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    Getting Paid for Outpatient Services: CPT Coding and Billing

  • RESOURCES & DISCIPLINES       Bring This Course to You!

    Appropriate Disciplines

    • Occupational Therapist
    • Physical Therapist
    • Physical Therapy Asst
    • Speech Language Pathologist
    • Speech Language Pathology Asst
    • Certified Occupational Therapy Asst

Course Description

There are two ways to participate in this live stream event (BOTH count as LIVE Continuing Education!):
  1. in the LIVE STUDIO audience in Gulf Breeze, Florida - Studio audience seats are limited - so register today!
  2. via LIVE STREAM around the world - Live stream participants will login to access the event from their computer and interact with the instructor.
Course time(s):
9:00 AM Central (10:00 AM Eastern; 8:00 AM Mountain; 7:00 AM Pacific)

Outpatient therapy services continue to be on the audit radar for various Medicare and private insurance carriers medical review entities for coding and billing issues. The seminar will teach participants the correct use of CPT codes for modalities and interventions used by physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants and speech-language pathologists in all outpatient settings. The seminar will discuss Medicare's "8-minute rule", definition of substantial per the American Medical Association, and provide billing scenarios to ensure therapists bill correctly to all insurance carriers. Finally, the seminar will teach participants the latest on the Medicare therapy threshold, targeted medical review for claims exceeding $3,000 in a calendar year, how the application of the multiple procedure payment reduction (MPPR) policy impacts your payment for Medicare beneficiaries receiving outpatient therapy services and when to and when not to issue an ABN to a Medicare beneficiary.

Due to the disproportionate amount of CPT codes for OT’s and PT’s, the CPT portion of the webinar is divided into 70% OT/PT specific guidelines and 30% SLP specific guidelines. All other course material is applicable across disciplines.

AOTA Classification Codes
Domain of OT: Performance Skills
OT Process: Intervention

Course Objectives

Upon successful completion of this course, participants will be able to:

  • Describe & understand how to select the correct CPT code(s) based on interventions provided and documentation in the medical record
  • Discuss the difference between Medicare’s “8-minute rule” and definition of substantial from the American Medical Association
  • Be able to charge correctly for the services you provide under outpatient therapy benefits for Medicare and private insurance carriers
  • Understand how MPPR reduces your payment for Medicare beneficiaries
  • Explain the annual therapy threshold and the targeted medical review threshold for claims exceeding $3,000 in a calendar year
  • List 3 reasons when to issue an advance beneficiary notice of noncoverage (ABN) to a Medicare beneficiary

Rick Gawenda


RICK GAWENDA, PT, is a licensed physical therapist with over 26 years of experience and currently serves as the founder and President of Gawenda Seminars & Consulting, Inc. He graduated with a Bachelor of Science degree in Physical Therapy from Wayne State University in Detroit, Michigan, in 1991. Mr. Gawenda is also Director of Finance for Kinetix Advanced Physical Therapy, a private practice with 2 locations. He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services. Mr. Gawenda has presented nationally since 2004 and currently presents over 80 dates per year around the United States. Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is a Past President of the Section on Health Policy & Administration of the APTA as well as a Past President of the Michigan Association of Medical Rehabilitation Program Administrators. Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.

Financial Disclosure: Rick Gawenda is President and owner of Gawenda Seminars & Consulting. He receives an honorarium for his speaking engagements. He receives royalties for the sale of his online courses.
Non-Financial Disclosure: none to disclose

Day 1

09:00 - 10:45
CPT Codes used by PT and OT
10:45 - 11:15
CPT Codes used by SLP
11:15 - 11:30
11:30 - 12:00
NCCI Edits and the use of Modifier 59
12:00 - 12:45
Medicare’s “8-minute rule”, definition of substantial and billing scenario’s for PT, OT and SLP
12:45 - 01:00
01:00 - 01:30
Multiple Procedure Payment Reduction policy
01:30 - 02:00
Therapy threshold and targeted medical reviews above $3,000
02:00 - 02:30
When to and when not to use an ABN
02:30 - 02:45
Question and Answer

Delivery VIA:

  • Live On Tour - This course is now being offered live on locations throughout the United States.
  • Live By Request - This course is available to come to you! Contact us to see how easy that can be. mail@ciaoseminars.com
  • Live Stream - This course is offered from our Live Stream studio. Watch and interact with the instructor from wherever you are or join us as part of the studio audience in sunny Gulf Breeze, FL. Included with each Live Stream registration is access to the course recording for the 14 days immediately following the broadcast.

Contact hours pre-approved for:

  • 5.0 Hours (0.5 CEUs)
  • CIAO is an ASHA Approved Provider #AAWA (SLPS) Bubble sheet required
  • CIAO is an AOTA Approved Provider #4119 (OT/COTAs)
  • This course meets PDU requirements for NBCOT (5 PDUs)
  • CIAO is an Illinois Approved Provider for PT/PTA Continuing Education
  • CIAO is recognized as an Approved Provider for PT/PTAs by the NYSE Dept State Board for PT
  • This activity is provided by the TX Board of PT Examiners Accredited Prov. #2202009#TX
  • This activity meets the continuing competence requirements for PT/PTA license renewal in TX
  • 5.0 Hrs. PT/PTAs in IL, TX(5 CCUs)
  • 6.0 Hrs. PT/PTAs in NY
  • 6.0 Hrs. OT/COTAs in FL (#20-645845)
  • 6.0 Hrs. PT/PTAs in FL (CE19-645845)

This course is offered for 0.5 ASHA CEUs (Introductory Level, Professional Area)

The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA.

CIAO is recognized on the NBCOT Provider Registry (meets PDU requirements for NBCOT)

CIAO Automatically reports to CE Broker for Florida Occupational and Physical Therapists and Assistants. Florida SLPs can either use the ASHA CE Participant Form (Bubble Sheet) or self-submit through CE Broker.


"The content was and teaching were fantastic. I think I can assist my facility in recovering some money not captured due to NCCI edits. However, I needed some clarifications on the edits. I did not type my question during that section bc I was busy taking notes and thinking about our scenarios here at our facility. Hence, when I did have time to type my question, it was not asked bc we were beyond that section in the discussion. "

- Live Streaming or Studio Audience, FL / Mar 2019

"Good course"

- Live Streaming or Studio Audience, FL / Mar 2019

"Great information. Thanks"

- Live Streaming or Studio Audience, FL / Mar 2019