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Utah Under CMS Probe

Home Health agencies state wide in Utah are under a probe from their CMS intermediary (a Celerian Group Company) based on data revealing recent higher utilization of therapy visits and a higher reimbursement rate than any other state served by CGS. 

According to CGS, the topic code for this review will be 5012W. The probe from CGS will select claims with 10 or more therapy visits.  The selected claims will then be reviewed for:

  • valid FTF encounter documentation
  • skilled need/ medical necessity
  • compliance with all CMS coverage guidelines
  • correct billing and coding
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