We have had a physical therapist performing in our orthopedic office for over a year now. We have a handful of Medicaid-only patients that have came for physical therapy. We first got the denials stating that our physical therapist could not be a part of our Medicaid group. So then we had to bill just using the PT numbers. Then we got our second set of denials stating that he needed an electronic provider agreement on file. So we sent that in.
Lastly we got a denial stating "Unable to provide services to patient's over the age of 21". I found this quite amusing when I first read it, b/c I could not make myself believe that this was even true! I called Medicaid customer service, spoke w/ 5 different representatives, called Provider Enrollment, and noone could seem to tell me exactly WHY this was true! Finally I called Medicaid provider services back and asked for a supervisor, (which took me over an hour to get to), but was finally informed that when Physical Therapist is classified as an Independent Practitioner (because he is performing in an office setting), then he can only receive payment for patients under the age of 21!!!!!!! This is insane!!!!!!!!!
She said we would be allowed to bill under our physician as the supervisor (like incident to) but he has to be in the office. Our MD is only if the office 3 days a week b/c he is in sx the other 2 days. We have took a major loss. I just wanted to warn any of you out there that are thinking about getting a PT dept in your office. Beware of Medicaid!!!!!!