State Specific Medical Coding Resources

articles, webinars, links, files and other resources for state specific coding, reimbursement and compliance


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recent articles

Select the title to see a summary and a link to the full article.

More Telehealth Changes Announced by CMS

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On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). See this article for further information as well as references & links to CMS information

tags  Topic: Coding    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: HCPCS Coding    Topic: Medicaid    Topic: Medicare    Topic: Modifier Coding    Topic: Procedure Coding    Topic: TeleMedicine   

CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes

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Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly.  Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...

tags  Specl: Chiropractic    Specl: Home Health|Hospice    Specl: Pain Management    Specl: Physical Medicine|Physical Therapy    Specl: Podiatry    Specl: Skilled Nursing    Topic: CPT Coding    Topic: Modifier Coding   

COVID-19 Chiropractic Resources

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COVID-19 Chiropractic Resources contains current, updated information regarding COVID-19. Included are lists of webinars, articles, websites and links pertaining to the ongoing changes.

tags  Specl: Chiropractic    Topic: Medicare    Topic: TeleMedicine   

Spotlight: UCR Fees are Available on DRGs- Check it Out!

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Check out the information page on any DRG! Look up DRGs by going to the list of DRG codes found under the Codes tab at the top of the page, or simply type in the desired DRG by using the search bar on the homepage. When using the search bar, be sure you have the ...

tags  Topic: Fees   

Providing Telehealth Services During COVID-19 Crisis

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The rules for providing telehealth services during this pandemic have changed and some requirements have been waived. Please keep in mind that “waiving requirements” does not mean that anything goes. Another important consideration is that Medicare and private payers may likely have different rules so you need to make sure that you know individual payer requirements during this time.

tags  Topic: CPT Coding    Topic: HCPCS Coding    Topic: Modifier Coding   

Interprofessional Consult Services

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The recent coronavirus crisis has brought non-face-to-face services to the forefront of coding and billing conversations. With the entire healthcare industry focused on caring for patients during an unprecedented and fast-moving pandemic, the goal of increasing patient access while reducing the risk of spreading infection has become paramount. In this climate, ...

tags  Topic: CPT Coding   

2020 Medicare Part D Coverage Gap (AKA donut hole)

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Not every Medicare drug plan has complete coverage for prescription drugs - most have some sort of coverage gap, known as the “Donut Hole”. The coverage gap is a temporary limit on coverage under the drug plan. This coverage gap will not affect everyone and begins after you have used ...

tags  Payer: CMS|Medicare    Topic: Pharmaceutical   

Medicare Part D Coverage Gap (Donut Hole) Closes in 2020

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Overview of the Part D coverage gap, how it got closed, what the picture looks like for 2020, and long-term outlook.

tags  Payer: CMS|Medicare    Topic: Medicare    Topic: Pharmaceutical   

New Biofeedback Codes to replace 90911 Eff 2020-01-01

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CMS announced 90912 and 90913 are to be used starting January 2020 in place of 90911. According to CMS MLN, these new codes, designated as “sometimes therapy”, are reported to furnish these services outside a therapy plan of care when appropriate. Codes are permitted to be used by physicians and Non-Physician Practitioners (NPPs), ...

tags  Specl: Acupuncture|Alternative    Specl: Physical Medicine|Physical Therapy    Topic: CPT Coding   

LATEST COVID-19 INFORMATION FOR BILLING NON-FACE-TO-FACE SERVICES

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Healthcare providers and the population at large are concerned about safe access to care considering the COVID-19 pandemic. As a result, we have received many inquiries this week about how to bill for “telehealth” services. Let’s first address that true telehealth services have some pretty stringent requirements from CMS, including that ...

tags  Specl: Internal Medicine    Specl: Pediatrics    Specl: Primary Care|Family Care    Topic: CPT Coding    Topic: HCPCS Coding   

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