AHA Coding Clinic® for HCPCS - 2013 Issue 1; For your Information

New HCPCS codes for "sometimes therapy"

Medicare pays separately for therapy services. Two of the designations that are used for therapy services by Medicare are: “always therapy” and “sometimes therapy.” An “always therapy” service must be performed by a qualified therapist under a certified therapy plan of care, and a “sometimes therapy” service may be performed by an individual outside of a certified therapy plan of care. Under the OPPS, separate payment is provided for certain services designated as “sometimes therapy” services if these services are furnished to hospital outpatients as a non-therapy service, that is, without a certified...

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