Recent News and Course Content Reminders of Medicare Billing Requirements

With recent news in Hawaii along with information provided during the Medicare class that HAPTA hosted in early October, we thought we should provide reminders about some Medicare billing areas that continue to cause problems for some providers:

  • In order to bill for physical therapy, services need to be provided by a licensed physical therapist, physical therapist assistant, or physical therapy student (please review the Hawaii Administrative Rules that clearly define “Support or auxiliary personnel”). Treatment rendered by an aide or tech is not billable (even if you are directing the aide to perform the service – this is still not billable).
  • Please review the definitions of CPT codes you are billing for so that there is no confusion on their use. Typically used codes like 97110 (therapeutic exercise), 97140 (manual therapy), 97530 (therapeutic activity) and 97112 (neuromuscular re-education)  all require direct one-on-one) patient contact.
  • Please also take a look at how many units you are billing. If you treat eight patients in an eight- hour work day, you should not be billing for more than about eight hours of PT treatment. If you typically are billing for more than 12 hours of PT treatment per day, insurances may question your one-on-one services unless your clinic is open for more than 12 hours a day. Total billed time for your facility per therapist should be less than the number of hours open or worked.
  • Your daily notes need to indicate: date of treatment, what treatment you provided, the indication of the need for skilled intervention and signed by a licensed PT or PTA.

Patti Taira-Tokuuke
Shawna Yee
HAPTA Payer Relations/Reimbursement Committee Co-Chairs

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