Medicare Part B - Billing Scenarios for PTs and OTs (11 pages of them straight from the CMS!)

Often, when we share information about treating Medicare patients in the pool, we hear "Where does it say that in writing?"

Well, here it is from the horse's mouth. And this document includes information about all kinds of billing snafus -- not just group billing. (Note: Although it was created in 2002, it was reviewed 9/2009).

A little sample from the 11-pg CMS billing tip-sheet...

Supervision: The services of a therapist or therapy assistant cannot be billed for supervising a patient who is independently performing a therapeutic exercise program. Medicare pays only for skilled, medically necessary services delivered by qualified individuals, including therapists or appropriately supervised therapy assistants. Supervising patients who are exercising independently is not a skilled service. See reference numbers 1. and 3. above.

Use of Aides: You cannot bill Medicare for the services of an aide that is supervised by the therapist or therapy assistant. Medicare Part B does not pay for the services provided by aides regardless of the level of supervision. Medicare pays only for skilled, medically necessary services delivered

Team Therapy: Where a physical and occupational therapist both provide services to one patient at the same time, only one therapist can bill for the entire service or the PT and OT can divide the service units.

Group Therapy (sample scenario): In a 45-minute period, a therapist works with 3 patients - A, B, and C - providing therapeutic exercises to each patient with direct one-on-one contact in the following sequence: Patient A receives 8 minutes, patient B receives 8 minutes and patient C receives 8 minutes. After this initial 24-minute period, the therapist returns to work with patient A for 10 more minutes (18 minutes total), then patient B for 5 more minutes (13 minutes total), and finally patient C for 6 additional minutes (14 minutes total). During the times the patients are not receiving direct one-on-one contact with the therapist, they are each exercising independently. The therapist appropriately bills each patient one 15 minute unit of therapeutic exercise (97110) corresponding to the time of the skilled intervention with each patient.

To download the document, click here...