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Wiki Physical Therapy Billing Question

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coding4fun

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Need help with following scenerio: PT sees pt today for EVAL (97001) as patient is s/p TKR. PT performs eval and documents appropriately. PT also performed therex (97110) during PT session. Typically I would bill 97001 (untimed procedure) + 97110 (1 unit). We were advised today that we could no longer bill for therex performed during the same time that the EVAL is performed as the insurance carriers will not pay. I have researched on website and it appears that these codes are billable together. Would appreciate whatever info you guys could offer. I have always been told bill for what you do and document it properly with modifiers, etc.
 
I would bill it exactly as you stated. 97001 + 97110. I am not aware of any insurances (other than WC) not paying for an eval and therex in one visit. I just took a Medicare course last week and this wasn't brought up, in fact, some of the examples shown during class had these codes billed together for the same date of service.

I'm curious to know where this information came from.
 
I work for an OP Physical Therapy dept and we have Palmetto as our MAC carrier. We were advised that we were getting denials for these services when billed together. Could you please provide the link to check reimbursement for CPTs for Medicare. Thanks!
 
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