Coding and Billing
International Classifications of Diseases 10th Revision, Clinical Modification (ICD-10-CM)
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 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
- 95992: Canalith Repositioning procedures
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
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.
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.
- Private Practice
- Skilled Nursing Facility (PDPM) and Home Health Payment Models (PDGM)
- Busting Medicare Part B Myths (and Regulating Your Expectations)
Special Topics
APTA Learning Center Courses on Payment and Reimbursement