TDI Changes For Physical Therapy, Occupational Therapy and Speech Pathology Services Effective 7/1/13

Austin, TX ( - The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) has adopted the Centers for Medicare and Medicaid Services (CMS) payment policies specific to Medicare, in effect on the date a service is provided, including its coding requirements, billing requirements, and modifiers as specified in the TDI-DWC's medical fee guideline rule in 28 Texas Administrative Code §134.203(a)(5) and (b)(1).

Workers' compensation system participants have asked for clarification regarding the applicability of new CMS billing and reporting requirements for certain physical therapy, occupational therapy, and speech pathology services (services) scheduled to become effective for these services furnished on or after July 1, 2013. These new reporting requirements implement a claims-based data collection strategy on patient functioning during the course of these services in order to better understand patient condition and outcomes. CMS provides detailed instructions for health care providers to implement and apply the reporting requirements, which include the application of new functional G-code(s) and appropriate modifier(s) with bills containing a defined set of CPT codes.

These new CMS billing and reporting requirements become effective July 1, 2013, and as a result, will also apply to services furnished on Texas workers' compensation claims on or after July 1, 2013.

For additional information, contact the TDI-DWC by calling CompConnection for Health Care Providers at 1-800-372-7713 and selecting option 3 or e-mailing

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