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
The procedural codes in use are known as Current Procedural Terminology or CPT codes that denote medical, surgical, and diagnostic services. In physical therapy, CPT codes help facilitate communication between providers and payers about services delivered.
Commonly Used Physical Therapy CPT 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 CPT 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.
CPT Code 97140
- 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
This code looks at muscle function, and patient assessment should be documented.
Medical Billing Code 95938
Documentation is an essential component to support medical necessity when it comes to obtaining insurance coverage for nerve conduction studies.
Best Practices for Accurate Medical Billing
- 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.
