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