Double Booking Medicare Patients: Is This Allowed

May 6, 2019
Rick Gawenda

Last week, I wrote an article explaining how much time of a time-based CPT code must be provided in order to bill that CPT code to an insurance carrier as well as explaining the difference between Medicare’s “8-minute rule” and the American Medical Association (AMA) definition of substantial when billing a time-based CPT code. This article then led people to ask me if I can double book and/or overlap Medicare patients receiving outpatient therapy services. I’m going to answer this question once and for all and the answer will not only apply to outpatient therapy services paid under Medicare Part B benefits, but will also apply to commercial and workers compensation carriers.

What we need to remember is no insurance carrier cares or dictates how you schedule their patient’s for outpatient therapy services and this also includes the Medicare program. What insurance carriers, including the Medicare program, do care about is that their patient’s receive quality and medically necessary therapy services and that those services are billed correctly based on the description of each CPT code and the amount of time spent with the patient.

The biggest mistake I find that providers make is that they do not realize the description of the CPT codes that state “requires direct (one-on-one) patient contact” applies to all patient’s and all insurance carriers, not just the Medicare program. So if a CPT code states “requires direct (one-on-one) patient contact”, the therapist or assistant must be one-on-one with that patient in order to bill that CPT code to the insurance carrier.

So lets answer the question “Can I double book Medicare patient’s”? The answer is

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  1. I have a question about double booking. Let’s just assume that we are talking about 2 commercial patients and not Medicare. You have a PT/PTA student working with you. As the PT I am working with one patient and the student is working with the other patient. We will assume that the practice act does not preclude the student from working in this fashion and there is nothing in the contract that prohibits a student from working on the patient. Would it be acceptable at that time for both the PT and the student to bill for the full time they spend with each patient since each one is being see one-on-one? Thanks for your insight?