APTA Coding and Billing Information

International Classifications of Diseases 10th Revision, Clinical Modification (ICD-10-CM)

Tiered Physical Therapy Evaluation Codes

The final CMS physician fee schedule for 2017 introduced the 3 new CPT codes for physical therapy evaluation and 1 new code for reevaluation. The new evaluation codes reflect 3 levels of patient presentation: low-complexity (97161), moderate-complexity (97162), and high-complexity (97163), and replace the current 97001 code. The new reevaluation code (97164) replaces the current 97002.

Common Procedural Codes (CPT)

 Common PT Codes for Neuro Populations

  • 97110: Therapeutic Exercise
  • 97112: Neuromuscular Re-education
  • 97116: Gait Training
  • 97140: Manual Therapy
  • 97150: Group Therapy (Group resource link)
  • 97530: Therapeutic Activities
  • 97452: Wheelchair Management
  • 97537: Community/Work Reintegration
  • 97750: Physical Performance Test 
  • 97760, 97763: Orthotic Management/Training
  • 97533 Sensory Integration
  • 90901, 90911: Biofeedback
  • 97032: Electrical Stimulation 
For information on National Correct Coding Initiatives (NCCI) click  here
 

8-Minute Rule

Governs the process by which rehab therapists determine how many units they should bill to Medicare for the outpatient therapy services they provide on a particular date of service:  The 8-Minute Rule: What it is and How it Works 

Medicare Coverage of Skilled Maintenance

In January 2014, the Centers for Medicare and Medicaid Services (CMS) issued revised portions of the Medicare Benefits Policy and Claims Processing manuals to clarify coverage of skilled therapy services in maintenance care. The revisions were mandated as a result of the Jimmo v. Sibelius settlement agreement.  CMS Webpage: Jimmo Settlement

KX Modifier Code

As of 2018, the former Medicare therapy caps are now annual thresholds that physical therapist are permitted to exceed when the append claims with the KX modifier for medically necessary services. An annual threshold amount is indexed annually and is combined for PT and SLP services.

CQ Modifier Code

CMS requires the use of the CQ modifier to denote outpatient therapy services furnished in whole or in part by a physical therapist assistant (PTA) in physical therapist (PT) private practices, skilled nursing facilities, home health agencies, outpatient hospitals, rehabilitation agencies, and comprehensive outpatient rehabilitation facilities.

 

Medicare Post-acute Care Reform and Value Based Payment Models 

Special Topics 

APTA Learning Center Courses on Payment and Reimbursement