Wiki Physical therapy

[tatianapotter]

Physical therapy is new to my practice and we are having trouble finding the correct way to code things, particularly the sequence in which the cpt's(modalities) should be listed and modifiers. I am aware that all our lines need the GP modifier, and if 97530 is done with 97140 then 97530 needs the 59 modifier and to be listed after 97140. However when we have an eval such as 97160 with 97140,97110,97530-59, we are still getting denials for a bundled service. Is there something that we are missing? Medicare is paying all lines but we cant get our commercial insurances to do the same, especially Humana. Any suggestions are appreciated. thanks

 

[hannahcarter1231@gmail.com]

Humana requires a modifier 96 or 97 in order to process the claims. As for the commercial insurances 97530 almost always will bundle with 97140 no matter the 59 modifier. Hope this helps!