AHA Coding Clinic® for HCPCS - 2013 Quarter 1; For your Information
New HCPCS codes for "sometimes therapy"
Medicare pays separately for therapy services. Two of the designations that are used for therapy services by Medicare are: “always therapy” and “sometimes therapy.” An “always therapy” service must be performed by a qualified therapist under a certified therapy plan of care, and a “sometimes therapy” service may be performed by an individual outside of a certified therapy plan of care. Under the OPPS, separate payment is provided for certain services designated as “sometimes therapy” services if these services are furnished to hospital outpatients as a non-therapy service, that is, without a certified...
Subscribe or sign in to view the full article.
Article Overview
This article covers Medicare OPPS guidance on services classified as "sometimes therapy" and notes the CY 2013 HCPCS additions used for reporting certain outpatient therapy-related wound care services. It is relevant for hospital outpatient coders, therapy billing staff, and compliance teams that track CMS payment classifications, reporting categories, and code updates.
Why This Topic Matters
Understanding which outpatient services fall into Medicare’s "sometimes therapy" category affects reporting and payment under OPPS, especially when new HCPCS codes are added. The article helps readers identify the scope of the CMS update and the affected service categories without substituting for the full code list and guidance.
Article Sections
-
Overview of therapy designations and OPPS payment context
Introduces the Medicare therapy designation framework and the outpatient payment context in which certain services are treated differently. The section sets up the purpose of the CMS update and the reporting category discussed in the article.
-
CY 2013 HCPCS additions for sometimes therapy services
Summarizes the calendar year 2013 update that expanded the HCPCS list used for outpatient reporting. The section focuses on the service category affected and the timing of the change.
-
Sometimes therapy services that are paid under the OPPS
Presents the outpatient service list associated with the guidance. The section includes the codes and related wound-care services referenced by the article.
What You Will Learn
- How Medicare distinguishes outpatient therapy-related service categories
- What type of CMS update the article describes
- Which general service group is affected by the reporting guidance
- How the article relates to OPPS payment and outpatient reporting
Who Should Read This
- Hospital outpatient coders
- Therapy billing specialists
- Revenue cycle staff
- Compliance professionals
- Medical coding auditors
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com