Physical Therapy Billing 101

28th Nov 2018

Posted by Sara Zuboff on

Physical Therapy Billing 101

Chances are the physical therapists in your practice don’t know a lot about billing. They got into rehabilitation to help people, not learn about insurance billing. However, making sure your practice receives enough money for its services is essential to keep your clinic thriving. Here are a few things to keep in mind when billing for your services to help take the guesswork out of the process.

Learning the ICD Codes for Physical Therapy Billing

When you want to bill for services, you’ll need to have a diagnosis that encapsulates the medical necessity of physical therapy for your patient under the latest version of the International Classification of Diseases code set (ICD-10). It’s especially important to use this billing code at the outset and have it reflect both the diagnosis and current condition. It’s recommended to choose the code that closely matches your patient’s condition based on an objective evaluation.

CPT codes or Current Procedural Terminology were developed by the American Medical Association to be used to bill insurance companies in order for physical therapy practices to receive reimbursement. It is this framework that must be understood in order to bill successfully.

The CPT codes more relevant to a physical therapy practice are located in the Physical Medicine and Rehabilitation section (97000’s). Keep in mind, you may bill for any code outside of this section as long as you can legally provide that service in your state. Another thing to remember is that just because you bill for it, doesn’t make it reimbursable by the payer.

The following codes are the most often used for physical therapy:

  • Evaluations (97161-97163 for PTs) and reevaluations (97164 for PTs)
  • Supervised (un-timed) modalities (97010–97028)
  • Constant attendance (one-on-one) modalities (97032–97039)-these can be billed in 15 minute increments
  • Therapeutic (one-on-one) procedures (97110–97546)
  • Active wound care management (97597–97606)
  • Tests and measurements (97750–97755)
  • Orthotic and prosthetic management (97760–97762)

Billing Terminology for Physical Therapy

In addition to the codes, there is some specific terminology that is important to know and understand. Below is a list of important terms:

Treatment: Refers to all therapeutic services.

Service-based (supervised or untimed) CPT codes: These apply to actions like evaluations for supervised or applying cold packs. This type of code can’t be billed in increments.

Time-based (constant attendance) CPT codes: These are the codes that allow for variable billing in 15-minute increments. These are for one-on-one services, primarily manual therapy or therapeutic exercise.

Evaluation/Reevaluation: This is mostly used for a patient’s initial evaluation which might include a complete patient history as well as any tests (like manual muscle testing).This is when the practitioner is able to determine the diagnosis. A re-evaluation can also be used if a patient’s condition or functional status changes.

Plan of care: A plan of care is necessary documentation for some insurance providers. The practitioner develops the plan of care based on the patient’s diagnosis, physical condition and therapeutic goals which will provide the foundation for future treatment sessions. The plan of care will be based off of any physician referrals for treatment.

Initial certification: The Initial certification is required by Medicare which states practitioners must “approve or certify the plan of care via signature in a timely manner (within 30 days of the evaluation).” Similar to the plan of care, the initial certification covers the first 90 days of treatment. Once the 90 days has past, patient’s must be re-certified to continue treatment.

Keep in mind, therapists must complete a progress report for Medicare patients at minimum every tenth visit.

Discharge note: A discharge note is an important part of charting and is completed at the end of treatment. This is also a necessary part of Medicare documentation.

Contact us today!

You take care of the treatment and billing, we can help your practice find the perfect devices and all necessary supplies and products to help your practitioners treat their patients successfully. Contact us today and we’ll answer any questions you may have about the benefits of using each device and what accessories you’ll need! Call us today at 1-801-770-3328 for more information.