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Thread Topic: Physical Therapy Billing!!!
Topic Originator: Misil
Post Date September 7, 2012 @ 7:52 PM
Physical Therapy Billing!!!


Misil
September 7, 2012 @ 7:52 PM Reply  |  Email Friend   |  |Print  |  Top

Hello, I have a question to ask you about Physical Therapy Billing to Medicare after cap exception has been reached.  I've been using KX modifier, but got denied, saying that it's not medically necessary.
Is there a way you can make it reimbursable from Medicare?
The office that I'm working at is the Physical Therapy office and the main source of income is from Medicare.

Jeremy
September 8, 2012 @ 11:06 AM Reply  |  Email Friend   |  |Print  |  Top

Again, we use modifier 59 on all our claims.  Mod 59 gets past the edits and pays the claims

Jeremy
September 8, 2012 @ 11:06 AM Reply  |  Email Friend   |  |Print  |  Top

Again, we use modifier 59 on all our claims.  Mod 59 gets past the edits and pays the claims

Misil
September 10, 2012 @ 10:11 AM Reply  |  Email Friend   |  |Print  |  Top

Do you use Mod 59 on all treament procedure codes after the cap limit reached? or use it on certain procedure codes?

Example,
Currently submitted as:           or Should I submit as:
G0283  GP KX                             G0283  GP  KX  59
97035  GP KX                             97035   GP  KX  59
97110  GP KX                             97110   GP  KX  59
97112  GP KX                             97112   GP  KX  59
97530  GP KX                             97530   GP  KX  59

Which senario is correct to input?
Getting confused.

Jeremy
September 10, 2012 @ 1:48 PM Reply  |  Email Friend   |  |Print  |  Top

We do
G0283  59
97035  59
97110  59
97112  59
97530  59

Jeremy
September 10, 2012 @ 1:54 PM Reply  |  Email Friend   |  |Print  |  Top

I forget to mention, we send all claims to Medicare on a paper HCFA 1500 form.

Cheri
September 28, 2012 @ 2:00 PM Reply  |  Email Friend   |  |Print  |  Top

Misil,

It is not approprite to use modifier 59 on every line item.  It sounds as though you are using the correct modifiers, GP and KX.  Were you getting paid on the exact same codes and dx before the patient used up the therapy cap?  It sound more like you might be getting denials for an LCD issue.

Cheri

Analisa Loder
October 4, 2012 @ 5:50 AM Reply  |  Email Friend   |  |Print  |  Top

Our specialty is billing Physical Therapy claims and we send all our claims electronically.  I have over 10 years in PT billing, the only time we use a mod 59 is on 97001, and 97002. As for all other codes, we  DO NOT use mod 59, that is incorrect billing and opens you for an audit. If you go to Medicare's website you can find the rules for billing all types of claims, as well as Physical Therapy. We have no problem getting paid by Medicare ,as long as you have proper documentation and it is medically neccessary, and billed correctly.

Thank you

MARIA A.
October 11, 2012 @ 7:56 PM Reply  |  Email Friend   |  |Print  |  Top

I am a PT Biller and I need your help on how to bill CPT 97800 (FCE).
1) Does it have a time base?
2) What is the Workers Comp reimbursement fee?
3) Do I need to bill with a modifier?
I am going to start billing for this code soon, and I have never used if before.  Please help me.   maria

mwayne
October 26, 2012 @ 6:02 PM Reply  |  Email Friend   |  |Print  |  Top

maria/ re: FCE

Yes, FCEs are time based (billed in 15 minute increments like other timed codes) and generally take several hours to complete. I have billed FCEs with 5 units or 10, it depends on what your company has laid out for an FCE protocol/what the employer has requested you test and measure/how much you choose to do with your patient. The CPT code for FCEs is 97750.

As for reimbursement, reimbursement from work comp payers will vary per your contract with said insurance payer. Some companies may only give you a flat dollar rate for the day, others may only cover a certain amount of units and you will have to contractually adjust off the remaining units, or some payers may not cover it at all. I would recommend that when you get a referral for an FCE that you call the insurance company directly to clarify these details.

asawyer
June 22, 2015 @ 10:26 AM Reply  |  Email Friend   |  |Print  |  Top

I have a provider billing
97110 gp
97140 gp
g0283 gp
all on the same day and rcvg a denial "payment is denied when performed/billed by this type of provider"

help?



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