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Thread: Medicare PT 97002

  1. #1

    Question Medicare PT 97002

    AAPC: Back to School
    I am having a problem w/ Medicare paying for this. Is there any reference material on this code only? Specific payable diagnosis? Modifiers needed or not? Time frame on when it can be done?

    I appreciate any help I can get with this.

    Thanks in advance.

    Christina H.

    Just needed to add mod 59 to it & got paid.
    Last edited by tdml97@yahoo.com; 11-22-2013 at 07:32 AM. Reason: updated

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    Are you billing it along with PT modalities the same day? If so, they are hitting the CCI edits. Also, check the Medicare Internet Only Manual; they have a lot of rules for PT.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Join Date
    Apr 2007


    Use GP modifier on PT billing for medicare.

  4. #4
    Join Date
    Apr 2007
    Phoenix, AZ


    You always need to add modifier 59 if you are billing for any treatment in addition to the 97002. This code is usually paid every 30 days (re-certification).
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  5. #5

    Default question on 97002

    Recently the topic has surfaced that 97002 should only be used when you are doing an actually re-evaluation...but other people say you can use it with Medicare and other insurance when you are doing a PR (progress note) and a recertification.
    Does anyone know where I can find clarity on this issue.

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