When Would I Use CPT Code 97799?

Per the American Medical Association (AMA), CPT code 97799 is defined as “Unlisted physical medicine/rehabilitation service or procedure”. CPT code 97799 would be used when the therapy service or procedure provided is not described by a more specific CPT code. Examples of services or procedures that would be billed using CPT code 97799 would include

Physical Therapy and Locum Tenens

The Centers for Medicare and Medicaid Services (CMS) will implement section 16006 of the 21st Century Cures Act that allows outpatient physical therapy services furnished by physical therapists to be billed under reciprocal billing and fee-for-time compensation arrangements in the same manner as physicians in certain areas of the United States. The term “locum tenens,”…

Habilitative vs Rehabilitative Therapy

Many insurance carriers, including many state Medicaid programs, have different outpatient therapy benefit coverage dependent upon whether the therapy is rehabilitative in nature or habilitative in nature. In addition, some insurance carriers are requiring a modifier be reported on the claim form to indicate if the therapy provided was rehabilitative or habilitative. In this article,…

Must I Participate in MIPS

In calendar year 2017 and 2018, physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetist are eligible to participate in the Merit-Based Incentive Payment System program. Physical therapists, occupational therapists and speech-language pathologists in private practice are not eligible to participate in MIPS in 2017 and 2018 , but may be…