how to bill for physical therapy when medicare is secondary

You’ve been seeing a Medicare patient for six weeks for post-op services, but the patient has now reached a functional plateau. However, she still wishes to attend PT for maintenance and to maintain accountability. You can use the GA modifier to either continue billing secondary insurances, or bill the patient directly.

Full Answer

How does Medicare billing for physical therapy work?

Physical therapy billing guidelines for Medicare and Medicaid services include a section about how much time you must spend with a patient for it to be “bill-worthy.” Medicare physical therapy billing works in increments of 15. So what are you supposed to do when your treatment only takes 13 minutes to complete?

How do I bill Medicare as the secondary payer?

You must follow the MSP rules and bill Medicare as the secondary payer after the primary payer has made payment. We’ll inform you on your remittance advice how much you can collect from the patient after we make payment. NOTE:

What is the 8-minute rule for Medicare physical therapy billing?

Medicare physical therapy billing works in increments of 15. So what are you supposed to do when your treatment only takes 13 minutes to complete? That’s where the eight-minute rule comes in. You only have to spend eight minutes with a patient to be able to bill for one “15-minute” unit.

Can a therapist Bill for the same service under Medicare Part B?

By contrast, therapists who practice in facilities and clinics that bill under Medicare Part B cannot bill separately for the same or different service provided to the same patient at the same time. That means therapists must limit total billing time to the exact length of the session.

How do I bill Medicare Secondary?

When Medicare is the secondary payer, submit the claim first to the primary insurer. The primary insurer must process the claim in accordance with the coverage provisions of its contract.

What is a GY modifier used for?

GY Modifier: This modifier is used to obtain a denial on a non-covered service. Use this modifier to notify Medicare that you know this service is excluded.

What is KX modifier for?

Modifier KX Use of the KX modifier indicates that the supplier has ensured coverage criteria for the billed is met and that documentation does exist to support the medical necessity of item. Documentation must be available upon request.

When would a biller most likely submit a claim to secondary insurance?

If a claim has a remaining balance after the primary insurance has paid, you will want to submit the claim to the secondary insurance, if one applies.

Does Medicare cover GY modifier?

The GY modifier must be used when physicians, practitioners, or suppliers want to indicate that the item or service is statutorily non-covered or is not a Medicare benefit.

What is GT modifier?

What is GT Modifier? GT is the modifier that is most commonly used for telehealth claims. Per the AMA, the modifier means “via interactive audio and video telecommunications systems.” You can append GT to any CPT code for services that were provided via telemedicine.

What is Medicare KX modifier?

The KX modifier is a Medicare-specific modifier that indicates a beneficiary has gone above their therapy threshold amount. To my knowledge, there are no other insurance payers that use this modifier.

What is KF modifier for Medicare?

Modifier KF is a pricing modifier. The HCPCS codes for DME designated as class III devices by the FDA are identified on the DMEPOS fee schedule by presence of the KF modifier.

Where do you put the KX modifier?

Use the KX modifier only in cases where the condition of the individual patient is such that services are APPROPRIATELY provided in an episode that exceeds the cap.

How does billing work with 2 insurances?

If you have multiple health insurance policies, you'll have to pay any applicable premiums and deductibles for both plans. Your secondary insurance won't pay toward your primary's deductible. You may also owe other cost sharing or out-of-pocket costs, such as copayments or coinsurance.

When submitting a secondary claim what fields will the secondary insurance be in?

Secondary insurance of the patient is chosen as primary insurance for this secondary claim; primary insurance in the primary claim is chosen as secondary insurance in the secondary claim. Payment received from primary payer should be put in 'Amount Paid (Copay)(29)' field in Step-2 of Secondary claim wizard.

What information do you send to an insurance company when billing a secondary claim?

Secondary Claim Adjustments When sending claims on to the secondary payers, those secondary payers want to see the total billed amount of the claim, the amount the primary insurance paid on the claim, and the reasons why the billed amount was not paid in full by the primary payer.

Introduction

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