PENNSYLVANIA SUSPENDS NURSING RENEWAL REQUIREMENTS

The Department of State has suspended certain requirements for nurses, including temporarily extending license expiration dates and waiving fees during the coronavirus outbreak.

This also means that:

  1. Temporary nursing practice permits and graduate permits will be extended beyond one year and extension fees will be waived.

  2. Registered Nurses will not have to apply for extensions of their RN graduate or temporary permits. All temporary and graduate permits that would normally expire during the next 90 days will be automatically extended for an additional 90 days.

  3. Practical Nurses will not have to apply for extensions of their PN graduate or temporary permits. All temporary and graduate permits that would normally expire during the next 90 days will be automatically extended for an additional 90 days.

  4. Registered Nurses, Certified Registered Nurse Practitioners (CRNPs) and Certified Nurse Specialists (CNS) can continue to care for patients if their licenses are currently “in renewal” and set to expire on April 30, 2020. These licenses will be extended for an additional three months until July 31, 2020.

PHYSICAL THERAPY, OCCUPATIONAL, SPEECH BILLING FOR TELEMEDICINE

When a PT/OT/ST is going to perform telehealth services, use the following CPT codes

and append CR modifier.  It may also need a 95/GT/GQ based on the payer, the billing side will determine that once we receive your claim. 

As per CMS’s latest update, PTs, OTs, and SLPs can bill Medicare (and receive payment) for the following telehealth services:

G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes


G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes


G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.”

Modifier CR
The CR modifier—which indicates that services are catastrophe/disaster-related—is mandatory when billing Medicare using the CPT codes for COVID-19-related E-Visits, which were recently made available to rehab therapists. (These codes are defined in the “Updated Coverage of Rehab Therapy Telehealth” subsection below.) This modifier is reserved for claims for which Medicare Part B payment is conditioned directly or indirectly on presence of a “formal waiver” like the one issued in response to COVID-19. It should be used for qualifying Part B items and services related to both institutional and non-institutional billing. (For reference, non-institutional billing includes claims—either a CMS-1500 paper claim form or an ANSI ASC X12 837P electronic claim—submitted by physicians and other suppliers.)

New Therapy Modifiers for PTAs and COTAs

Effective 1/1/20, if more than 10% of a visit is provided by a PTA or COTA - we must append the CQ or CO modifier to all lines for Medicare patients.

It is anticipated that by 2021, lines with the appended CQ or CO modifier will be reduced by up to 8%
CQ modifier: Outpatient physical therapy services furnished in whole or in part by a
physical therapist assistant.


CO modifier: Outpatient occupational therapy services furnished in whole or in part
by an occupational therapy assistant.


NEW PHYSICAL THERAPY G REPORTING CODES FOR 2020

For all PT providers who are required to report G reporting codes on PT evaluation, please be aware that there were codes that were discontinued and new codes added.

Please find full list here: https://hcpcs.codes/new-codes/ 

Please review and familiarize yourself with the new changes and start applying them immediately on your charges for PT evals to Medicare. 
01/01/2020

G8649

Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Code Discontinued01/01/2020

G8650

Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the knee fs prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code01/01/2020

G8653

Risk-adjusted functional status change residual scores for the hip impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Code Discontinued01/01/2020

G8654

Risk-adjusted functional status change residual score for the hip impairment not measured because the patient did not complete the fs intake survey on admission and/or follow up fs status survey near discharge, reason not given
Change in short description of procedure code01/01/2020

G8657

Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Code Discontinued01/01/2020

G8662

Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the low back fs prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code01/01/2020

G8665

Risk-adjusted functional status change residual score for the shoulder impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Code Discontinued01/01/2020

G8666

Risk-adjusted functional status change residual score for the shoulder impairment not measured because the patient did not complete the shoulder fs prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code01/01/2020

G8669

Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Code Discontinued01/01/2020

G8670

Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the elbow/wrist/hand fs prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code01/01/2020

G8673

Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
Code Discontinued01/01/2020

G8674

Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the general orthopedic fs prom at initial evaluation and/or near discharge, reason not given
Change in long description of procedure or modifier code01/01/2020

G8861

Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
Code Discontinued01/01/2020

G8978

Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G8979

Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G8980

Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G8981

Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G8982

Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G8983

Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G8984

Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G8985

Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G8986

Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G8987

Self care functional limitation, current status, at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G8988

Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G8989

Self care functional limitation, discharge status, at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G8990

Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G8991

Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G8992

Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G8993

Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G8994

Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G8995

Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G8996

Swallowing functional limitation, current status at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G8997

Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G8998

Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G8999

Motor speech functional limitation, current status at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G9017

Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
Code Discontinued01/01/2020

G9018

Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project)
Code Discontinued01/01/2020

G9019

Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project)
Code Discontinued01/01/2020

G9020

Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
Code Discontinued01/01/2020

G9033

Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project)
Code Discontinued01/01/2020

G9034

Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project)
Code Discontinued01/01/2020

G9035

Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project)
Code Discontinued01/01/2020

G9036

Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project)
Code Discontinued01/01/2020

G9158

Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G9159

Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G9160

Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G9161

Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G9162

Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G9163

Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G9164

Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G9165

Attention functional limitation, current status at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G9166

Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G9167

Attention functional limitation, discharge status at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G9168

Memory functional limitation, current status at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G9169

Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G9170

Memory functional limitation, discharge status at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G9171

Voice functional limitation, current status at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G9172

Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G9173

Voice functional limitation, discharge status at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G9174

Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals
Code Discontinued01/01/2020

G9175

Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued01/01/2020

G9176

Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting
Code Discontinued01/01/2020

G9186

Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Code Discontinued

New SI injections codes for 2020

Please be advised there are several new SI coding injections available for 2020

Please be clear in your notes, requests for prior authorization, and fee slips to differentiate the below services.

27096 - Injection, procedure for sacroiliac joint, anesthetic agents and/or steroid; with image guidance (i.e. fluoroscopy)

(Fluoro and DUS will bundle) 

Anticipated average pricing:  In Office $166.37 / Outpatient $86.25

64451 Injection, anesthetic agents and/or steroid; nerves innervating the sacroiliac joint, with image guidance (i.e. fluoroscopy)

(Fluoro and DUS will bundle)  

  Anticipated average pricing:  In Office $216.18 / Outpatient $82.65  
64454 - Injection, anesthetic  agents   and/or steroid; genicular nerve branches, including imaging guidance when performed (Fluoro and DUS will bundle)      Anticipated average pricing:  In Office $218.34 / Outpatient $85.1764624 - Destruction by neurolytic agent (Genicular RFA), genicular nerve branches including imaging guidance, when performed.  (Fluoro and DUS will bundle)   Anticipated average pricing:  In Office $417.56 / Outpatient $152.66  64625 - Radiofrequency ablation (SI RFA), nerves innervating the sacroiliac joint, with image guidance (i.e. fluoroscopy)
(Fluoro and DUS will bundle)    Anticipated average pricing:  In Office $510.31 / Outpatient $201.74 Please let me know if you have any questions!ThanksKristyn

NEW PAIN MANAGEMENT RFA CODES COMING 1/1/20!!

Head's up! New payment rates for Pain Management procedures for 2020 have been released.

https://www.asipp.org/Fee%20Schedules/2020PhysicianFinalRates.pdf

Also - there will be two new RFA codes in 2020

64624 - GENICULAR NERVE BRANCHES, RADIOFREQUENCY

$417.56 in office / $152.66 outpatient

64625 - SACROILIAC JOINT NERVES, RADIOFREQUENCY

$510.31 in office / $201.74 outpatient


Please note! These are replacing two previously questionable procedures that did not have dedicated codes. For the Knee RFA, docs had to choose nerve block or other unlisted codes. For the SI RFA, docs leaned towards 64635 x 1, 64640 x 3
Now both codes will have dedicated and specific coding and pricing.
Please begin using these codes 1/1/20. Remember! Prior authorizations for these procedures will need to use the new codes in January as well.
Please let me know if you have any questions
Thank you

New Labor Laws regarding Salary Employees

Please be aware that on 1/1/20 the labor laws are updating the rules regarding salary employees.

Please note that not all employees can be salary. A salary employee is defined by a "Salary Basis test" and a "Salary level test"


Basis test - the employee must be full time and primarily involve executive, administrative, and professional duties and/or outside sales

Level test - as of 1/1/20, the minimum wage acceptable for a salary employee is increasing to $684 weekly or $35568 annually or $17.10 hourly.

This means that if you place an employee on salary, they must be in a professional type position AND make at least $17.10 an hour for full time.

Cigna Patient Reviews are available!


PATIENT REVIEWS NOW AVAILABLE For Health Care Providers
October 2019

Preview your patient reviews on CignaforHCP.com
In April 2019, we announced that we would started asking our customers after their preventive care or specialty* office visit if they would recommend you to their family and friends. Their responses will begin to appear as patient reviews in the myCigna.com provider directories starting in early 2020. You have the opportunity to view their responses we may have received for you.   

How to see your reviews
Before you can see your reviews for the first time, you will need to:

  • Log in to the Cigna for Health Care Professionals website (CignaforHCP.com). If you are not registered for the website, go to CignaforHCP.com > Register Now.

  • Under Latest Updates: View your patient reviews, click Learn more.

  • Ask your practice’s website access manager for access to patient reviews.

  • Once you are granted access, see your patient reviews by logging into(CignaforHCP.com)> Working with Cigna > Patient Reviews. Note that not all providers will have reviews.

If you need assistance gaining access to your reviews, please call 1.800.853.2713.

After reading your patients reviews
You can simply log out, respond to a patient, or request removal of the review if you think it is inappropriate or inaccurate. If we agree, we will remove the feedback. You may also choose to opt out of having reviews published on myCigna.com

If you need assistance interacting with the patient reviews, please call 1.888.535.0873, Monday-Friday, 8:00 am – 5:00 pm, PT.

Thank you for the quality care you provide to our customers.If you have questions about patient reviews, please contact Cigna Customer Service at 1.800.88Cigna (882.4462)

THE HEALTH PLAN TIMELY FILING

THE HEALTH PLAN HAS UPDATED ITS TIMELY FILING TO 180 DAYS

Effective 1/1/2020, the timely claims filing deadline for professional and facility claims submitted to The Health Plan (THP) will be 180 days from date of service (DOS). This includes medical, behavioral health, vision, dental and pharmacy claims. Make sure to view the complete announcement below for all information regarding the change.