Wiki Help with pt eval 97001/Medicare

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jenks66

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Medicare is recently denying 97001 due to a "billing /coding submission error", we cannot figure out why - nothing different is being done and they've always paid. Any experience with this - this is a Physical Therapy provider.
 
Did you use the Functional G codes with modifiers? You also have to use them at the tenth visit to update progress and thereafter. This is required after July 1,2013.

FUNCTIONAL REPORTING, which is required on claims for all outpatient therapy services pursuant to 42CFR410.59, 410.60, and 410.62, uses nonpayable G-codes and related modifiers to convey information about the patient's functional status at specified points during therapy. (See Pub 100-04, chapter 5, Section 10.6)

AAPC had an issue that went over all of that I think it was either Feb or March this year.
 
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