BC Advantage - 2017 Issue 5
Calendar Year 2017 – Changes to PT & OT
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Article Overview
This article reviews calendar year 2017 updates affecting physical therapy and occupational therapy billing. It is intended for coding, compliance, and revenue cycle professionals who need a broad understanding of Medicare outpatient therapy changes, including revised evaluation and re-evaluation coding structure, required modifiers, therapy cap-related thresholds, and related documentation and review considerations.
Why This Topic Matters
Therapy coding and Medicare outpatient limits affect claim accuracy, documentation, and patient financial responsibility. Understanding the scope of these changes helps practices and facilities stay aligned with current billing requirements and avoid unnecessary claim issues.
Article Sections
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Physical Therapy evaluation and re-evaluation changes
Covers the update to physical therapy evaluation and re-evaluation coding for the calendar year 2017 timeframe. The section focuses on the shift from older code structure to a more detailed approach and notes related modifier requirements.
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Occupational Therapy evaluation and re-evaluation changes
Summarizes occupational therapy coding updates for evaluation and re-evaluation services. The section also notes the associated modifier requirement and the removal of an older code.
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Medicare therapy caps and related review processes
Discusses outpatient therapy cap amounts, patient cost-sharing considerations, and the threshold associated with additional review activity. It also mentions exceptions, documentation, and applicability across certain facility settings.
What You Will Learn
- How the article frames the 2017 outpatient therapy coding updates
- Which therapy service areas are discussed
- What general Medicare cap and threshold topics are covered
- What broad compliance and documentation considerations are highlighted
Who Should Read This
- Medical coders
- Outpatient therapy billers
- Compliance staff
- Revenue cycle professionals
- Therapy practice administrators
Codes Discussed
Modifiers Discussed
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