Documentation Tip: An Essential Element for Physical Therapy Claims

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  • October 28, 2014
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Documentation Tip: An Essential Element for Physical Therapy Claims

Physical therapy has made it in the Office of Inspector General’s (OIG’s) work plan for several years running. With medical reviewers on the lookout for high utilization of outpatient physical therapy services, coders and billers need to be vigilant about how their physical therapists are documenting services.
Per Chapter 15, Section 220.1.1 of the Medicare Benefit Policy Manual, payment for physical therapy is dependent on the certification of the plan of care for the patient receiving services. A signed and dated order is acceptable as certification if it meets the requirements of the plan of care.
A valid plan of care for physical therapy, occupational therapy, or speech-language pathology services prescribes the:

  • Type,
  • Amount,
  • Frequency, and
  • Duration of services.

A diagnosis and anticipated goals that are consistent with the patient function reporting on claims for services must also be in the plan of care.
Bottom line: Medicare Part B only pays for therapy services if a physician, or other non-physician practitioner with knowledge of the case, signs and dates the care plan as soon as possible (within 30 days of the initial therapy treatment). Without this information, claims will be denied due to insufficient documentation.

Source: Medicare Learning Network, Medicare Quarterly Provider Compliance Newsletter: Guidance to Address Billing Errors, Volume 5, Issue 1, October 2014

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

No Responses to “Documentation Tip: An Essential Element for Physical Therapy Claims”

  1. amit says:


  2. Kelley says:

    How often must the order for PT be updated? Is it good as long as the patient remains in continuous therepy?
    Thank you!