Skip to main content

Details are still emerging around exactly how CMS intends to walk back a decision to change coding methodologies that prevented PTs from billing an evaluation performed on the same day as therapeutic activities and/or group therapy activities. But we know a little more now: namely, that the decision is retroactive to January 1 of this year, the date when the short-lived system was set in place.

APTA pressed CMS for the logistics of how its do-over would be worked out as soon as its decision was announced on January 24. On January 28, CMS informed the association that while the agency is still working on its messaging to the Medicare administrative contractors, or MACs, the reversal will be extended to claims made from January 1, 2020, on.

The current state of flux leaves physical therapy providers with three basic options: delay submitting claims until after CMS gives the green light; resubmit claims denied because of the coding edits once the change is official; or appeal any claims denied due to the edits to the MAC, supplying supporting documentation.

APTA regulatory affairs staff will remain in communication with CMS on the change and share new information as it becomes available.


You Might Also Like...

News

Time To Defend the Profession: Add Your Voice in Opposition to Payment Cuts

Aug 11, 2020

We're making it easy to do your part to call for action against a proposed 9% Medicare payment cut. Momentum is building.

News

MIPS Performance Scores Now Available

Aug 07, 2020

CMS has released its MIPS scores for your 2019 performance, which could affect your payment in 2021.

News

APTA Presents "Project 11" Live Q&A Event

Jul 22, 2020

Two members of Alex Smith's care team will join Stephania Bell for a closer look at the powerful ESPN documentary.