Making it possible to bill 1 unit provided by PT and 3

Making it possible to bill 1 unit provided by PT and 3 units provided by PTA of the same treatment

Hello,

I was reading the following Q & A in Gawenda Seminars as follows:

Question – Posted November 21, 2019

When a Medicare beneficiary is being treated by a physical therapist assistant or occupational therapy assistant, what are the requirements of the physical therapist or occupational therapist regarding their participation in the care of the Medicare beneficiary?

Answer

The physical therapist or occupational therapist must personally furnish in its entirety at least 1 billable service on at least 1 day of treatment during each reporting period

I called WebPT today to see how to bill a visit if the PTA does 3 units of 97140 and the PT does 1 unit of 97140, so that the CQ modifier is not attached to the unit that the PT performed and I was informed there was no way to do this. With the upcoming cuts to PTA provided services and the need to comply with Medicare PTA requirements, how do we correctly bill for a service where the PTA provided 3 units and the PT provides 1 unit if it is all one CPT code (so all manual therapy or all THX, etc...)?

Guest
Oct 12 2021
Planned

Documentation

Oct 13, 2021

Admin response

Hello, and thanks for your question! We are currently working on a new design to accommodate splitting the minutes of treatment between the therapist and assistant so that the correct use of modifiers can be applied. We hope to have this in place in time for the new year, however the final rule for CMS has yet to be released.

If you have any further questions, feel free to leave a comment or contact WebPT Support using support@webpt.com.

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Guest commented

October 28, 2021 19:37

I am trusting WebPT will be in sync with any CMS Final rule changes. Proper use of modifiers might become even more important for maximizing revenue!

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