Wiki Naturopath billing 97110

[EricaCR]

Our naturopath billed a 97110 once to Premera and once to Regence (we are in Washington state, where naturopaths are licensed). It was denied by both insurance plans for not having an appropriate modifier. When I looked at their policies regarding appropriate modifiers for this code, I see that it requires a modifier to indicate whether the code is associated to a plan of care. Can this code only be billed by physical therapists and such? Is there a more appropriate code our doctor could be using when she gives patients exercises to do at home?

 

[sls314]

Our naturopath billed a 97110 once to Premera and once to Regence (we are in Washington state, where naturopaths are licensed). It was denied by both insurance plans for not having an appropriate modifier. When I looked at their policies regarding appropriate modifiers for this code, I see that it requires a modifier to indicate whether the code is associated to a plan of care. Can this code only be billed by physical therapists and such? Is there a more appropriate code our doctor could be using when she gives patients exercises to do at home?

This is just for exercises being sent home with the patient? Not actually being performed and supervised by a provider in the office under a plan of care?

97110 would not be an appropriate CPT code for that - not even if a physical therapist was billing it. 97110 is for therapeutic exercises performed under the supervision of a qualified health care provider and billed in 15-minute increments.

If your provider is just giving your patients a handout with exercises for the patient to try at home, most likely that's just part of the Medical Decision Making for the E/M service.