Wiki PT Coding Question

[Billing500]

Hi!

We're billing the following PT codes:
97163
97014
97010
97140
97535
All are affixed with a GP modifier for Medicare, however is a -59 needed? All of our notes seem to indicate that it's only required if billing CPT 97164 (Re-Eval). Can someone please confirm?
Also, for Medicare, please confirm that the cap is based on ALLOWED AMOUNT and NOT the # of visits. We've been getting conflicting statements, but Medicare shows $1980 as the cap (for PT and SLP).

Also, when billing the following, please confirm NO -59 is required:
97014
97140
97112
97110

Thank you very much!

 

[jflynn124]

Don't forget to bill the functional G-code set with the therapy.


97163-59-GP
97014-GP
97140-59-GP
97112-GP
97110-GP

 

[dbardales]

Why is my CPT 97163 been denied as maximum allowed amount