Physical Therapy Part B Billing

Does anyone know if an orthopedic practice who owns their own physical therapy department can provide in home services and bill under part B. This would occur when transportation is the only issue and the patient is not home bound and does not qualify for home health services.

Any regulatory resources or coding references you could provide would be appreciated.

Thanks,

Sue

Comments

  • edited May 2017
    Sue,

    Yes, they can bill under Part B billing @ home with POS 12 without any issues.

    Kristen M. Beury
    President/CEO
    Medical Resource Association, Inc.
    Telephone: 1-888-279-0232 x102
    Fax: 1-866-804-6331
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    Skype : kristenmrasrq
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  • You may want to be sure you're aware of who’s performing the service, who may need to be present when services are being provided, to follow with who the service is being billed under. Perhaps review this and then reach out to your local PT society to verify too because things do vary state-to-state.


    The following table lists the various PTA supervision requirements:

    Table A

    Medicare Therapy Provider Setting

    PTA Supervision Level

    Supervisory Requirement

    Outpatient Hospital

    General

    PT Presence not required on premises

    Nursing Facility

    General

    PT Presence not required on premises

    CORF’s

    General

    PT Presence not required on premises

    ORF’s

    General

    PT Presence not required on premises

    HHA’s

    General

    PT Presence not required on premises

    PT in Private Practice (PTPP)

    Personal

    PT Present in-the-same room

    Physician Office (Incident to)

    Direct

    Physician Present in Office Suite

    Physician Office (PTPP)

    Personal

    PT Present in-the-same room




    You can find this at: https://www.cms.gov/medicare/billing/therapyservices/downloads/61004ptartc.pdf



    Hope this helps.



    Kris



    Kris Cuddy, CPC, CIMC

    Healthcare Compliance Analyst

    Compliance Office

    Michigan State University HealthTeam

    East Lansing, MI

    Ofc: 517-355-4547

    Fax: 517-353-5292




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