National Government Services (NGS) has released the findings of their post-payment review they conducted on the physical therapy reevaluation CPT code, 97164 for the states of New York, Connecticut, Massachusetts, Maine, New Hampshire, Vermont and Rhode Island. The review focused on bill type 13X or 85X which means the claims selected were submitted by a hospital outpatient therapy department (bill type 13X) or a critical access hospital (bill type 85X).
The results of this review provide a summary of claims with dates of service of 1/1/2019 through 2/28/2020 and do not include appeal results for overturns and decision reversals.
Number of Claims Reviewed: 1,258
Number of Claims Denied: 956
Claims Denial/Error Rate: 75.99%
Charges/Payment Error Rate: 86.48%
To read the full report and see what the denial reasons were, click HERE.
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