News & Information

Question:

We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as TMJ related so they can be more widely covered?

Answer

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The list of settings where a physician’s services are paid at the facility rate include:
  • Telehealth (POS 02);
  • Outpatient Hospital-Off campus (POS code 19);
  • Inpatient Hospital (POS code 21);
  • Outpatient Hospital-On campus (POS code 22);
  • Emergency Room-Hospital (POS code 23);

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Physicians’ services are paid at nonfacility rates for procedures furnished in the following
settings:
 
  • Pharmacy (POS code 01);
  • School (POS code 03);
  • Homeless Shelter (POS code 04);

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On May 11, 2018, the Department of Veterans Affairs (VA) released its final rule on the "Authority of VA Health Care Providers to Practice Telehealth." Effective June 11, 2018, VA providers will be able to provide telehealth services across state lines. This move will make it easier for veterans to obtain services, particularly if they are in remote, rural or underserved areas. It is anticipated that this ruling will shorten wait times for patients seeking care.

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We recently heard about a small practice that had been faithfully submitting all the required “G” codes for the Quality Payment Program (QPP) only to discover that for 2018 they are excluded from MIPS because the low volume threshold increased from $30,000 in Part B allowed charges or 100 Part B beneficiaries to $90,000 in Part B allowed charges or 200 Part B beneficiaries. They were unsure about what they needed to do at this point and how it would impact their practice.

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