Grassi Healthcare | E-Alert: 2018 Rehab & Prolonged Services Changes
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E-Alert: 2018 Rehab & Prolonged Services Changes

Are you getting denials for your rehab prosthetic & orthotic services?  

For 2018, the (CPT) Editorial Panel revised the set of codes physical and occupational therapists use to report orthotic and prosthetic management and training services by differentiating between initial and subsequent encounters.
New code descriptions to differentiate initial encounters vs. subsequent encounters have been added. CPT codes 97760 and 97761 now contain the wording “initial” and a new CPT code for 2018, 97763, has been added to describe all subsequent encounters for orthotics and/or prosthetics management and training services. CPT code 97762 has been deleted.
97760 – Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes)

97761 – Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes)

97763 –  Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minute

Make sure to update your code sets and train providers on the distinction to avoid claims denials and/or revenue take-backs at a future date.

Cognitive Therapy Gets Some Changes

The CPT Editorial Panel also created CPT code 97127 – Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact to replace/delete CPT code 97532. Medicare, however, replaced this with a timed service code in the MPFS with G0515 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact—each 15 minutes.
For Medicare services, HCPCS code G0515 is designated as a “sometimes therapy” code. This means that when the service is provided by a PT, OT, or SLP under a therapy plan of care, you must append the appropriate GO, GP or GN modifier to reflect the service is being delivered by a physical, occupational or speech language therapist plan of care. The modifier is always required when this service is furnished by therapists; and, when it’s furnished by or incident to physicians and certain Nonphysician Practitioners (NPPs), e.g. nurse practitioners, physician assistants, and clinical nurse specialists services. G0515 may sometimes be reported by physicians, NPPs, and psychologists without a therapy modifier when it is furnished directly by these providers and outside an SLP, OT, or PT plan of care.

Prolonged Preventive Services, CMS has Added New Codes for Preventive Services that exceed the Typical Time for Care

G0513 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service first 30 minutes (list separately in addition to code for preventive service)
G0514 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service)
New codes have been added to the MFPS for use with Medicare covered Preventive Medicine Services. The codes are to be used as an add-on code when the typical time required to provide an approved PM service has been exceeded. A list of the CMS approved preventive medicine codes can be found here.

For more information, contact Stephanie Fiedler, CPC, ACS-EM, Director, Revenue Advisory Services, Grassi Healthcare Advisors, LLC, at