How is physical therapy billed

So, what are one-on-one services? During her Ascend presentation, Deb Alexander explained that these codes are cumulative, require constant attendance, and are time-based, which—as this article points out—means that the 8-minute rule applies.

See how many units you can bill based on treatment time. Group therapy still requires constant attendance, but it does not involve one-on-one contact with the patient. To learn more about the differences between billing for one-on-one services and group services, read this article. Sometimes billing feels like guessing game—one that can leave you scratching your head over claim rejections and denials. Looking for a refresher on your billing terminology?

Today, most payers—and providers—prefer electronic claim forms. However, some payers—a dwindling few—do still accept paper ones. Occasionally, you may actually submit your billing information to a claims clearinghouse that will create the bill and send it out on your behalf.

A lot of providers use a billing software to prepare and submit their claims. The really smart ones use an electronic medical record system that includes or integrates with a top-notch therapy billing software hello, WebPT. That way, they eliminate double data-entry—as well as the errors associated with it. To learn more about selecting the right billing software for your clinic, read this article.

In addition to everything listed above, Therabill offers credit card processing, auto-eligibility checks, a patient portal, an integrated, no-fees clearinghouse, and unlimited claims submission and support—all designed to help you get paid quickly and accurately. WebPT has 30 years of outpatient rehab therapy billing experience, making it the largest and most tenured RCM company in the industry. Our RCM team processes more than 5 million claims per year and more than , visits per month.

That way, you can be sure the company will relentlessly post and reconcile payments—and investigate, correct, and appeal claim denials. Wondering which billing solution is best for your practice?

Download our flowchart to find out. Stressing about which type of billing is the best option for your practice? Software or service? Much of the services you can provide can fall under therapeutic exercise, even though it may fit better under another code, allowing for a higher rate of reimbursement.

Healthie offers a cloud-based EHR and telehealth platform that is quick to implement while supporting compliance with HIPAA regulations — while being customizable to meet your business needs.

In addition, the Healthie platform integrates with insurance billing tools, so that you can quickly create Superbills and CMS claims, send invoices, and collect payments for out-of-pocket services. We have seen physical therapists and occupational therapists that use Healthie find success with reimbursement for virtual services.

Let us help you launch your practice. Platform Features. Physical Therapy CPT Codes There are a variety of different codes that can be used when billing for physical therapy; we are going to go over 13 of the most commonly used ones here. From now on, for initial evaluations, providers should choose from one of three codes, that deem the level of complexity of the patient presents: Physical therapy evaluation, low complexity Physical therapy evaluation, moderate complexity Physical therapy evaluation, high complexity Code was replaced with Re-evaluation of physical therapy established plan of care, and requires an examination to take place and a new revised plan of care to be presented.

Timed vs. Untimed Codes for Medicare For rehabilitation providers that bill Medicare, there are two different types of billing codes: untimed and timed codes.

Modifier Codes There are a variety of modifier codes that PTs can include on their insurance claim. Physical Therapy Billing for Telehealth While insurance reimbursement for telehealth services was primarily provided to medical doctors, there has been a dramatic rise in the reimbursement for virtual specialty services, including physical therapy.

Using Healthie for Physical Therapy Billing Healthie offers a cloud-based EHR and telehealth platform that is quick to implement while supporting compliance with HIPAA regulations — while being customizable to meet your business needs.

Ability for clients to log images and journal entries: for you to assess their progress between sessions. Make more time to grow your business Use a platform that automates the administrative, so you can focus on growth and care. Free day Trial. Related Articles. Read Healthie's telemedicine physical therapy guide. Learn about the benefits of tele physical therapy using our telehealth platform. Getting credentialed by an insurance payer helps you to become an in-network physician that can help you access a wider base of potential customers, and support them.

When you have not already earned a credential in your region with a big payer, you may want to try and change it. In order to obtain reimbursement from Medicare for a time-based code, you must have direct treatment for at least eight minutes, according to the law. However, although it sounds basic, there are some tricky 8-minute rule scenarios that could make you trip up. There are however other avenues in which you can offer support to patients in need.

Learn your insurance policies carefully and find out more about what the payers deem appropriate when it comes to helping patients cover the costs of their care. If you still hit a dead end-handed, contact directly with your payers. If there are different therapists who give treatment to the same patient at the same time then what is the rule?

On the other hand, therapists can bill separately if they are billed under Medicare part A, therapists should provide thorough treatment sessions and each therapist should be of different specialty and offer various treatments to the same patient at the same time.

To put it plainly, the time spent on a patient being treated is billable. There are a few complexities to bear in mind though. You cannot bill for:. Under the following situation one should bill for a reevaluation :. The cap does not reset for each diagnosis. Still, to ensure the cap does not prevent Medicare patients from obtaining medically necessary care, Congress has also passed legislation every year that allows exceptions for exceeding the cap.

In , there is a two-tiered exceptions process. In order to provide Medicare patients with services that you believe are either not covered by Medicare or not medically necessary e. To learn more about how and when to correctly administer an ABN, read this article. Modifier 59 If you provide two wholly separate and distinct services during the same treatment period—specifically, services that are typically bundled together—you may need to apply modifier 59 to signal that you should receive payment for both services.

Download your printable modifier 59 decision chart here. If you believe it is medically necessary for a patient who has already reached the therapy cap to continue treatment—thus qualifying the patient for an exception—you would attach the KX modifier and clearly document your reasons for continuing therapy.

Please note that if you use the GA modifier, you should not use the KX modifier. Speaking of ABN-related modifiers, there are three more you should know about :. Take this quiz to test your smarts. There you have it: 10 must-know rules of PT billing in digest form.

How do you stay on top of PT billing rules? What resources are your favorites? Tell us in the comment section below. About the Author Heidi Jannenga is co-founder and president of WebPT , the leading electronic medical record solution for physical therapists and a three-time Inc. Toggle navigation o Physiospot.