Medicare Coding & Billing

Information and resources on Medicare coding and billing. If you have questions about this information, contact advocacy@apta.org.

General Information

• CMS: Medicare Coverage Database
• CMS: Beneficiary Notices Initiative
• CMS: Therapy Services Overview
• Comparison of Cotreatment Requirements in Physical Therapy Settings (.pdf)
• Comparison of Requirements in Outpatient Settings (.pdf)
• Functional Limitation Reporting under Medicare
• Podcast: How Codes are Valued for Medicare Payment
• APTA Summary of the Revisions to the Medicare Benefit Policy Manual (.pdf) - 5/2011
• APTA Summary of the Correct Coding Initiative (CCI)

2013 Medicare Therapy Cap

• FAQ: 2013 Medicare Therapy Cap
• 2013 Medicare Changes: January 2013

Manual Medical Review

• Manual Medical Review Complaint Form

  If you are experiencing issues with the Medicare therapy cap exceptions process for 2012 or other issues related to the therapy cap and you have been unable to resolve your issues by contacting your Medicare Administrative Contractor (MAC), you may complete this complaint form. APTA staff will contact you within two business days using the information in the form to help you resolve your issue.

• Manual Medical Review Information for MAC Websites (.pdf) - 9/17/12
• CMS: Medicare Administrative Contractor Contact List

Additional Therapy Cap Resources

• APTA Comments on MedPAC Report on Outpatient Services in Medicare, Including Therapy Cap and MPPR (.pdf) - 10/9/12
• Video: 2012 Outpatient Therapy Cap Webinar - 9/11/12
• APTA Comments on MedPAC Report on Outpatient Services in Medicare (.pdf) - 9/10/12
• Podcast: Heard on the Hill: 2012 Medicare Therapy Cap Update - 8/28/12
• Medicare Therapy Cap Exceptions Process: CMS Fact Sheet (.pdf) - 8/2/12
• Medicare Therapy Cap Exceptions Process: CMS FAQ (.pdf) - 8/2/12
• APTA Comments on Medicare Therapy Cap MedPAC Meeting (.pdf) - 3/13/12
• President Signs Legislation Inclusive of Medicare Payment Cut Reprieve and Therapy Cap Exceptions Process Extension - 2/23/12

Rules & Settings

• ICD-10
• Medicare Physician Fee Schedule
• Medicare Payment and Policies for Home Health
• Medicare Payment and Policies for Hospitals
• Medicare Payment and Policies for Skilled Nursing Facilities (SNFs)

• Last Updated: 1/2/2013
• Contact: advocacy@apta.org
• = Members Only