Trailblazer , the MAC J4 contractor has released a DRAFT Physical Medicine & Rehabilitation Outpatient LCD (local coverage determination). The draft LCD is posted as of October 30, 2009 for a 45 day comment period that ends December 14, 2009. According to Trailblazer: This LCD establishes frequency limitations of 5 (15-minute) PT or OT services per [...]
Automated reviews of rehab untimed codes are underway by the Recovery Audit Contractors in Region C & Region D. It is entirely possible that rehab providers have received recoupment letters as you read this. Simultaneously within CMS the conversion from fiscal intermediaries and carriers to the Medicare Administrative Contractor format has resulted in the development/conversion [...]
First Coast Services Options, the Medicare Administrative Contractor (MAC) for Florida has updated the rehab local coverage determinations (LCD) for Part A and Part B. According to a FCSO statement regarding the changes: Indications and Limitations of Coverage and/or Medical Necessity” section of this LCD has been revised under Neuromuscular Reeducation (CPT code 97112) to [...]