Introduction:
A biller’s role is crucial in the medical field and even in the specialty area such as physical therapy. Therefore, one should clearly understand Physical Therapists’ CPT Codes. To learn more about some vital insurance Physical Therapy CPT codes like 76815, 59025, 95861, and 95938, as well as the two universal CPT codes 97140 and 97110, read our blog post.
Understanding Physical Therapy CPT Codes (PT CPT Codes)
The procedural codes in use are known as Current Procedural Terminology or CPT codes that denote medical, surgical, and diagnostic services. Physical therapy codes help facilitate communication between providers and payers about services delivered.
Commonly Used Physical Therapy Procedure Codes
- 97110: Strength, endurance, range of motion, and flexibility exercises for treatment.
- 97140: This code applies to hands-on therapy techniques like mobilization or manipulation. It is also a 15-minute timed code and is billed the same way as 97110.
Often a component of other tests, this code describes an ultrasound examination of soft tissues. - 59025: This is for maternal-fetal medicine billing; this code is if, specifically, you are doing fetal non-stress tests, but I’m putting it in here because- that’s what the billing is- maternal-fetal nonstress test.
- 95861: That code is for measuring muscle strength & tone.
- 95938: This code is used for nerve conduction studies.
Reimbursement Rates for Physical Therapy Services
While researching rates, I noticed differences due to location, and payers’ fees may alter due to the location and policy changes. Below are some of the points you should generally consider:
Medicare Rates:
For instance, Medicare is even cheaper than private insurance most of the time. For physical therapists to practice correctly, they must understand what Medicare recognizes about fees for physical therapy services.
Private Insurance:
Controlling the advantages and authorization before you render any service is crucial since each insurance company has its reimbursement policy.
Geographical Variability:
The reimbursement rates can differ depending on the provider’s location because of the GCAF.
Medical Coding guidelines for specific physical therapy billing codes (PT Procedure Codes)
CPT Code 97110
- Documentation Requirements: Record a patient progress note, list the exercises done, and record the patient’s reaction.
- Reimbursement Considerations: Ensure service duration can support billing intervals evenly, usually in quarters.
97140 CPT Code Reimbursement
- Documentation Requirements: Explain the procedures that one is required to perform during exceptional manual therapy sessions.
- Reimbursement Considerations: As with 97110, be compliant with time-based billing.
Medical Billing Code 76815
This code is used in physical therapy, working with ultrasound imaging. This unveiled the need to explain why this imaging was clinical within the context of reimbursement.
Medical Billing Code 59025
Most of the time, we can relate this to obstetric care, but you can keep this in mind when you have a PT scenario that crosses with maternal care.
Medical Billing Code 95861
The procedure code 95861 of CPT, which stands for Needle electromyography, is a test that helps diagnose muscle and motor neuron functionality. More particularly, this code relates to the inspection of two limbs, arms, or legs, with or without the adjacency to different muscles associated with the spinal column in some instances. Electromyography is mainly used to diagnose neuromuscular diseases, neurological disorders, or symptoms that may include weakness, sensibility loss, or impaired functioning of muscles.
In terms of billing code, 95861 depends on the extremities that are examined. Reimbursement claims require detailed information on the muscles that have been discussed, together with the symptoms exhibited by the patient. Some of the conditions that trigger the order of the test are carpal tunnel syndrome, peripheral neuropathy, and ALS or motor neuron disease. EMG testing may have some provisos by the medical insurance companies for its use, so before getting EMG, one should ensure whether the insurance company will support it or not.
Medical Billing Code 95938
Medical code 95938 refers to somatosensory evoked potentials (SSEP), also known as the test for measuring the nervous system’s electrical response to stimulation. This code is for SSEP study with upper and lower limbs, so it adequately assesses the brain’s peripheral nerves, spinal cord, and sensory areas. For example, using the results, it will be possible to define whether the further treatment will be surgery or physical therapy. For every 95938 billed, the details of the nerves that have been tested and the reason for doing the study should be well documented.
Insurance firms may need prior authorization to evaluate persistent ailments when using SSEP. It is typically claimed at other rates higher than some of the other evoked potential studies because of its extensive approach that covers both upper and lower limbs. Therefore, the procedure must be coded correctly to be fully and accurately reimbursed.
97110 Billing Code
In medical billing, the 97110 code describes therapeutic exercises to address a patient’s strength, range of motion, flexibility, and endurance. Those are the exercises from the physical therapy program, and the physician bills them in 15-minute intervals. The code is often used by physical therapists, occupational therapists, and other caregivers to chart and bill for a plan of individual exercise to remedy a certain degree of disability. Documentations are necessary to justify exercising and reviewing a patient’s improvement to obtain reimbursements and meet payer requirements.
Best Practices for Accurate Medical Billing CPT Code For Physical Therapy
- Thorough Documentation: Document all services rendered—patient evaluations and treatment plans.
- Stay Updated on Coding Changes: Keep up with updates from the American Medical Association (AMA) on changes to CPT codes.
- Utilize Coding Software: When coding software is implemented, the billing process becomes efficient, eliminating the possibility of developing some errors.
- Verify Insurance Benefits: Patients’ insurance status should be verified before services offered result in denied claims.
Conclusion
Another difficulty in medical billing for physical therapy codes is understanding all the varieties of physical therapy CPT codes and what should be documented. Of all the potential areas where providers may encounter problems in their billing process, there are three critical ways in which they can implement adjustments to optimize the accuracy of their billing and the efficacy of reimbursement procedures.
