This week, I will provide 3 billing scenario’s that can be applicable to either outpatient physical therapy or outpatient occupational therapy services and provide the billing answer for Medicare beneficiaries and those insurance carriers that follow the Medicare Program billing rules (i.e. “8-minute rule) and will also provide the billing answer for those insurance carriers that do not follow the Medicare Program billing rules, rather, follow the definition of a substantial portion of a time-based CPT per the American Medical Association (AMA).
- 16 Minutes of joint mobilizations, soft tissue mobilization, and myofascial techniques
- 20 Minutes of range of motion and strengthening exercises
- 20 Minutes of unattended electrical stimulation for pain reduction
Scenario #1 Answer
- 10 Minutes of unattended electrical stimulation
- 12 Minutes of strengthening and active assist range of motion exercises
- 6 Minutes of manual therapy techniques to increase ROM
- 7 Minutes of functional activities of lifting and carrying
Scenario #2 Answer
- 27 Minutes performing a medically necessary reevaluation
- 12 Minutes patient on the upper body ergometer (UBE) for shoulder warm-up
- 18 Minutes of shoulder strengthening and range of motion exercises
- 12 Minutes of manual therapy techniques to increase AROM
Scenario #3 Answer
I hope you found this article helpful. Watch for a Part 2 article where I will provide additional billing examples for physical and occupational therapy. Thank you for being a Gold Member!
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