Colonoscopy Frequency Rules & Eligibility (Medicare Quick Chart)
Colorectal cancer screening remains one of the highest-volume preventive services in the U.S., and yet it is also one of the most audited when billed incorrectly. CMS outlines detailed frequency rules for who qualifies as high risk vs average risk, how often a screening colonoscopy can be billed, and how those rules interact with other […]
Colonoscopy Billing 2025: Screening vs Diagnostic, Modifiers ….
Colonoscopy is both one of the most common preventive procedures in the U.S. and one of the most frequently denied when billing errors occur. The challenge lies in determining whether the procedure qualifies as screening or becomes diagnostic mid-procedure, applying the correct modifiers (PT vs 33), and understanding how anesthesia codes 00812 vs 00811 affect […]
Dry Needling 20560/20561: Coverage Reality, LCDs & Claim Setup
Dry needling billing Dry needling is increasingly popular in outpatient rehab and musculoskeletal practices, but billing for it remains challenging. The services are described by CPT 20560 (needle insertion without injection in one or two muscles) and CPT 20561 (needle insertion without injection in three or more muscles). These codes were introduced in 2020, and […]
Telehealth for PT Through Sept 30, 2025—What’s Still Allowed
The COVID-19 Public Health Emergency reshaped care delivery, bringing telehealth to the center of rehabilitation services. While many temporary flexibilities have since expired, pt telehealth 2025 remains active under an important extension. According to the CMS Telehealth FAQ, April 2025, physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) remain eligible to furnish telehealth […]
KX Modifier Thresholds (2025): How to Bill Over $2,410
Medicare’s therapy cap may be gone, but thresholds remain, and they still shape billing for physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. For pt telehealth 2025, these rules apply just as they do for in-person care. The therapy threshold 2025 levels are set at $2,410 for PT and SLP combined, and […]
PTA/OTA Modifiers (CQ/CO) & the 15% Differential (2025)
When it comes to therapy billing under Medicare, few policies cause as much confusion as the assistant modifiers. The cq modifier (for physical therapy assistants) and the co modifier (for occupational therapy assistants) must be applied when an assistant furnishes services “in whole or in part.” These modifiers don’t just flag assistant involvement, they also […]
97110 vs 97530: Units, Time & the 8-Minute Rule (2025 Guide)
If you’ve ever paused before clicking submit because you weren’t fully confident that your pt CPT units match your note, you’re not alone, most therapy denials stem from the same handful of errors, confusing 97110 vs 97530, misapplying the 8 minute rule, or failing to “show the math” for mixed minutes, despite the fact that […]
Medicare Fraud Prevention: 7 Billing Practices to Avoid
Medicare is the backbone of health coverage for more than 65 million Americans. With that size comes vulnerability. Billions of dollars are lost each year to billing errors, fraudulent claims, and documentation failures. These are not just administrative hiccups, they directly affect taxpayer trust, provider reputation, and program sustainability. The Centers for Medicare & Medicaid […]
Understanding the No Surprises Act in 2025
The No Surprises Act 2025 represents one of the most significant healthcare billing reforms in recent history. First enacted in 2022, the law was designed to protect patients from surprise billing, large, unexpected medical charges that arise when patients unknowingly receive care from out-of-network providers or facilities. Such bills created both financial hardship and mistrust […]