CMS Coding Reversal Will Apply to Claims Made Beginning January 1, 2020

Details are still emerging around exactly how CMS intends to walk back a decision to change coding methodologies that prevented PTs from billing an evaluation performed on the same day as therapeutic activities and/or group therapy activities. But we know a little more now: namely, that the decision is retroactive to January 1 of this year, the date when the short-lived system was set in place.

APTA pressed CMS for the logistics of how its do-over would be worked out as soon as its decision was announced on January 24. On January 28, CMS informed the association that while the agency is still working on its messaging to the Medicare administrative contractors, or MACs, the reversal will be extended to claims made from January 1, 2020, on.

The current state of flux leaves physical therapy providers with three basic options: delay submitting claims until after CMS gives the green light; resubmit claims denied because of the coding edits once the change is official; or appeal any claims denied due to the edits to the MAC, supplying supporting documentation.

APTA regulatory affairs staff will remain in communication with CMS on the change and share new information as it becomes available.