Physical therapy/occupational therapy/speech-language pathology services

 

How often is it covered?

 

Medicare Part B (Medical Insurance) helps pay for medically necessary outpatient physical and occupational therapy, and speech-language pathology services.

In 2018, Congress eliminated the limits on how much Medicare pays for therapy services in one calendar year (also called “therapy caps” or “therapy cap limits”). However, for Medicare to pay for your services, the law requires your therapist or therapy provider to confirm that your therapy services are medically reasonable and necessary when they reach certain amounts each calendar year.

Your therapist or therapy provider will need to add information to your therapy claims and your medical record if your therapy services reach these amounts in 2018:

  • $2,010 for physical therapy (PT) and speech-language pathology (SLP) services combined
  • $2,010 for occupational therapy (OT) services

If your therapy services reach these amounts, your therapist or therapy provider will need to add a special notation to your therapy claim. By adding this notation, your therapist confirms that:

  • Your therapy services are reasonable and necessary
  • Your medical record includes information to explain why the services are medically necessary

A Medicare contractor may review your medical records to be sure your therapy services were medically necessary. This review may happen if your therapy services reach these amounts in 2018:

  • $3,000 for PT and SLP services combined
  • $3,000 for OT services

Your therapist or therapy provider must give you a written notice before providing services that aren’t medically necessary. This includes therapy services that are generally covered but aren’t medically reasonable and necessary for you at the time. This notice is called an “Advance Beneficiary Notice of Noncoverage” (ABN). The ABN lets you choose whether or not you want the therapy services. If you choose to get the medically unnecessary services, you agree to pay for them.

 

Who’s eligible?

All people with Part B are covered as long as the services are medically reasonable and necessary.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

    • Other insurance you may have
    • How much your doctor charges
    • Whether your doctor accepts assignment
    • The type of facility
    • Where you get your test, item, or service

 

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.  Copied from  medicare.gov/pt-and-ot-and-speech-language-pathology   pdf

Back Pain – What can be done?

Physical Therapy

tinhtamvn.net/how-to-use-a-tennis-ball-to-relieve-sciatic-nerve-pain-and-back-pain/

Anthem Blue Cross Muscoloskeletal Fitness Program

Yoga for Back Pain

 

Yoga with Adrianne

Cole Yoga TX

 

Thumbs on Back Pain

Epidural

wikipedia.org/Epidural_steroid_injection

 

Pinched Nerve?

 

Buy it at Office Depot

The pressure may be the result of repetitive motions. Or it may happen from holding your body in one position for long periods, such as keeping elbows bent while sleeping.

NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen may reduce swelling.

Pinched Nerve Web MD

Cartoon Explanation

Not Acetomenifin, but you can’t use it if you are allergic to aspirin   Cleveland Clinic

Pain Slide Show

Wiki How – set up ergonomic workspace

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Shoulder Injury – Frozen Shoulder

70% of patients will improve with non-surgical care. Initial treatment involves anti-inflammatory medication, ice, avoiding over shoulder reaching and lifting activities. In the very acute painful phase exercises are avoided. When pain subsides somewhat, rotator cuff exercises are begun. The primary goal of the exercises is to work the uninjured portion of the rotator cuff. This is accomplished by emphasizing internal and external rotation exercises using an elastic tubing. Scapula stabilizers are also strengthened. Deep tissue work by a physical therapist can help relieve associated spasm. Isolated strengthening of the most commonly injured supraspinatous tendon should be avoided. If there is no response to this treatment program, an injection of cortisone is provided. Cortisone is a strong anti-inflammatory medication that, when used appropriately and sparingly, is safe and can be dramatically beneficial. iasm.com

Resources & Links

Exercises for Neck

praxis physical therapy.com

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Video's trying to explain Medical Necessity  

If you know of a better video, please email us the link [email protected]

many mental health professionals wonder, "What is medical necessity?"

Medicare denials for medical necessity on chiropractic claims.

three components that must be present to establish Medical Necessity for Chiropractic Manipulative treatment (CMT)

 

Our webpage on Medical Necessity  

 

Medicare and You 2021 #10050   
Everything you want to know - Read Along

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Steve's video on Medicare & You

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