Comparative Billing Reports Released

March 20, 2017
Rick Gawenda

eGlobalTech (EGT) and Palmetto GBA have developed and disseminated a national provider Comparative Billing Report (CBR) in February 2017 on physical therapy services provided by physical therapists in private practice. The report contains data-driven tables with an explanation of findings that compare these providers’ billing and payment patterns to those of their peers in their state and across the nation.

Approximately 15,000 letters were sent to physical therapists in private practice identified as having different billing practices when compared to their peers. This most recent CBR includes claims with dates of service July 1, 2015 to June 30, 2016. This CBR examines physical therapy services billed with Current Procedural Terminology (CPT®) codes 97001, 97002, 97035, 97110, 97112, 97140, 97530, and Healthcare Common Procedure Code System (HCPCS) code G0283 billed with the GP modifier, signifying services delivered under an outpatient physical therapy plan of care.

The CBR focuses on 5 areas that include the following 5 tables:

  1. Table 1 provided the CPT®/ HCPCS codes covered in this CBR with the abbreviated description
  2. Table 2 provides a summary of your utilization of the procedure codes included in this CBR.
  3. Table 3 provides an analysis of the percentage of beneficiaries with KX modifier.
  4. Table 4 provides an analysis of the average minutes per visit.
  5. Table 5 provides an analysis of the average allowed charges per beneficiary.

Table 3 provides the percentage of Medicare beneficiaries who exceeded the therapy cap for each state as well as the national average. Table 4 provides the average minutes per visit for each state as well as the national average. Table 5 provides the average allowed charges per beneficiary by each state as well as the national average. Below< I will discuss Tables 3-5 more in-depth.

Percentage of Beneficiaries with KX Modifier

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  1. Hello, I received my CBR letter. I skimmed through the contents. Since I receive so many letter of solicitation I threw it away. Should I be alarm by this. Should I be doing something about it.

    1. I would suggest you go find it from the trash and review the findings. Based on the findings, conduct a self audit of some of your Medicare charts to ensure the documentation shows the medical necessity of your interventions provided and that it required the unique skills of a therapist to provide.

  2. Rick,
    So…What is going to happen from there? Will these facilities be audited by medicare? Will medicare be looking at the national data or state data more to compare one facility? Do they mention anything about outcomes of the therapy performed, or is this strictly financial? Thank you for your response.

    1. The report does not discuss outcomes. The report is solely focused on utilization of the KX modifier, minutes of therapy provided and dollars per beneficiary. It’s impossible for them to measure outcomes since most facilities do not have outcomes and those that do, they are not standardized across the United States for the different conditions we treat. Receiving a report does not mean you will be audited by your Medicare contractor, but could you be at a higher risk, especially if you received a letter a few years ago with the first CBR?