Beginning August 17, 2020, CMS directed the MACs to resume fee-for-service medical review activities beginning with post payment reviews of items/services provided before March 1, 2020. Items and services are selected based upon high error rates and/or potential overutilization identified through data analysis. Physical Therapy/Occupational Therapy: CPT Codes 97110, 97112, 97140, 97530
The goal of CGS’s Medical Review (MR) program is to reduce errors through claims reviews and education on Medicare’s coverage, coding, payment and billing policies. To achieve this goal, we conduct data analysis to identify provider billing services of CPT/HCPCS codes that pose the greatest risk to the Medicare program.
The reviews involve providers billing CPT codes 97110 (Therapeutic exercises), 97112 (Neuromuscular reeducation), 97140 (Manual therapy techniques), and 97530 (Therapeutic activities.) Documentation will be reviewed for compliance with Medicare rules and regulations such as: medical necessity; required components and signatures; deliverance of the service; as well as correct coding and billing per medical necessity.