Pelvic Health Payment and Policy / May 2024 Updates

Posted By: Kari Nies Smith Practice & Advocacy,

The Federal Trade Commission: Non-Compete Clause Rule

The new policy, effective September 4, 2024, brings a significant change by prohibiting noncompete agreements for future employment arrangements and rendering existing ones unenforceable. An employer is now required to provide “clear and conspicuous notice” to an employee with an existing noncompete, stating that the clause can no longer be enforced.  The exceptions to the rule are for senior executives in policymaking positions (making at least $151,164) and legitimate business sales as part of the sale agreement. More information on the Fact Sheet on Proposed Final Rule  and APTA news article

Caregiver Training Codes

To provide clarification on the new codes for caregiver training when the patient is not present.   CMS has clarified the determination for individual training codes (97550 and 97551) and the group codes (97552).  When multiple caregivers for one beneficiary are trained simultaneously, the individual codes (97550 and 97551) are only billed once, regardless of the number of caregivers.   If multiple caregivers for more than one beneficiary are trained at the same time, the code is billed once for each patient represented in the group.  (ie: 4 caregivers representing 3 patients- bill this code once to each of the 3 patients) More information is available in  FAQ on Caregiver Training Codes

Medicare fee schedule

Have you ever wondered how much Medicare reimburses for services in your area?  You can access the Medicare physician fee schedule and look up specific CPT codes.  For example, the new caregiver codes reimbursement is:  

  • 97550 is $50.72

  • 97551: $ 25.39

  • 97552: $20.80

Biofeedback Codes

The CPT codes for biofeedback will be reviewed. 90901 is the generic biofeedback code, and 90912 and 90913 are the pelvic floor biofeedback codes. These codes will be discussed at the next CPT meeting, and APTA has submitted a code change application to be re-valued at the next RUC meeting. APTA has engaged the Academy of Clinical Electrophysiology and Wound Management for subject matter expertise on these codes. 

Change Healthcare Cyber Attack

On February 21, Change Healthcare, a UnitedHealth Group subsidiary, had the largest-ever cyberattack on the US healthcare system. APTA began publishing resources on its website and all social media platforms on March 6th. Scan this QR code to see the updated resources and information or click here

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