As much as your goal is to help your patients live more fulfilling lives, that alone is not sufficient to keep your clinic running. In this regard, generating revenues is crucial, but it remains one of the main challenges physical therapy clinics face. This is not due to a limited number of clients or insufficient billable sessions but because of billing errors.
One area that’s proven to be highly problematic with physical therapy billing is determining the right amount to charge patients. When insurance companies deem that sessions billed are unnecessary or are billed incorrectly, there will be delays with processing your insurance claims.
The American Medical Association (AMA) developed the Current Procedural Terminology (CPT) to help with this. These physical therapy CPT codes assist clinics in processing health insurance claims accurately. However, it is important to understand what each code represents and when to use them. If you misuse them, there will be complications with insurance claim processing. Correct physical therapy CPT codes are crucial to keeping your clinic afloat. Here are the most common physical therapy CPT codes and how to use them.
What are CPT Codes?
Physical therapy CPTs are numerical codes used by qualified healthcare providers to report different procedures and services rendered to patients. In essence, they describe the type of care you’ve given to a patient, making them an integral part of the billing process. For the patient’s insurance company to process your claim, the physical therapy CPT codes used must match the services offered.
Challenges with Physical Therapy Billing
If an individual with medical coverage meets the criteria required to qualify for physical therapy, their insurance provider should pay for their sessions. However, insurance providers are the ones who determine when such care is necessary and also impose stringent measures for processing claims. If a patient is declared to be “functional,” the insurance provider will not cover physical therapy costs.
On the other hand, if a candidate qualifies, the insurance company may delay or even fail to process claims due to minor technicalities. The key to avoiding insurance billing errors is understanding how to charge your patients and submit claims correctly. This involves knowing how to use physical therapy CPT codes and preparing clean insurance claims.
Common Physical Therapy CPT Codes and Their Usage
Undoubtedly, physical therapy CPT codes and how they are applied is confusing and only designed to favor insurance companies. Whereas there is no education about the codes in PT school, it is up to you to take the initiative to learn and understand them.
1. 971110 Therapeutic Exercise
Under this physical therapy CPT code, you can only bill sessions where you’ve had direct contact with the patient. It covers exercises for endurance, ROM, strengthening, and flexibility. Whereas most practitioners prefer using this code as it seems like a safe bet, you will receive higher reimbursement if you bill under the code for therapeutic activity. Though the difference is only a few dollars, it will tally up to something worthwhile at the end of the year.
The primary reason therapeutic exercises receive lower reimbursement is that it does not require as much skill as neuromuscular re-ed or therapeutic activities.
2. 97112 Neuromuscular Re-education
Covers physical therapy activities aimed at re-educating a patient’s body aspects such as posture, movement, coordination, balance, and kinesthetic sense. Other things that can be billed under this physical therapy CPT code include time spent kinesio taping, performing facilitation or inhibition, ergonomic training, plyometrics, and desensitization.
3. 97116 Gait Training
Whenever you use this code, ensure that the sessions’ primary focus is the biomechanics of the gait cycle. Applicable activities include training using a modified weight-bearing status, sequencing, completing turns with proper form, and employing assistive devices.
4. 97140 Manual Therapy
In comparison with therapeutic activities, neuromuscular re-ed, and therapeutic exercise, manual therapy is reimbursed at a lower rate. Sessions that can be billed under this physical therapy CPT code can cover joint mobilization, soft tissue mobilization, muscle energy techniques, manual traction, and manual lymphatic drainage.
Though manual resistive exercise can be billed under therapeutic exercise, it can also be included in manual therapy as it involves improving endurance or strength.
5. 97535 Self-Care/Home Management Training
Activities aimed at improving one’s capacity to live independently are billed under this physical therapy code. Sessions can cover ADL training, meal preparation, use of assistive devices and equipment, going over safety procedures, and compensatory training.
The six basic ADLs covered include:
6. 97150 Group Therapy
When you provide physical therapy care for two or more patients simultaneously on land or in an aquatic setting, the sessions should be billed under group therapy. Though you need to give a lot of attention to the patients, it does not necessarily require one-on-one time. Use this code anytime you see multiple Medicare patients at the same time.
Additional information you should provide includes the type of group and the number of participants. Expect the reimbursement rate to be lower as compared to handling all the patients separately.
7. 97530 Therapeutic Activities
Activities billed under this code are those aimed at improving functional performance. These include dynamic activities such as sit-to-stand training, step-ups/stair negotiation, bed mobility, squatting mechanics, swinging a golf club or bat, hip-hinge training, proper lifting mechanics, and car transfer training.
These activities require a high level of skill and repetition for the patient to regain full function. This is why this code is reimbursed at a higher rate than therapeutic exercises.
Avoid the Hassle of Physical Therapy CPT Codes
As a physical therapist, your primary objective is to offer quality care to patients and help restore their quality of life. Errors with physical therapy CPT codes when billing will serve as an obstacle to your agenda. Delayed payments translate to cashflow challenges, which will limit your capacity to serve patients in the future or honor obligations to staff and creditors.
Whereas understanding the codes is crucial, you can avoid the stress of determining the appropriate physical therapy codes to use. A2C Medical has the right solution for you. Our EMR features billing solutions and revenue cycle management services that simplify the insurance billing process. Schedule a demo today to find out how much easier insurance billing can be.