Gawenda Seminars & Consulting, Inc.

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Gawenda Seminars & Consulting, Inc.

Compliance, Coding and Billing Expert for Physical Therapy, Speech Therapy and Occupational Therapy

11/12/2025

If you’re attending the APTA Private Practice Section Annual Conference in Orlando, Florida this week, I’d love for you to join my sessions.

🗓 Friday at 4:30 PM – Contract Negotiations and Renegotiations
🗓 Saturday Morning – 2026 Regulatory and Payment Updates

We’ll be covering not only Medicare changes, but also updates for Aetna, Anthem Blue Cross, Cigna, and Humana.

If you’ll be there, come say hello. I look forward to connecting and sharing valuable information to help your practice stay compliant and profitable!

11/11/2025

Many clinics use the treadmill as a warmup, especially for patients with lower extremity injuries or low back pain. But here’s the key question:

Is simple walking on the treadmill billable?

❌ No. A patient casually walking for 5–10 minutes to “warm up” is not skilled therapy and is not billable time.

✅ When can treadmill time be billable?

When you are actively providing skilled intervention, such as:
• Working on cadence
• Coaching stride length
• Addressing gait asymmetry
• Cueing heel strike → foot flat → push off
• Making corrections and providing skilled feedback

During that time, you’re observing, correcting, and giving cues — so the service can meet the definition of skilled, billable therapy.

11/10/2025

Is the stationary bike billable time?

Short answer is.. not always.

If a patient is simply pedaling to warm up before therapeutic exercise or manual therapy, that time is not billable — there’s no skilled service being provided.

Example:
– 33-year-old ACL repair
– 45-year-old meniscal repair
– 72-year-old total knee replacement

If they’re just pedaling to “get loose,” it doesn’t meet the standard of a skilled, billable intervention.

When CAN it become billable?

When you’re providing skilled instruction—for example, teaching self-stretching techniques for knee flexion and extension:
• Adjusting seat height for proper positioning
• Using the uninvolved leg to assist the involved leg
• Coaching on mechanics (don’t hike the hip, don’t lean, keep alignment, etc.)
• Providing cues and correction

During that instruction and cuing, the time may be billable.

Once the patient can independently perform it correctly, it becomes non-billable again.

11/07/2025

Can you bill for treatment on the same day as the evaluation?

Short answer: Yes. No. Maybe.
Because (as always)… it depends.

Here’s what clinicians need to know:

Medicare does reimburse for treatment on the same day as the evaluation for PT, OT, and SLP.

In most cases, you’re already providing skilled intervention on that first visit — like implementing a home exercise program, therapeutic exercise, therapeutic activities, or for SLPs, CPT 92507.

Some Medicaid programs and commercial payers also reimburse for same-day treatment. If the payer allows it (and you performed it) bill for it.

❌ However, not all insurers authorize or reimburse treatment on the day of the evaluation.

A common example: payers that require prior authorization.
If authorization isn’t in place, you’ll likely only be paid for the evaluation, even if treatment was billed.

Know your payer rules. If same-day treatment is allowed and medically necessary — bill for it. If prior authorization or payer policy prohibits it, stick to the evaluation only to avoid denials.

Have questions about billing, authorization, or payer policy nuances? Drop them in the comments or send me a private message!

11/05/2025

It’s almost a new year and with that, new, revised and deleted CPT codes become effective on January 1, 2026 and payment changes occur in terms of the annual Medicare therapy threshold dollar amount, use of the KX modifier for claims exceeding the therapy threshold, the targeted medical review process for claims exceeding $3,000 in a calendar year and the annual Medicare Part B deductible and its impact on the annual therapy threshold dollar amount.

In calendar year 2026, what is the status of outpatient therapy delivered via telehealth?

For those of you who participate in the Merit-Based Incentive Payment System (MIPS) program, what changes are occuring in 2026 compared to 2025?

Lastly, will Medicare reimbursement increase or decrease in calendar year 2026 compared to 2025 and might some localities see a bigger increase or decrease than others?

It will all be covered in this 1.5 hour online webinar on November 19th. Don't miss it!

https://gawendaseminars.com/events/2026-outpatient-therapy-updates/

11/03/2025

On October 31, 2025, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2026 Medicare Physician Fee Schedule (MPFS) final rule. This final rule does have regulatory and reimbursement implications for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings.

Learn more here:
https://gawendaseminars.com/cms-releases-cy-2026-medicare-physician-fee-schedule-final-rule/

10/31/2025

2026 Therapy Regulatory + Payment Updates are coming!

New year = new CPT codes, revised payment rates, and updated Medicare thresholds.

Join us on November 19th from 1–2:30PM EST for an in-depth look at what’s changing for outpatient PT, OT, and SLP services in 2026 — including:

✅ Updated CPT codes (new, revised, deleted)
✅ Therapy threshold and KX modifier updates
✅ Targeted medical review process
✅ Medicare Part B deductible changes
✅ Telehealth and MIPS updates
✅ Reimbursement outlook for 2026

Register now for the 2026 Outpatient Therapy Regulatory and Payment Updates online course and start the new year fully prepared.

👉 https://loom.ly/UGiQaw8

10/29/2025

Remember those progress reports you didn’t want your parents to see? 😅
These are a little different.

Medicare and other payers require progress reports to show how your patient is actually improving and it’s not just about checking boxes.

10/28/2025

There’s a lot of confusion online about billing Medicare Advantage patients, especially when the provider isn’t contracted with the MA plan.

In this week’s article, we clear up the misinformation and answers key questions about out-of-network billing, assignment, and what you can and can’t charge patients.

Check it out here 🔗
https://loom.ly/xfSWRak

10/27/2025

Think you can bill a re-eval just because you did a progress report? Not exactly.

Medicare (and every other payer) doesn’t see it that way.Your progress report time counts toward your regular treatment minutes—not a separate re-evaluation.

10/24/2025

If you’re still doing progress reports every 30 days… it’s time for a quick update. Medicare’s rule changed back in 2013!

Here’s what you actually need to know about progress report requirements.

10/23/2025

Want to get properly reimbursed for cupping in your outpatient therapy practice? Make sure you’re using the right CPT code!

You can learn more here ⬇️
🔗 https://loom.ly/dPH6mcQ

Address

PO Box 971862
Ypsilanti, MI
48198

Telephone

+17345317718

Website

https://www.gawendaseminars.com/

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