Despite its catastrophic toll, the COVID-19 public health emergency has also brought some helpful changes to healthcare that make service delivery more convenient and cost-effective.
For physical and occupational therapists, the opportunity to provide treatment via telehealth has enabled them to continue critical treatment for COVID-exposed and infected patients. Finding telehealth less cumbersome and time-consuming, many patients and PTs have continued telehealth appointments even with the decline in the COVID threat.
CMS Issues New Telehealth Physical Therapy CPT Codes
Recognizing this trend (and playing catch-up on backlogged PT telehealth services), the Centers for Medicare and Medicaid Services or CMS has proposed a new category of digital health services—Remote Therapeutic Monitoring (RTM)—to complement the existing suite of Remote Physiological Monitoring (RPM) codes covered under Medicare.
With CMS taking the lead (and covering 100 million consumers), many payers are following suit, allowing PTs and OTs to provide and bill for an array of virtual services. These include:
- Telehealth/E- visits
- Virtual check-ins
- Telephone visits
Coding with accurate ICD-10CM and PCS, CPT, and HCPCS codes is critical for practice viability. Billing administrators who stay up-to-date on precise coding details will win more prior authorizations approved and claims paid on time. We’ve brought you the most current codes and modifiers here.
Know Your Location Codes
When billing for remote therapy services, you typically must notate two “site” locations.
- The originating site is where the patient is located. The Place of Service (POS) type is “home” or POS code 12.
- The distant site is where the physician is located. Choose POS type “office” and POS code 11.
Next, there are three time-based CPT codes that Medicare will cover when providing physical therapy telehealth visits:
These services can only be furnished to established patients that are not originated from a related E/M service provided within the previous 7 days or lead to an in-person office visit/procedure within the next 24 hours.
Before this period, Medicare was not paying for remote physical therapy services. As of March 1, 2020, however, Medicare began covering certain PT CPT code ranges:
97161–97164, 97165–97168, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, and 97761.
Also, be aware that payment for outpatient therapy services furnished by physical therapist assistants will be reimbursed at 85 percent of the Medicare Physician Fee Schedule.
Know Your PT Modifiers
By using the appropriate modifiers, you can avoid denials and ensure proper, timely payment. Make sure you’re clear on the differences between these three modifiers.
- Modifier 95 – Telemedicine service rendered via real-time interactive audio and video telecommunications system. Telehealth will be paid at the normal facility rate, which is typically less than the non-facility rate under the Medicare physician fee schedule.
- GP Modifier – indicates that a physical therapist’s services have been provided and should be used in any case where there could be confusion as to which provider delivered services to a patient.
- KX Modifier – is used for services provided after a patient exceeds Medicare’s $2,010 threshold. Ensure you verify this with the patient’s plan before appending, this may raise a flag if used prior to the threshold.
Coding edits can be put in place in EMR systems to catch these.
Keep Up With How PT Patients Want To Receive Care Today
Too often, PT and OT procedures are under-coded, miscoded, under-documented, or misclassified. These missteps result in more denials, underpayments, and claims abandonments. Nobody likes a write-off. Getting coding right as social forces and healthcare protocols change is critical.
If your physical therapy or occupational therapy practice is burdened by staff shortages and inefficient, costly revenue cycle management, a third-party partner helps them recoup revenue. We bring artificial intelligence (AI) and machine learning capabilities through an integrated and secure HL7 technology to PT and OT providers. Our highly-trained billing specialists come in to help in complex or unique cases. Our solution achieves 98+% coding accuracy, a shift that translates into reduced denials and timely collections.
Schedule a demo to see how our coding support solutions assists your billing specialists so that prior authorizations and claims are submitted accurately the first time.