sensory Integrative Techniques
        • Self-Care Management
        • Community/Work Integration
        • Wheelchair Management Training
        • Work Hardening

        Modalities

        • Biofeedback Modality
        • Biofeedback Training; initial 15 minutes
        • Biofeedback Training; each additional 15 minutes
        • Hot or Cold Packs
        • Mechanical Traction
        • Vasopneumatic Devices
        • Paraffin Bath
        • Whirlpool
        • Diathermy
        • Ultraviolet
        • Electrical Stimulation (manual)
        • Iontophoresis
        • Contrast Baths
        • Ultrasound
        • Hydrotherapy
        • Electrical Stimulation (unattended)
        • Electrical Stimulation (Non wound)

        Assessments and Orthotics/Prosthetics

        • Range of Motion Measurements
        • Range of Motion; hand
        • Canalith Repositioning
        • Cognitive Testing HC Pro
        • Physical Performance Test
        • Assistive Technology Assessment
        • Orthotic Management
        • Prosthetic Management
        • Orthotic/Prosthetic Management

        Wound Care

        • Removal Devitalized Tissue 20cm/<
        • Removal Devitalized Tissue addl 20 cm<
        • Wound Care (non-selective
        • Negative Press Wound tx < 50 cm
        • Negative Press Wound tx > 50 cm
        • Negative Press Wound tx </=50 sq cm
        • Negative Press Wound tx >50 cm
        • Low Frequency, Non-Contact, Ultrasound

        Speech Therapy

        • Treatment of Speech; individual
        • Treatment of Speech; group
        • Laryngeal Function Studies
        • Evaluation of Speech Fluency
        • Evaluation of Speech Sound Production
        • Evaluation of Speech with Evaluation of Language Comprehension
        • Behavioral and Qualitative Analysis of Voice and Resonance
        • Treatment of Swallowing Dysfunction
        • Evaluation for Use and/or Fitting of Voice Prosthetic Device
        • Evaluation for Prescription of Speech-Generating AAC Device; first hour
        • Evaluation for Prescription of Speech-Generating AAC Device;  30 minutes
        • Therapeutic Services for Use of Speech-Generating Device
        • Evaluation of Oral and Pharyngeal Swallowing Function
        • Motion Fluoroscopic Evaluation
        • Endoscopic Swallow Evaluation (FEES)
        • Laryngeal Sensory Testing
        • Flexible Fiberoptic Endoscopic Evaluation (FEESST)
        • Assessment of Aphasia


      • January 2022 NCCI Edits for Practitioners

        27 Dec 2021 12:40 PM | Zachary Edgar (Administrator)

        PT/OT Evaluations and Re-evaluations

        • PT Eval; low complexity
        • PT Eval; med complexity
        • PT Eval; high complexity
        • PT Reevaluation
        • OT Eval; low complexity
        • OT Eval; med complexity
        • OT Eval; high complexity
        • OT Reevaluation

        Therapeutic Procedures

        • Therapeutic Exercise
        • Neuromuscular Reeducation
        • Aquatic Therapy
        • Gait Training
        • Massage Therapy
        • Therapeutic Intervention; 15 min
        • Therapeutic Intervention; add 15 min
        • Physical Medicine Procedure
        • Manual Therapy
        • Group Therapy
        • Therapeutic Activities
        • Sensory Integrative Techniques
        • Self-Care Management
        • Community/Work Integration
        • Wheelchair Management Training
        • Work Hardening

        Modalities

        • Biofeedback Modality
        • Biofeedback Training; initial 15 minutes
        • Biofeedback Training; each additional 15 minutes
        • Hot or Cold Packs
        • Mechanical Traction
        • Vasopneumatic Devices
        • Paraffin Bath
        • Whirlpool
        • Diathermy
        • Ultraviolet
        • Electrical Stimulation (manual)
        • Iontophoresis
        • Contrast Baths
        • Ultrasound
        • Hydrotherapy
        • Electrical Stimulation (unattended)
        • Electrical Stimulation (Non wound)

        Assessments and Orthotics/Prosthetics

        • Range of Motion Measurements
        • Range of Motion; hand
        • Canalith Repositioning
        • Cognitive Testing HC Pro
        • Physical Performance Test
        • Assistive Technology Assessment
        • Orthotic Management
        • Prosthetic Management
        • Orthotic/Prosthetic Management

        Wound Care

        • Removal Devitalized Tissue 20cm/<
        • Removal Devitalized Tissue addl 20 cm<
        • Wound Care (non-selective
        • Negative Press Wound tx < 50 cm
        • Negative Press Wound tx > 50 cm
        • Negative Press Wound tx </=50 sq cm
        • Negative Press Wound tx >50 cm
        • Low Frequency, Non-Contact, Ultrasound

        Speech Therapy

        • Treatment of Speech; individual
        • Treatment of Speech; group
        • Laryngeal Function Studies
        • Evaluation of Speech Fluency
        • Evaluation of Speech Sound Production
        • Evaluation of Speech with Evaluation of Language Comprehension
        • Behavioral and Qualitative Analysis of Voice and Resonance
        • Treatment of Swallowing Dysfunction
        • Evaluation for Use and/or Fitting of Voice Prosthetic Device
        • Evaluation for Prescription of Speech-Generating AAC Device; first hour
        • Evaluation for Prescription of Speech-Generating AAC Device;  30 minutes
        • Therapeutic Services for Use of Speech-Generating Device
        • Evaluation of Oral and Pharyngeal Swallowing Function
        • Motion Fluoroscopic Evaluation
        • Endoscopic Swallow Evaluation (FEES)
        • Laryngeal Sensory Testing
        • Flexible Fiberoptic Endoscopic Evaluation (FEESST)
        • Assessment of Aphasia


      • Webinar Recordings for Yearly Members

        14 Dec 2021 10:00 AM | Zachary Edgar (Administrator)

        We have added a new section that allows yearly members to access recorded webinars with greater ease.  Webinar Recordings for Yearly Members. 


      • Congress Passes Law to Prevent Medicare Cuts

        11 Dec 2021 10:26 AM | Zachary Edgar (Administrator)

        Congress has officially passed legislation aimed at offsetting most of a planned 3.75% cut to the conversion factor under Medicare Part B. The changes also avert across-the-board budget cuts and delay the return of the 2% "sequester" reduction next year.

        The legislation was first passed by the House of Representatives on Dec. 7, with its companion bill approved in a 59-35 bipartisan vote in the U.S. Senate on Dec. 9.

        The bill sets out three major (but temporary) relief provisions:

        • CMS will receive a 3% appropriation for 2022 to partially offset its planned 3.75% cut to the conversion factor used to set payment for codes used by providers.
        • Implementation of a looming 4% across the board "pay as you go" cut mandated through budget rules will be postponed until 2023.
        • A temporary moratorium on the 2% Medicare sequestration cut required by law since 2011 as part a deficit spending mechanism will be continued through part of 2022. The moratorium will last until April, when a 1% sequestration will return, with the full 2% sequestration reduction beginning in July. Given that sequestration cuts are baked into the Medicare system, the temporary reprieve has amounted to a small payment increase for providers since the moratorium was put in place in 2020.


      • Arkansas Speech Therapy Scope of Practice

        23 Nov 2021 4:20 PM | Zachary Edgar (Administrator)

        Scope of Practice

        How is the practice of speech language pathology defined in Arkansas?

        “Speech-language pathology” means the application of principles, methods, and procedures for the measurement, testing, evaluation, prediction, counseling, instruction, habilitation, or rehabilitation related to the development and disorders of speech, voice, or language, and dysphagia for the purpose of evaluating, preventing, ameliorating, or modifying such disorders and conditions in individuals and groups of individuals.

        What is included in the practice of speech-language pathology?

        Providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up services for disorders of:

        • Speech (i.e., articulation, fluency, resonance, and voice including aeromechanical components of respiration);
        • Language (i.e., phonology, morphology, syntax, semantics, and pragmatic/social aspects of communication) including comprehension and expression in oral, written, graphic, and manual modalities; language processing, preliteracy and language-based literacy skills, including phonological awareness;
        • Swallowing or other upper aerodigestive functions such as infant feeding and aeromechanical events (evaluation of esophageal function is for the purpose of referral to medical professionals);
        • Cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions);
        • Sensory awareness related to communication, swallowing, or other upper aerodigestive functions.

        Establishing augmentative and alternative communication techniques and strategies including developing, selecting, and prescribing of such systems and devices (e.g., speech generating devices).

        Providing services to individuals with hearing loss and their families/caregivers (e.g., auditory training, speechreading, speech and language intervention secondary to hearing loss, visual inspection and listening checks of amplification devices for the purpose of troubleshooting, including verification of appropriate battery voltage).

        Screening hearing of individuals who can participate in conventional pure-tone air conduction methods, as well as screening for middle ear pathology through screening tympanometry for the purpose of referral of individuals for further evaluation and management.

        Using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy, computer technology) to observe, collect data, and measure parameters of communication and swallowing, or other upper aerodigestive functions in accordance with the principles of evidence-based practice.

        Selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication, swallowing, or other upper aerodigestive functions (e.g., tracheoesophageal prostheses, speaking valves, electrolarynges). This does not include sensory devices used by individuals with hearing loss or other auditory perceptual deficits.

        Collaborating in the assessment of central auditory processing disorders and providing intervention where there is evidence of speech, language, and/or other cognitive communication disorders.

        Educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decision making about communication, swallowing, or other upper aerodigestive concerns.

        Advocating for individuals through community awareness, education, and training programs to promote and facilitate access to full participation in communication, including the elimination of societal barriers.

        Collaborating with and providing referrals and information to audiologists, educators, and health professionals as individual needs dictate.

        Addressing behaviors (e.g., perseverative or disruptive actions) and environments (e.g., seating, positions for swallowing safety or attention, communication opportunities) that affect communication, swallowing, or other upper aerodigestive functions.

        Providing services to modify or enhance communication performance (e.g., accent modification, transgendered voice, care and improvement of the professional voice, personal/professional communication effectiveness).

        Recognizing the need to provide and appropriately accommodate diagnostic and treatment services to individuals from diverse cultural backgrounds and adjust treatment and assessment services accordingly.

        What is specifically excluded from the practice?

        N/A

        Are there any special trainings or requirements?

        N/A

        Reference

        A.C.A. § 17-100-103

        Ark Rules Board of Examiners in Speech-Language Pathology § 11


      • Medicare Therapy Documentation Changes

        13 Nov 2021 11:04 AM | Zachary Edgar (Administrator)

        Sample Audit Form - Can be used to audit outpatient therapy documentation. 

        General Documentation Requirements

        • Document Requirements
        • The Patient is under the Care of a Physician/NPP
        • Services Require the Skills of a Therapist
        • Services are of Appropriate Type, Frequency, Intensity and Duration 
        • Needs of the Patient
        • Dictated Documentation
        • Dates for Documentation

        Evaluations

        • When it is Appropriate for an Initial Evaluation
        • Contents of an Evaluation
        • When the Evaluation is the Only Service Provided
        • When the Evaluation Serves as the Plan of Care
        • Additional Assessments
        • Evaluations by Multiple Disciplines

        Plan of Care

        • Establishing the Plan of Care
        • Elements of the Plan of Care
        • Modifying the Plan of Care

        Certification and Re-certification of the Treatment Plan

        • What does it mean to have the plan of care certified?
        • Do I need an order/prescription/referral from a physician/NPP?
        • When does the POC need to be certified?
        • Is the initial treatment date when I began treating the patient or when I performed the evaluation?
        • How long do certifications last?
        • What happens if I can’t get the plan certified within ninety (90) days?
        • Do I need to submit additional evidence to justify the delay?
        • Who must certify the POC?
        • Which practitioners are not allowed to certify a plan of care?
        • Can I have the physician/NPP sign a document other than the POC?
        • Are verbal certifications acceptable?
        • When does the POC need to be recertified?
        • What happens if the recertification is delayed?
        • What happens if my claim is denied due to certification issues?

        Progress Reports 

        • Timing of the Progress Report
        • Content of the Progress Report
        • Clinician’s Participation in the Report
        • Assistant’s Participation in the Report

        Treatment Notes

        • Required Elements
        • Optional Elements
        • Additional Tips for Notes
        • Making Changes to the Note
        • Signature on the Note
        • Identification of the Supervisor

        Reevaluations

        • Who may Perform a Reevaluation?
        • Role of the Assistant
        • When can a Reevaluation be Performed?
        • Reimbursement
        • Content of the Reevaluation
        • Billing for a Reevaluation
        • Documentation

        Discharge Summary

        • What is Required in the Discharge Note?
        • Unanticipated Discharge
        • Optional Information

          Medicare Signature Requirements

          • Which outpatient therapy documentation requires and signature and who must sign?
          • What is required for a valid signature?
          • What if I use a scribe when documenting medical record entries?
          • How are orders treated differently than other medical documentation?
          • What should I do if I did not sign an order or medical record?
          • What if I signed the order or progress note but my signature is not legible?
          • What is a signature log?
          • What if I do not have a signature log in place?
          • Am I able to attest to my signature?
          • Do my signatures need to be dated?


        • Arkansas Occupational Therapy Scope of Practice

          2 Nov 2021 4:17 PM | Zachary Edgar (Administrator)

          How is the practice of occupational therapy defined in Arkansas?

          “Occupational therapy” means the evaluation and treatment of individuals whose ability to cope with the tasks of living is threatened or impaired by developmental deficits, the aging process, poverty or cultural differences, environmental or sensory deprivation, physical injury or illness, or psychological and social disability.

          What is included in the practice of occupational therapy?

          Occupational therapy treatment utilizes task-oriented activities to prevent or correct physical or emotional deficits or to minimize the disabling effect of these deficits in the life of the individual so that he or she might perform tasks normally performed at his or her stage of development.

          Specific occupational therapy techniques include, but are not limited to:

          • Instruction in activities of daily living, design, fabrication, application, recommendation, and instruction in the use of selected orthotic or prosthetic devices and other adaptive equipment;
          • Perceptual-motor and sensory integrative activities;
          • The use of specifically designed crafts;
          • Exercises to enhance functional performance; and
          • Prevocational evaluation and treatment.

          Services specifically excluded from the scope of practice

          N/A

          Are there any specific procedures or modalities regulated by the board?

          N/A

          Reference

          AR Code § 17-88-102

        About Me

        Zachary Edgar JD, LLM is Therapy Comply's managing partner.  Zachary is a healthcare attorney who specializes in federal and state healthcare regulatory issues particularly for physical, occupational, and speech therapy practices.  

        Learn More 

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