Medicare Reverses Billing Restrictions

Your voice has been heard!

CMS has just announced some good news for rehab therapists.

At the start of the new year, we learned that Medicare had made changes to their billing combinations that were detrimental to providers. Their original announcement stated that Therapeutic Activities (97530) and Group Therapy (97150) were no longer allowed to be billed with Evaluation codes for Medicare claims. If these code combinations were billed together, Medicare would not reimburse the claims.

However, due to consistent public backlash, CMS has decided to reverse this restricting change.

  • Nothing has changed with the new requirement for Manual Therapy (97140). It will STILL require a 59 modifier when billed with an Evaluation code. We have automatically added the following CCI edits to all On-Site and Web databases.

  • Therapeutic Activities (97530) and Group Therapy (97150) CAN continue to be billed with Evaluation codes for Medicare claims. Medicare will be paying on these claims as they normally would.

It’s worth noting that CMS still hasn’t released exact details on when these reversals will officially go into effect and for what dates of service the original billing restrictions would apply to (if any).

If you have any questions or concerns on this matter, please do not hesitate to contact our support department.​

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