Gawenda Seminars & Consulting, Inc.

01/16/2026

Do you need an ABN for statutorily non-covered services?

Not always.

An Advance Beneficiary Notice (ABN) is only required when a service is normally covered by Medicare, but you expect Medicare will deny payment for that specific situation.

Services that are statutorily non-covered like:
• Fitness
• Wellness
• Prevention
• Return-to-sport

are never covered by Medicare, which means an ABN is not required for those services.

Knowing when an ABN is and is not required helps protect compliance, avoid unnecessary paperwork, and prevent patient confusion.

For more details on ABNs and Medicare rules ⬇️
https://gawendaseminars.com/faq/abn/

01/15/2026

New RTM management CPT codes are now in effect

As of 2026, new Remote Therapeutic Monitoring (RTM) management services CPT codes are available for billing therapist and assistant time spent managing RTM data and communicating with patients.

CPT 98979
• Billed per calendar month
• Covers the first 10–19 minutes of RTM management services
• Requires at least one interactive communication with the patient or caregiver during the month

When 20 or more minutes of RTM management services are provided in the same calendar month, CPT 98980 is billed instead.

These new codes create a compliant pathway for billing RTM management work such as reviewing patient data, adjusting care plans, and communicating with patients remotely.

For a deeper breakdown of RTM billing and documentation rules in 2026, use the link to access the on-demand webinar.

https://gawendaseminars.com/product/remote-therapeutic-monitoring-for-outpatient-physical-and-occupational-therapy-in-2026/

01/14/2026

New SLPs in the practice? CPT coding confusion is common and costly.

Speech-language pathologists are expected to navigate CPT codes, NCCI edits, and modifier 59 correctly from day one, but most graduate programs do not teach the realities of billing and compliance.

That gap leads to:
• underbilling
• overbilling
• denied claims
• and unnecessary compliance risk

The January 20, 2026 CPT Coding & Billing for Speech Therapy Services webinar is designed to close that gap.

This live training covers:
• the CPT codes most commonly billed by SLPs
• what interventions belong under each code
• how NCCI edits and modifier 59 work
• Medicare’s 8-minute rule vs. the AMA substantial portion methodology
• real-world billing scenarios with correct answers

Whether onboarding a new clinician or tightening up current billing processes, this webinar provides the clarity teams need to bill correctly and confidently.

🔗 Click the link to learn more and register.
https://gawendaseminars.com/events/2026-speech-therapy-cpt-coding-billing/

01/13/2026

Every once in a while, even the most organized clinic has this happen..

A daily note doesn’t get entered.
A progress report is missed.
A discharge summary is forgotten.

The question is not if it happens.
The real question is how you fix it without creating a compliance problem.

That’s exactly why I published this week’s new article..
“How to Document Late Entries in the Medical Record”

In this article, I walk through:
• What CMS actually allows when documentation is entered after the fact
• How late entries must be dated, timed, and labeled
• What not to do if you want to avoid audits, denials, and repayment demands

Most compliance issues I see aren’t intentional. They come from trying to “fix” documentation the wrong way after the fact.

This article gives you the correct process straight from CMS guidance.

If you’re a Gawenda Seminars & Consulting member, you can read it now inside the Members Library. If you’re not a member, this is one of the many compliance updates you get access to year-round.

Because in today’s audit environment, how you document matters just as much as what you do.

Members can access this article here:
https://gawendaseminars.com/how-to-document-late-entries-in-the-medical-record/

01/12/2026

Can you bill CPT 97750 for writing a progress report?

This is a question that comes up often and it’s an important one to get right.
The short answer: No.

There is no CPT code for a progress report.

CPT 97750 (Physical Performance Test or Measurement) cannot be billed for the time spent:
• asking the patient subjective questions
• gathering progress updates
• performing routine re-tests
• documenting or writing the progress note

That time does not disappear, but it must be handled correctly.

The minutes spent collecting and documenting progress are rolled into the timed CPT codes you are billing that day (such as therapeutic exercise, neuromuscular re-education, therapeutic activities, etc.). Those added minutes may or may not increase the total number of billable units depending on how the time works out.

This rule applies not only to Medicare, but to all insurance carriers.

Getting this right protects your reimbursement and your practice.

If you want to stay ahead of issues like this in 2026, make sure your coding and billing team understands exactly how these rules work.

01/09/2026

If an Original Medicare beneficiary presents to outpatient therapy with a physician referral that is:

• signed and dated
• specifies the discipline of therapy
• and is included in the medical record
.and the therapist sends the Plan of Care to the physician within 30 days of the initial evaluation, that referral can now serve as the initial Plan of Care.

That means you do not need the physician to sign and return the Plan of Care for it to be valid.

This is a major workflow and compliance shift for outpatient therapy clinics.
But only if you follow the documentation rules correctly.

Small regulatory details like this make the difference between getting paid.. and getting denied.

01/08/2026

January is one of the most common times we see unexpected Medicare reimbursement issues show up in outpatient therapy practices.

Here’s why 👇

At the start of the year, many Medicare beneficiaries:
• switch from Traditional Medicare to a Medicare Advantage plan
• change Medicare Advantage plans without realizing the impact
• forget to tell their provider altogether

Now add this layer..

Some Medicare Advantage plans require prior authorization.

That means you could be:
• 4, 5, or even 6 visits into care
• providing services in good faith
• and later find out those visits aren’t reimbursable

All because the insurance change wasn’t identified early.

This is why January intake conversations matter.

Make it routine to ask:
✔️ Did you switch from Original Medicare to Medicare Advantage?
✔️ Did you change Medicare Advantage plans for the new year?

Catching this early can save your clinic time, revenue, and frustration down the road.

For more guidance on Medicare regulations, payment updates, and compliance strategies for outpatient therapy services, stay connected with Gawenda Seminars & Consulting and explore the educational resources available year-round.

01/07/2026

New grads bring energy and clinical skill. But CPT coding and billing is often where confidence drops.

If your team could use a clearer understanding of CPT coding and billing for PT & OT in 2026, this upcoming webinar is designed to fill those gaps.

✔️ Breakdown of CPT codes used by PTs, PTAs, OTs, and OTAs
✔️ What interventions fall under which codes
✔️ Medicare’s 8-minute rule vs. AMA’s substantial portion methodology
✔️ Real billing scenarios with clear explanations of the correct approach

📅 January 15

Click below to learn more and register.
https://gawendaseminars.com/events/2026-pt-ot-cpt-coding-billing/

01/06/2026

Two new 2026 updates just dropped on the Gawenda Seminars and Consulting Members Website 👇

This week’s articles cover:
• 2026 MIPS Quality Measure Specifications for Medicare Part B claims and registry reporting
• 2026 Dollar Amount to Appeal to an ALJ, including the updated threshold set by CMS

Both are the kind of details that can easily get missed but have real implications for compliance, reporting, and reimbursement in the year ahead.

Members can log in now to read the full breakdowns.
https://gawendaseminars.com/news/

Not a member yet? This is exactly the type of update you’ll get year-round to help you stay informed, prepared, and confident as regulations continue to evolve.

01/05/2026

Don't miss our next webinar: Boulder/Denver, Colorado

This seminar will teach participants what they need to know about documentation, CPT Coding, NCCI Edits, and Billing

01/05/2026

CMS has spoken on the 2026 Medicare Physician Fee Schedule, and while the conversion factor is increasing, it doesn’t end there.

Yes, the overall conversion factor is up approximately 3.25% for 2026, but individual CPT codes tell a more nuanced story. Many therapy codes are seeing smaller increases, while some have decreased due to changes in relative value units.

For outpatient physical, occupational, and speech therapy providers, this matters. And it doesn’t stop with Medicare. Commercial payer policies from Anthem Blue Cross, Aetna, Cigna, Humana, and others are also evolving.

Understanding what’s changing, and how it impacts reimbursement and compliance, is critical heading into 2026. Want the full breakdown? You can purchase our webinar where we covered this in detail.

Available here 🔗
https://gawendaseminars.com/product/2026-outpatient-therapy-regulatory-and-payment-updates/

01/02/2026

Happy New Year from the Gawendas! We brought in the New Year with great friends. 🥳

Kennedy Hawkins
Frances R Hawkins
Michelle Gawenda
Rick Gawenda

No matter what changes come this year, our goal at Gawenda Seminars and Consulting remains the same: helping you feel informed, supported, and confident in your outpatient therapy practice.

Wishing you a happy, healthy, and successful new year.