Is the CPT code 97003 going away forever?
You might find it hard to believe, but with this CPT coding update, the evaluation and re-evaluation codes that PTs and OTs have come to know and love—97001, 97002, 97003, and 97004—are going away forever (well, presumably forever; we can’t predict the future).
Are the 11 Part B billing scenarios specific to pts and OTS?
As a result, the 11 Part B Billing Scenarios are specific to PTs and OTs. We will update this Web Page to reflect changes in policy (for example, CCI edits, new codes, new coverage determinations) that impact therapy billing and/or to provide clarification on billing policy for PTs, OTs and/or SLPs. Check the manuals first.
Is there a replacement code for 97002?
Instead, there is one replacement code for 97002 and one for 97004, as shown below. Now, the million-dollar question for any therapy professional affected by these coding updates is: how does one go about selecting the appropriate level of complexity for each patient evaluation? We’re glad you asked.
How do I Bill for CPT code 97110?
Code 97110 must be billed for at least 2 units as it contains two 15-minute blocks. To determine the allocation of the third unit, compare the “remaining minutes”, and apply the additional unit to the service with the most remaining minutes.
What CPT code replaced 97001?
Two familiar CPT codes for PT evaluation and re-evaluation were eliminated in January 2017 and replaced by new codes that indicate complexity. 97001 was replaced by the following codes: 97161 (low complexity), 97162 (moderate) or 97163 (high complexity). 97002 was replaced by 97164.
Is 97001 a valid CPT code?
Physical therapy evaluation codes 97161, 97162, and 97163 are added and 97001 is deleted.
Does Medicare pay for gait training?
Gait Training (CPT Code: 97116) Medicare will cover Gait Therapy for training patients whose walking abilities have been impaired by neurological, muscular or skeletal abnormalities or trauma.
How do you bill for CO treatment?
Billing Concerns for Co-Treatment Most likely, one person will charge 2 units and the other will charge 1 unit and two non-billable units, depending on if the setting incorporates non-billables. This rule applies in any setting where Medicare Part B is the payer source.
What does CPT code 97001 mean?
The Current Procedural Terminology (CPT) manual defines physical and occupational therapy evaluation as follows: 97001 Physical Therapy evaluation. 97003 Occupational Therapy evaluation.
How do you code a physical therapy evaluation?
Three codes — 97161, 97162, and 97163 — are used for physical therapy evaluation.
How do I bill gait training?
CPT code 97116 can be used to report gait training.
What is the CPT code for gait training?
97116Version 27.0 Correct Coding Initiative (CCI) EditsCPT CodeDescriptionTimed?97110Therapeutic ExercisesY97112Neuromuscular Re EducationY97113Aquatic Therapy/ExercisesY97116Gait TrainingY72 more rows•Apr 22, 2019
What is the CPT code for gait training first 30 minutes?
You count the first 30 minutes of CPT code 97110 as two full units.
What are CO and CQ modifiers?
The modifiers are defined as follows: CQ modifier: Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant. CO modifier: Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant.
What insurances require a CQ modifier?
Beginning January 1, 2020, 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, ...
What are CMS modifiers?
Modifiers indicate that a service or procedure performed has been altered by some specific circumstance, but not changed in its definition or code. They are used to add information or change the description of service to improve accuracy or specificity.
What is the code for physical therapy?
Instead, they will choose from a set of three different evaluative codes that are tiered according to complexity. Those codes are: 97161. Physical therapy evaluation: low complexity. 97162.
What is an OT assessment?
The OT completes an assessment (s) identifying 5 or more performance deficits (i. e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions.
How long does an OT spend with a patient?
OT (97165) Typically, the OT spends 30 minutes face-to-face with the patient and/or family. The patient’s occupational profile and medical and therapy history includes a brief history with review of medical and/or therapy records related to the presenting problem.
What is re-evaluation of occupational therapy?
Re-evaluation of occupational therapy established plan of care requiring: An assessment of changes in patient functional or medical status, along with a revised plan of care. An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals.
What is the CPT code for habilitation?
The CPT© code 97110 is for therapeutic exercises to develop strength and endurance, range of motion and flexibility.
How long is a certified treatment interval?
INTERVAL of certified treatment (certification interval) consists of 90 calendar days or less, based on an individualls need. A physician/NPP may certify a plan of care for an interval length that is less than 90 days. There may be more than one certification interval in an episode of care.
What does an occupational therapist consider?
Occupational therapists also consider the level of the current impairments and the probability of prolonged impairment, functional limitation, the living environment, prior level of function, the social/cultural supports, psychosocial factors, and use of adaptive equipment.
What is the code for orthoptics?
When performing simply orthoptics, the appropriate code to use is 92065. It is uncommon for an optometrist providing any form of vision therapy to do only orthoptics. Some third party networks expect professionals of each specialty group to bill the majority of their services within their specialty code set.
Is rehabilitative therapy needed for terminal illness?
Rehabilitative therapy may be needed, and improvement in a patientts condition may occur, even when a chronic, progressive, degenerative, or terminal condition exists. For example, a terminally ill patient may begin to exhibit self-care, mobility, and/or safety dependence requiring skilled therapy services.
Is there separate coverage for CPT?
The educational components of treatment are included in the service described by the specific CPT code; therefore there is no separate coverage for education. Documentation of services is part of the coverage of the respective CPT; therefore there is no separate coverage for time spent on documentation.
Is rehabilitative therapy covered by a maintenance program?
Skilled therapy services that do not meet the criteria for rehabilitative therapy may be covered in certain circumstances as maintenance therapy under a maintenance program. The goals of a maintenance program would be, for example, to maintain functional status or to prevent or slow further deterioration in function.
How often is 97150 billed?
In private practice settings for physical and occupational therapists and in physician offices where therapy services are provided incident to the physician, Medicare expects the group therapy code (97150) to be billed only once each day per patient. In the facility/institutional therapy settings, the group therapy code could be applied more than once. However, the occasional situation where group therapy is billed more than once each day would require sufficient documentation to support its medical necessity and clinical appropriateness of providing more than one separate session of group therapy.
How long can a therapist bill for a supervised modality?
In the same 15-minute time period, one therapist may bill for more than one therapy service occurring in the same 15-minute time period where "supervised modalities" are defined by CPT as untimed and unattended -- not requiring the presence of the therapist (CPT codes 97010 - 97028). One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact. However, any actual time the therapist uses to attend one-on-one to a patient receiving a supervised modality cannot be counted for any other service provided by the therapist.
Can a therapist bill a patient separately?
Therapists, or therapy assistants, working together as a "team" to treat one or more patients cannot each bill separately for the same or different service provided at the same time to the same patient.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Article Guidance
This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy Outpatient Physical and Occupational Therapy Services L34049.
ICD-10-CM Codes that DO NOT Support Medical Necessity
The following ICD-10-CM Codes do not support the medical necessity for the CPT/HCPCS code 97035.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.