Coding & Reimbursement Resources

Toolkits

AAPM&R Spine Care Toolkit

Spine care, including the management of low back pain (LBP), is one of the major areas of musculoskeletal treatment in our country. Developed by the Academy’s Innovative Payment and Practice Models (IPPM) Committee, the Spine Care Toolkit is a clinical and educational resource that AAPM&R members, payers and healthcare systems can utilize to develop care structures and alternative payment models (APMs) to allow for the provision of high value spine care.

This toolkit offers members the tools they need to develop a physiatrist-led spine care APM, in which clinical outcomes and patient satisfaction will improve and costs will be reduced through consistent and direct involvement of physiatry in spine care across the continuum.

Toolkits

AAPM&R Spine Care Toolkit

Spine care, including the management of low back pain (LBP), is one of the major areas of musculoskeletal treatment in our country. Developed by the Academy’s Innovative Payment and Practice Models (IPPM) Committee, the Spine Care Toolkit is a clinical and educational resource that AAPM&R members, payers and healthcare systems can utilize to develop care structures and alternative payment models (APMs) to allow for the provision of high value spine care.

This toolkit offers members the tools they need to develop a physiatrist-led spine care APM, in which clinical outcomes and patient satisfaction will improve and costs will be reduced through consistent and direct involvement of physiatry in spine care across the continuum.

AAPM&R Stroke Rehabilitation Toolkit

Stroke remains the second leading cause of death, the third leading cause of death and disability combined, and a leading cause of institutionalization in the world. Developed by the Academy’s Innovative Payment and Practice Models (IPPM) Committee, the Stroke Rehabilitation Toolkit is a clinical and educational resource that AAPM&R members, payers, and health care systems can utilize to develop care structures and alternative payment models (APMs) to allow for the provision of high value stroke rehabilitation care.

This toolkit offers members the tools they need to develop a physiatrist-led stroke rehabilitation APM, in which clinical outcomes and patient satisfaction will improve and costs will be reduced through consistent and direct involvement of physiatry in stroke rehabilitation care across the continuum.

The Physiatrist Articles

AAPM&R has developed a Coding & Reimbursement Tips column in the The Physiatrist to provide you with coding insights. These articles can be used as supportive coding data to appeal insurance denials, validate coding to auditors, train staff and answer day-to-day coding questions. Note: Accurate coding is the responsibility of the provider. These coding article are intended only as a resource to assist in the coding and billing process.

• 2023 Medicare Physician Fee Schedule and CPT Code Changes Impacting PM&R Practice (February 2023)
• Inpatient and SNF E/M – What You Need to Know for 2023 (December 2022/January 2023)
• Medicare Physician Fee Schedule Payments: Unsustainable and At Risk (July 2022)
• 2022 Medicare Physician Fee Schedule and CPT Code Changes Impacting PM&R Practice (February 2022)
• Office and Outpatient E/M – What You Need to Know for 2021 (December 2020/January 2021)
• Coding for Imaging Guidance (April 2020)
• An Introductory Guide to Electrodiagnostic Billing - Part 3 (February 2020)
• An Introductory Guide to Electrodiagnostic Billing - Part 2 (October/November 2019)
• An Introductory Guide to Electrodiagnostic Billing - Part 1 (September 2019)
• Direct Prolonged Service Coding (August 2019)
• New Medicare Payments: Communication Technology-Based Services (May 2019)
• Earning a Seat for PM&R on the RUC (March 2019)
• MACs, RACs, etc.: Working with Medicare's Contractors (June 2018)
• Modifiers for Physiatry (May 2018)
• Urine Drug Testing: What You Need to Know (April 2018)
• RUC and the Code Valuation Process (Oct/Nov 2018)

Guide to Telehealth Under COVID-19

Click here to access the Guide to Telehealth.

Payer Denials

Members of the Reimbursement and Policy Review Committee (RPRC) and the Health Policy and Legislation Committee (HP&L) have been working for the past year to gather information and vocalize the Academy’s concern about payer denials to Congress and the Centers for Medicare and Medicaid Services (CMS). Learn more and find information to contact us if you have received a denial. 

Coding and Reimbursement Webinars

Throughout the year, AAPM&R sponsors webinars that focus on issues concerning the regulatory, federal, quality, and coding, and reimbursement issues directly related to physiatry.

Template Appeals Letter for Physicians Challenging Denials

Template Appeal Letter for Modifier 25

Medicare Resources

Learn more about Medicare and find resources to help your practice. 

Toolkits

AAPM&R Spine Care Toolkit

Spine care, including the management of low back pain (LBP), is one of the major areas of musculoskeletal treatment in our country. Developed by the Academy’s Innovative Payment and Practice Models (IPPM) Committee, the Spine Care Toolkit is a clinical and educational resource that AAPM&R members, payers and healthcare systems can utilize to develop care structures and alternative payment models (APMs) to allow for the provision of high value spine care.

This toolkit offers members the tools they need to develop a physiatrist-led spine care APM, in which clinical outcomes and patient satisfaction will improve and costs will be reduced through consistent and direct involvement of physiatry in spine care across the continuum.

AAPM&R Stroke Rehabilitation Toolkit

Stroke remains the second leading cause of death, the third leading cause of death and disability combined, and a leading cause of institutionalization in the world. Developed by the Academy’s Innovative Payment and Practice Models (IPPM) Committee, the Stroke Rehabilitation Toolkit is a clinical and educational resource that AAPM&R members, payers, and health care systems can utilize to develop care structures and alternative payment models (APMs) to allow for the provision of high value stroke rehabilitation care.

This toolkit offers members the tools they need to develop a physiatrist-led stroke rehabilitation APM, in which clinical outcomes and patient satisfaction will improve and costs will be reduced through consistent and direct involvement of physiatry in stroke rehabilitation care across the continuum.

The Physiatrist Articles

AAPM&R has developed a Coding & Reimbursement Tips column in the The Physiatrist to provide you with coding insights. These articles can be used as supportive coding data to appeal insurance denials, validate coding to auditors, train staff and answer day-to-day coding questions. Note: Accurate coding is the responsibility of the provider. These coding article are intended only as a resource to assist in the coding and billing process.

• 2023 Medicare Physician Fee Schedule and CPT Code Changes Impacting PM&R Practice (February 2023)
• Inpatient and SNF E/M – What You Need to Know for 2023 (December 2022/January 2023)
• Medicare Physician Fee Schedule Payments: Unsustainable and At Risk (July 2022)
• 2022 Medicare Physician Fee Schedule and CPT Code Changes Impacting PM&R Practice (February 2022)
• Office and Outpatient E/M – What You Need to Know for 2021 (December 2020/January 2021)
• Coding for Imaging Guidance (April 2020)
• An Introductory Guide to Electrodiagnostic Billing - Part 3 (February 2020)
• An Introductory Guide to Electrodiagnostic Billing - Part 2 (October/November 2019)
• An Introductory Guide to Electrodiagnostic Billing - Part 1 (September 2019)
• Direct Prolonged Service Coding (August 2019)
• New Medicare Payments: Communication Technology-Based Services (May 2019)
• Earning a Seat for PM&R on the RUC (March 2019)
• MACs, RACs, etc.: Working with Medicare's Contractors (June 2018)
• Modifiers for Physiatry (May 2018)
• Urine Drug Testing: What You Need to Know (April 2018)
• RUC and the Code Valuation Process (Oct/Nov 2018)

Guide to Telehealth Under COVID-19

Click here to access the Guide to Telehealth.

Payer Denials

Members of the Reimbursement and Policy Review Committee (RPRC) and the Health Policy and Legislation Committee (HP&L) have been working for the past year to gather information and vocalize the Academy’s concern about payer denials to Congress and the Centers for Medicare and Medicaid Services (CMS). Learn more and find information to contact us if you have received a denial. 

Coding and Reimbursement Webinars

Throughout the year, AAPM&R sponsors webinars that focus on issues concerning the regulatory, federal, quality, and coding, and reimbursement issues directly related to physiatry.

Template Appeals Letter for Physicians Challenging Denials

Template Appeal Letter for Modifier 25

Medicare Resources

Learn more about Medicare and find resources to help your practice.