Inquiring minds want to know:
- How frequently is aquatic therapy billed under Medicare Part B?
- How often do private practice PTs use the code 97113? How about OTs?
- What setting is the most likely to bill for aquatic therapy?
Answers to these questions -- straight from CMS (click here for master document). Here are a few of the highlights. (From 2006; published Feb 1, 2008)
[Editor's note: Looking for more recent statistics? You can order the 2008 data from Medicare for $100. Download the BESS file here. Contains private practice data only.]
How
big a percentage of Medicare Part B claims does “aquatic therapy”
(97113) represent?
In 2006, aquatic therapy comprised
approximately .9% of claims. It was the 14th most
frequently billed outpatient code behind:
97110
(therapeutic exercise) 33.03%
97140
(manual therapy) 11.37%
97530
(therapeutic activities) 9.52%
97112
(neuromuscular reeducation) 7.51%
G0283
(electrical stimulation - not wound care) 6.23%
97116
(gait training) 6.01%
97035
(ultrasound) 5.82%
97001
(PT eval) 3.09%
97535
(self care management) 2.95%
97032
(electric stimulation) 2.23%
97526
(treatment of swallowing dysfunction) 1.70%
97150
(group therapy) 1.33%
97124
(massage) 1.23%
Which settings are the most likely to bill for aquatic therapy?
Obviously,
therapists/physicians are more likely to use the procedure “aquatic
therapy” in a hospital, outpatient rehab facility. or outpatient PT
setting than in a SNF or home health setting. So, although the code
97113 represented less than 1% of all claims to Medicare Part B in
2006, it represented over 2% of all claims made by hospitals. More here
How much were providers reimbursed for aquatic therapy?
Although “aquatic therapy” represented less than 1% of all claims
to Medicare B, it was responsible for 1.75% of all dollars reimbursed overall and over 2.3% of payments doled out to private practice PTs. Why? CPT code 97113 has a higher relative value (and thus
a higher reimbursement rate) than many of the other codes on the list. More here
How frequently do private practice PTs bill for aquatic therapy? How about private practice OT?
In
2006, private practice PTs were over 3x more likely to bill for
“aquatic therapy” than private practice OTs. More here
There's tons more info available... including the most commonly used ICD-9 codes, the average number of visits by ICD-9 diagnosis, and more. Click here for
CMS outpatient therapy utilization document.
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