Part B Insider (Multispecialty) Coding Alert

Published on Thu Jun 14, 2007 PDF

Make sure your PTs meet new certification requirements

Q: Can a physical therapist bill Medicare for her own services, such as PT Evaluation, orthotic evaluation, ADL evaluation and patient education? The referral would be from a physician of the same group. 


NY Subscriber


A: Yes, physical therapists (PTs) can bill under their own provider numbers, says Pat Larabee, a coding specialist at InterMed in South Portland, ME. You can also have your physical therapists bill -incident to- your physician's services if they don't have their own provider numbers.

If the physical therapist is a member of a physician group, then you should bill the claims under the group's ID number, with the therapist listed as the rendering provider, says Stephanie Fiedler with Loeb & Troper in New York.

There's no such thing as a -patient education- service that a PT can bill, Fiedler adds. PTs generally provide re-evaluation services, which include education as part of establishing a maintenance program and you should bill for these under their regular therapeutic interventions, Fiedler adds.

Important: PTs can only bill for CPT codes within the range of 97001-97799, Fiedler points out.

You should list the referring practitioner on the claim, notes Collette Shrader, compliance and education coordinator with Wenatchee Valley Medical Center in Wenatchee, WA.

Check your state requirements: Some states, such as New York, no longer require physical therapists to have a doctor's referral to perform an evaluation, notes Fiedler. But Medicare generally requires a doctor to order the evaluation and certify the services, she adds.

Watch out: Medicare has tightened the rules as to who can work as a physical therapist, notes Quinten Buechner with ProActive Consulting in Cumberland, WI.

A physical therapist must be state licensed, and must have graduated from a physical therapy curriculum approved by the American Physical Therapy Association, the American Medical Association, or the Council on Medical Education of both organizations, according to Part B carrier NHIC.

Editor's note: To read NHIC's physical therapy -billing guide,- go to www.medicarenhic.com, click on -Part B--New England,- click on -Publications- on the left side, and then go to -billing guides.-