Wiki Physical therapy aide

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Lunap99

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Local Chapter Officer
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West Saint Paul , MN
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We have a new therapist who is insisting that he can bill private insurance for his aide time. I am sure that you cannot. However, while looking for supporting documentation, I have only found info on what tasks the aide is allowed to do but nothing specific about billing for their time. Can anyone help?
 
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Normally PTA's services are billed under the physical therapist. Are you talking about the time they spent performing one-on-one services with patient? Feel free to list an example and I can help you or message me directly. I would suggest checking the APTA for supporting documentation.
 
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No. An aide or tech is not a Physical Therapy Assistant (PTA) or OTA or SLPA. Refer to the Medicare Benefit Policy Manual 230.1 - Practice of Physical Therapy (Rev. 179, Issued: 01-14-14, Effective: 01-07-14, Implementation: 01-07-14) https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
C. Services of Physical Therapy Support Personnel Reference: 42CFR 484.4
Services provided by aides, even if under the supervision of a therapist, are not therapy services and are not covered by Medicare. Although an aide may help the therapist by providing unskilled services, those services that are unskilled are not covered by Medicare and shall be denied as not reasonable and necessary if they are billed as therapy services."

Outpatient Therapy Settings
Therapy Aides
Therapy aides cannot provide skilled services. Also, unskilled service minutes provided by the therapy aide cannot be counted and are not reimbursable even when provided under direct supervision by the qualified therapist or assistant e.g.
  • The patient arrived at the clinic and worked in the gym with the therapy aide for 15 minutes, then the qualified therapist provided direct patient treatment for 20 minutes, then the patient worked for another 15 minutes in the gym with the therapy aide. Total of 20 individual minutes of service were provided by the qualified clinician and are billable for the session.
  • The patient arrived at the clinic and received direct patient treatment with the qualified therapist for 10 minutes, then the patient worked in the gym with a qualified therapy assistant for 15 minutes, then the patient received direct patient treatment with the qualified therapist for an additional 15 minutes. Total of 40 individual minutes of service were provided by qualified clinicians and are billable for the session.
Other reference:

Also, you would refer to state practice rules and the individual payer manuals.
 
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