Happy New Year!!

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We made it to 2021! It certainly will be a fast-paced year in healthcare upcoming and I look forward to the return of our world to some type of normalcy. Whatever happens, we are in it together and will continue to be a company “where rehab is a team sport.”

Code Edits

There has been a lot of talk about CMS’s unfortunate decision to reinstate code edits that had been suspended the prior year. These code edits, limit certain CPT code combinations for billing on a given day. Many of these combinations now require a 59 modifier which indicates that the two procedures are separate and distinct. The good news is that Casamba has already loaded the edits (as of 1/1/21) and the modifier will automatically be used.

There are a few codes that cannot be used together on the same patient and the same date of services, as the 59 modifier does not apply. These include:

  • Re-evaluation (97164, 97168) combined with any of the following:
    • Evaluation code (97161-97163 and 97165-97167)
    •  Physical performance test 97750
    • Orthotic prosthetic management 97760
    • Assistive technology assessment 97755
  • Manual therapy 97140 with Massage 97124

Advocacy in 2021

The legislative fix to the physician fee schedule cuts looks like it will offset the 2021 cuts to therapy to some degree, but it’s important to remember that we are still being hit with a significant cut to reimbursement. Also concerning is the potential impact of the proposed 15% decrease in reimbursement for services provided by assistants, scheduled for 1/1/2022. We have lots of work to do! We know that our services are essential, effective and crucial for the population we serve. Now more than ever, we need to be focused on outcomes and advocacy. I will keep you updated throughout the year on opportunities to support your profession and your residents.

I am excited for all the opportunities that 2021 will bring and look forward to hearing your suggestions for the clinical department as well as your success stories.