Coronavirus and Therapy in the Home
Due to the coronavirus (COVID-19), I am receiving many questions regarding the ability for physical therapists, occupational therapists and speech-language pathologists to provide outpatient therapy services in a patient’s home and to have those services reimbursed by the Medicare program and private/commercial insurance carriers. See below for some of the common questions I receive and the answers to each question. This article was originally published on March 16, 2020, but I republished it today and added additional Q&As.
Question
Does the Medicare program reimburse for outpatient therapy in a patient’s home?
Answer
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Question
What is considered a patient’s home?
Answer
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Question
With the outbreak of the coronavirus (COVID-19), instead of a Medicare beneficiary coming to my clinic or department for outpatient therapy, can I switch and start seeing them for outpatient therapy in their home?
Answer
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Question
If I am a private practice, how do I notify my Medicare Administrative Contractor that I’m now treating the Medicare beneficiary in their home and not in my clinic?
Answer[restrict paid=true]
On the 1500 claim form, you would change the Place of Service (POS) code from an 11 to a 12. In a non-private practice setting, you submit claims on a UB-04 claim form and a POS code is not required.[/mepr-show]
Question
Can a hospital send a therapist into a Medicare beneficiaries home to treat them as an outpatient?
Answer
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Question
If I own a private practice, can I send my physical therapist assistant (PTA) or occupational therapy assistant (OTA) to treat a Medicare beneficiary in their home for outpatient therapy services?
Answer
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Question
Can a physical therapist assistant (PTA) or an occupational therapy assistant (OTA) employed by a hospital and submitting claims on a UB-04 claim form be utilized to treat Medicare beneficiaries in their home as an outpatient?
Answer
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Question
Do private/commercial insurance carriers reimburse for outpatient therapy services provided in a patient’s home?
Answer
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Question
Can I bill the Medicare program and other commercial insurance carriers for my drive time and mileage?
Answer
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Question
Can I charge the Medicare patient cash for my drive time to their house?
Answer
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I hope you found the questions and answers helpful in making your decision whether or not to provide outpatient therapy services in a Medicare beneficiaries home. Thank you for being a Gold Member!
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In the process of contacting insurances to see what is needed on the 1500 form to notify them of the home visit. I’ve been told by two insurances so far, that place of service should be 12 and box 32 should include the address where the patient was treated. Is this accurate? I’m not getting consistent information – seems to vary insurance to insurance.
Box 32 is used to indicate the name and address of the facility where services were rendered. Enter the name, address, city, state, and ZIP code of the location.
Seeing mixed information on the place of service code. Some places you read say place of service is 02 but here I see it is saying 12? Was there a recent update? Also some placed you read say a modifier 95 should be used others say nothing about the modifier, should a modifier be used?
I did add an additional question to this article regarding place of service code. Regarding Modifier 59, you would need to check with the insurance carrier. Modifier 59 is only to be used with CPT codes listed in Appendix P in the 2020 CPT Book.
I’m sorry not modifier 59.. modifier 95
No. But you are commenting about Telehealth on the wrong article. This article is about providing therapy in a patient’s home.
Just to clarify, is a private PT doing physical therapy in a patient’s home different than a patient getting physical therapy through a home health agency for billing purposes? I know that home health bills a period of care, but a private PT could bill per visit? Would the visit apply to the Medicare Part B benefits? Also, does the PT need any additional credentialing from Medicare?
Thank you.
A private practice providing an outpatient therapy visit in the home is different that a Medicare beneficiary receiving home health services under an active home health plan of care. No additional credentialing is required and all the documentation, coding, billing, etc. are the same whether you see them in their home or they come to your office.
Rick the MBPM says “when a hospital sends its therapists to the home of an individual who is registered as an outpatient of the hospital, but who is unable, for medical reasons, to come to the hospital to receive medically necessary services, the services must meet the requirements applicable to outpatient hospital therapy services, as set forth in the regulations and applicable Medicare manuals. The hospital may bill for those services directly using bill type 13x or 85x for critical access hospitals.” I think you commented earlier that these services may also be billed on a UB-04. Is that correct? We have a hospital based outpatient department and are trying to figure out the billing requirements. Thank you!
It would be billed on the UB-04 claim form since you are billing under the hospital’s NPI number.
Is my understanding that there is no change to UB billing when hospital based outpatient therapy is provided onsite vs in the home correct?
Correct
Do therapist have to wear PPE kits to treat in the home?
That is not a question for me to answer. You would want to contact the appropriate person or department in your organization. I would also recommend you read the current CDC guidelines.
Thanks for the article. I am part of a critical access hospital’s OP therapy department.
Question: Are we able to perform the initial evaluation with the patient’s home as the point of service? We have a number of elective surgery patients that would not come in to the hospital after the emergency declaration.
Per the Indiana State Department of Health, while CMS allows OPT to provide services in the home, the State of Indiana requires a home health license to do so. At the time I reached out to them, they were not considering any waivers to this requirement. Check with your State laws to verify that they are not more restrictive than CMS.
Hi Rick, Thank you for the information. On page 18 of the CMS 855b application, section 4D “Rendering services in patients’ home”, does this need to be filled out to provide “outpatient” physical therapy with POS 12?
I understand the above states that nothing extra is needed and coding is all the same, but is that assuming this section was filled out?
I appreciate your help!
Thank you.
I work in an CAH outpatient therapy dept (bill on a UB04). I am wondering if we provide outpatient services in a patient’s home would we have to indicate to CMS the patient’s address as a PBD? I only thought of this since we are going to have to jump through that hoop to provide synchronous audio/video “telehealth” (although I do understand it is not considered telehealth). Never thought about this before. Or do we just bill as if we saw the person in clinic?
thanks
If seeing a Medicare patient in their home as an outpatient (therapist going into the home), you would not add the home as a PBD since you are not delivering the services remotely. Read Section 230.6B of this link:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
I know this thread is quite old, and not sure if this the correct place to ask this question, but what about OPPT in an ASC to provide post op gait training etc. More and more surgeons are going to ASC for TJAs.
Typically, that cost is included in the APC payment for the total joints and is not separately billable and payable.