Can a Medicare Beneficiary Receive Outpatient Therapy at More Than One Practice/Organization During the Same Time Period?
There may be circumstances where a Medicare beneficiary may be receiving therapy services at more than 1 practice/organization during the same time period, either by the same discipline or different disciplines. However, when this occurs, will the Medicare program reimburse both practices/organizations of outpatient therapy services?
The answer is
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Rick, sorry to say that this is not true if one of the institutions is a home health agency or if the patient is under hospice care. Mitch Kaye
Mitch, This article is not talking about home health services. The article is discussing receiving outpatient therapy at more than one location during the same time period. Also, a patient in hospice can have outpatient therapy separate from hospice if certain conditions are met. Please read my Hospice FAQs at https://gawendaseminars.com/faq/hospice/
I love your response about all other carriers. Unfortunately there is less and less medicare every year, and will continue that way.
Hi Rick, Thank you so much for your updated information and guidance. Before reading the above article, I always thought a Medicare beneficiary cannot get concurrent P.T. services at 2 different locations for different body parts.
Knowing that now, raises a question for scenario 1:
Does the Medicare $2330.00/yr limit apply to both clinics combined?
Would appreciate your clarification.
Thank you
-Jaya
Yes!
Rick,
How would the MPPR be applied in the situations you described? Would it be determined by which facility got their bill in first?
I have added this content to the article.
Thank you for this information, if I remember correctly this was not so a few years ago. Also can you clarify if the therapy at different locations could be for body parts such as cervical radiculopathy and same side shoulder or must be distinctly separate without overlap?
This has always been true. Simple answer is documentation needs to support the therapy you provide.
In scenario #2, you were specific about it being ok to receive both services on the same day (different disciplines). In scenario #1, can that patient receive services from both clinics on the same day?
Medicare, yes. Other payers, you would need to check.
Does this also apply when the patient is seen on the same day by more than one practice/organization?
Also can a Medicare patient be seen by a PCP/MD and an outpatient physical therapy on the same day?
We have been told by some patients that they cannot, so I am just trying to clear this up.
Thanks
If the physician services and therapy services are at the same location, you may need to look at the NCCI edits to see if modifier 59 would be required on any of the CPT codes.
I’ve had patients going elsewhere, but they can not see me the same day, as services are denied! Sadly, there were too many manual therapy codes billed (Manual Lymph Drainage is still just a 97140 code) and they had manual therapy for the total knee service earlier that day. I always tell patient’s to schedule my service on a different day.
It all depends on the insurance carrier.