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February 24, 2022 – Updated 03.01.23

Targeted Probe and Education Program to Focus on Therapy Service Claims

The CGS Targeted Probe and Education program will begin review of claims associated with outpatient therapy services. Guidance for therapy services provision and documentation may be found in the CGS' LCD L34049External Website and CGS' LCD L34046External Website located in the Part B Medical Policies section of the CGS website.

All therapy services must meet all requirements regarding medical reasonableness and necessity as outlined in the applicable statute, regulations, and manual provisions.

All therapy services must be provided under a plan of care. There are requirements for both the plan of care and claim submission for these services.

We expect the documentation submitted to include a copy of the following legible and signed documentation from each patient's medical record:

  • Beneficiary's name
  • Date of service
  • Provider of service
  • Physician / Non-Physician (NPP) order or evidence of intent to order
  • Initial evaluation, plan of care, progress reports, treatment encounter notes, therapy minute logs, and discharge summary
  • Initial Evaluation/Re-evaluation Signed by Ordering Physician or Practitioner
  • Physician/Non-Physician Practitioner (NPP) certification of Plan of Care for claim period including justification when the Certification is delayed more than 30 days
  • Progress reports written by the clinician-services related to progress reports are to be furnished on or before every 10th treatment day. Please provide all pertinent progress notes related to the reviewed date of service (two progress notes prior to date of service reviewed is recommended, if applicable)
  • For all therapy services rendered submit attendance/treatment records for the claim period – must include total treatment time and identify each specific skilled modality provided
  • Documentation supporting the diagnosis code(s) required for the item billed
  • Any other supporting documentation
  • Appropriate signatures
  • Signature and credentials of person performing the service
  • Amendments/corrections/delayed entries are properly identified
  • Amendments/corrections/delayed entries are initialed and dated by author within 30 days of the billed service.

For additional documentation requirements, please reference:

CPT codes under review will include:

  • 97110 – therapeutic exercises to develop strength, endurance, range of motion and flexibility
  • 97112 – neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
  • 97140 – manual therapy techniques, 1 or more regions, each 15 minutes
  • 97530 – use of dynamic activities to improve functional performance
  • 92507-92612 – Speech Language Pathology Services

For more information on Targeted Probe and Education, please see the following links:

Consider using the myCGS Portal for claim review status and submission of documentation. For more information, please access myCGS.

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