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NY, CT Medicare Contractor Makes Official Announcement of Documentation Rule Changes

Physical therapists (PTs) in New York and Connecticut have received official word that 2 burdensome requirements have been lifted. The changes reduce reporting and documentation rules that were in conflict with national Medicare policy.

National Government Services, the Medicare administrative contractor (MAC) for the 2 states, released a statement on October 24 announcing that PTs are no longer required to submit progress reports every 5 days after services exceeded the therapy cap, and that requirements for documentation of a physician reexamination for services that exceeded either 90 days or the therapy cap have been removed. The changes are effective for dates of service on or after August 1, 2013.

APTA and chapters in New York and Connecticut advocated for changes to the NGS requirements, which directly conflicted with national Medicare policy. NGS posted detailed information about the changes to Outpatient Physical and Occupational Therapy Services (L26884) Local Coverage Determination (LCD) on its website.


Local Coverage Determination Changes for Outpatient Physical and Occupational Therapy Services (L26884)

Attention: Part B Providers

Effective for dates of service on or after August 1, 2013, the following statements in the Documentation Requirements section no longer apply and have been deleted from the Changes for Outpatient Physical and Occupational Therapy Services (L26884) LCD:

Under Progress Reports: The text that reads, "Where therapy exceeds an established cap, progress reports will be required at least every five treatment days" has been deleted.

Under Certifications and Re-certification: The text that reads, "National Government Services may require specific documentation of referring physician re-examination and re-evaluation which demonstrates the need for physical therapy services, in cases where services exceed the 90-day certification period, or where services have exceeded the therapy cap" has been deleted.

For more information about changes made to the L26884 LCD, please refer to the Outpatient Physical and Occupational Therapy Services LCD - Upcoming Changes article on our Web site. Please review the LCD for very specific information about Dates of Service and full implementation.


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