Optimize revenue by Outsourcing Physical Therapy billing services in the U.S.

The most common CPT codes that are used in physical therapy are 97110 for Therapeutic Exercise, 97112 for Neuromuscular Reeducation, 97140 for Manual Therapy 97116 for Gait Training, and 97530 for Therapeutic Activities.

Physical Therapy billing typically includes specific codes for rehabilitation and therapeutic services and may be subjected to unique authorization requirements and insurance coverage guidelines as compared to other medical services.

Proper documentation justifies the necessity of the treatment, enlists the services provided, and ensures compliance with insurance requirements, thus facilitating accurate billing and reimbursements.

Modifiers are used to add additional information regarding the service provided. They impact the reimbursement rates and are pivotal for accurate billing, especially for indicating therapy cap exceptions or specific conditions treated. Modifiers that are commonly used in physical therapy billing are GP Modifier, 59 Modifier, 76 Modifier, KX Modifier, GJ modifier, CQ and CO Modifiers.

Timed CPT codes are billed in increments of 15 minutes. According to the standardized guidelines, therapy for a specific timed procedure must be at least 8 minutes to be billed as one unit.

Patients should be communicated in advance for services that are not covered by the insurance. Such services are billed directly to patients’ accounts. It is important to have the eligibility for benefits checked before any procedure is performed. It gives an insight into the financial liability of the patient.

Medicare has specific guidelines for physical therapy services including therapy caps, necessary documentation, and approved CPT codes. It is crucial to stay updated with Medicaid policies for complaint billing.

Yes, like other medical billing, physical therapy services can be billed on the same day. It depends on the insurance provider’s rule and the service rendered by the physical therapist. Proper use of CPT codes and Modifiers along with comprehensive documents is essential to prevent claim denial.

For denied physical therapy claims, review the cause of claim denial, rectify any errors, and resubmit the claim. It is important to be aware of typical claim denial reasons in physical therapy to address them proactively to minimize claim denials and enhance reimbursements.

The best practices for medical billing include comprehensive and accurate record keeping, staying up to date with modern coding and billing regulations, understanding payers’ policies, applying correct modifiers, and conducting regular training for the billing and coding team to educate them about current procedures and compliances.