Wiki PT billing

Create Wiki Sort by date
K

kalahey

New
Messages
3
Best answers
0
What is the rule when billing physical therapy codes 97140, 97112 and 97530 on the same day? I have appended modifier 59 to the 97140 but they are still not paying that code. The reasoning is " the CPT code 97140 cannot be processed because your facility has met the 2 unique therapy codes cap per day per MA state guidelines". These are on a workers comp patient. Thanks for any help you can give me.
 
0
I'm sorry but I guess I don't understand what they mean by 2 "unique" codes? I've searched to find the MA state guidelines but have found nothing to help.
 
0
You can only bill two of those CPT per day is what it means. Unique means one of it's kind in this case. You have three (different) or unique codes there.
"(g) Therapeutic Procedures. Pre-approval should be obtained if a provider believes that more than two therapeutic procedures should be performed at a session. The number of units allowed per session is limited only by medical necessity. "
They are saying you can only bill two of those. Depending on the carrier, you would have to look at their policy but it sounds like it is determined by the state. Or, you may be able to get authorization. I don't know, never done MA WC.
 
You must log in or register to reply here.
Top