FAQ – PT/OT

Question – Posted April 24, 2014

How do we bill for a patient referred by a physician for pre-op gait training? Does it matter if there is no formal evaluation completed? This question is in regards to all insurances, Medicare and private? If Medicare, would I have to report G-codes?

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Question – Posted April 19, 2014

Can non-private practices bill daily to Medicare.

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Question – Posted April 19, 2014

How does Medicare define a re-evaluation and what is the criteria for performing and billing for a re-evaluation?

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Question – Posted April 19, 2014

In order to bill Medicare for services provided by an occupational therapy assistant (OTA) or physical therapist assistant (PTA), must the occupational therapist (OT) or physical therapist (PT) be on the premise?

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Question – Posted April 19, 2014

In a private practice setting, can a PTA or an OTA treat and bill for services provided to a Medicare beneficiary without the therapist being on the premise?

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Question – Posted April 19, 2014

In a private practice setting, does the Medicare program reimburse for CPT codes 97597 and 97598?

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Question – Posted April 19, 2014

Has anyone seen any clarification from Medicare on how to handle situations where you are certifying the plan of care in the outpatient setting and the plan of care document is returned to you without being dated by the physician?

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Question

On the 1500 claim form used by private practices, where does the physicians name and NPI number who is certifying the outpatient therapy plan of care go?

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2012-09-28 02:09 AM

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Does therapy provided in a hospital outpatient therapy department prior to October 1, 2012 count against the therapy cap threshold?

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In 2012, if a Medicare contractor approves an advance exception request for therapy above the $3700 threshold, do we still append the KX modifier to the CPT codes on the claim form?

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2012-09-28 02:09 AM

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Does the therapy cap and manual medical review process also apply to Medicare Advantage plans.

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2012-09-28 01:09 AM

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If a Medicare patient exceeds $3700 prior to October 1, 2012, can the Medicare contractor come back after October 1, 2012 and take the money back?

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2012-09-28 01:09 AM

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Do L codes count towards the therapy cap?

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2012-09-28 01:09 AM

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I practice in a non-private practice setting. If a Medicare patient reaches the therapy cap in a given month for either occupational therapy or physical therapy and speech-language pathology services combined, must we append the KX modifier to all CPT codes billed that month depending which cap was met?

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2012-09-28 01:09 AM

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If a Medicare patient is at or above the $1880 or $3700 threshold for occupational therapy or physical therapy and speech-language pathology services combined, and they come in for an evaluation on or after October 1, 2012, will the Medicare program reimburse us for the evaluation so we can then submit for an advance exception request?

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2012-09-28 01:09 AM

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I practice in a hospital outpatient department. We are in phase 3 for the manual medical review process that begins December 1, 2012. If I treat Medicare patients in October or November and they have exceeded the therapy cap threshold of $1880, must I use the KX modifier or not until December 1, 2012?

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2012-09-23 06:09 PM

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On October 1, 2012, a Medicare patient requires outpatient therapy services and the patient is already above the $3700 threshold for the manual medical review process. If I am in phase 2 or phase 3, do I have to request an advance exception request for services provided in October 2012?

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2012-09-23 06:09 PM

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If our Medicare contractor denies therapy provided above $1880, is the Medicare patient responsible for those charges even if an ABN was not provided to the patient.

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2012-08-23 10:08 PM

Question

Must our state license number be attached to our documentation or next to our signature?

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2012-08-23 10:08 PM

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Is it permissible for a PTA to apply a TENS unit to a patient without an assessment being completed by the physical therapist?

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2012-07-13 06:07 PM

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Must we use a V code as the primary diagnosis on the claim form for outpatient therapy services?

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2012-07-13 06:07 PM

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Can you provide any guidance on the use of the “8-minute rule” in the inpatient hospital setting?

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2012-06-23 03:06 AM

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Under Medicare Part B outpatient therapy services, what are the supervision requirements for a physical therapist assistant and an occupational therapy assistant?

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2012-06-23 03:06 AM

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Will Medicare managed care plans be included in the therapy cap dollar amount of $1880 for OT and $1880 for PT and SLP combined?

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2012-06-23 03:06 AM

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Can a student therapist or student therapist assistant document in the medical record for a Medicare Part B patient?

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2012-06-02 03:06 PM

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Under Medicare Part B, can a PTA or OTA write the Discharge Report and have the PT or OT co-sign the Discharge Report?

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2012-06-02 03:06 PM

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I am an OT in private practice, my company has a Group PTAN Medicare provider number. I just started providing PT services two weeks ago. Do my physical therapist need to have a Medicare provider number? or is OK to do PT billing under my Group Medicare provider #?

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2012-06-02 02:06 PM

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If a physician writes an order for the therapy services for 3 times per week for 6 weeks, does the 6 weeks start from the date on the order or from the date that the initial evaluation is performed?

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2012-06-02 02:06 PM

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Under what CPT code would you bill fluidotherapy?

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2012-04-30 03:04 PM

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When the therapy cap is implemented to hospital outpatient therapy departments in 2012, will the therapy cap also apply to critical access hospitals?

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2012-04-30 02:04 PM

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When you are currently treating a patient for one condition and while still treating the first condition, the patient presents with a new referral for another condition, should I bill an evaluation or re-evaluation?

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2012-04-24 06:04 PM

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Under what CPT code would I bill for crutch training after a patient has had ambulatory surgery?

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2012-04-20 04:04 PM

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If I am providing trigger point electrical stimulation on a patient with Bell’s Palsy, what CPT could would I bill for that intervention?

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2012-04-01 02:04 PM

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How long is a physician order/prescription valid for?

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2012-04-01 02:04 PM

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Can a physical therapist or occupational therapist evaluate and treat a patient referred by an out of state physician or non-physician practitioner (NPP)?

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2012-04-01 02:04 PM

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Is there a problem if a patient is shared between an OT and a PT for a diagnosis like lymphedema or lateral epicondylitis? If both do their own plan of care and get a physician prescription for PT and one for OT, physician signs off on both their plan of cares; is it a problem that the patient goes back and forth between the two therapists (i.e. sees the PT 2x/week and the OT 1x/week for pretty much the same treatment)? The main reason this happens is due to part-time staff and getting patients in if they need more than 2x/week, especially with specialized treatment like lymphedema.

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2012-03-29 10:03 PM

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Where do I find information about the amount of dollars that my patient has accrued toward the therapy cap?

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2012-03-29 10:03 PM

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What is the current status on the therapy cap and the therapy cap exception process for 2012?

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2012-03-11 07:03 PM

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Does Medicare’s “8-minute rule” apply to non-Medicare insurance companies such as commercial insurance companies and state workers compensation programs?

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2012-02-25 11:02 PM

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Can a physical therapist, occupational therapist, speech-language pathologist in private practice opt out of the Medicare program and see Medicare patients as cash paying patients?

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2012-02-25 10:02 PM

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What is Medicare’s position on treating a patient for 2 different conditions? Will the Medicare program reimburse for a second evaluation for the second diagnosis?

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2012-02-25 10:02 PM

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Regarding the orthotic management codes, do I report 97760 for the initial visit when you do the patient assessment and fabricate the orthotic, and then use the 97762 for further visits when you are making adjustments? Or if you use 97760, does that one time you report that code include every follow up visit for the orthotic in the future?

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2012-02-07 03:02 AM2012-02-07 03:02 AM

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If I am only taking range of motion (ROM) measurements or performing manual muscle testing (MMT) and not performing a complete re-evaluation, can I bill the ROM CPT codes (95851-95852) and MMT CPT codes (95831-95834) ?

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2012-02-07 03:02 AM

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Does the Medicare program and other insurance carriers reimburse for more than 1 unit of a physical and/or occupational therapy evaluation if multiple body parts are evaluated on the same day?

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2012-02-07 03:02 AM2012-02-07 03:02 AM

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What is the documentation of time requirements for non-Medicare insurance companies?

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2012-02-07 03:02 AM

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What is the documentation of time requirements for outpatient therapy under the Medicare program?

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2012-02-07 03:02 AM

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Can you be reimbursed for other one-on-one codes on the same day you bill 95992 to the Medicare program?

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Question

Does the Medicare program reimburse for CPT code 95992, Canalith Re-positioning?

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2012-02-07 03:02 AM

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How do you document to show your Medicare contractor that modalities and/or procedures were performed at separate and distinct times and that the use of modifier-59 was appropriate?

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2012-02-07 03:02 AM