Physical Therapy Medical Billing Guidelines

Physical Therapy Billing

Your Guide on How to Guarantee Success with Physical Therapy Medical Billing 

Physical therapy is a form of healthcare that helps patients recover from injury or improve their physical function through the use of exercise, massage, and other techniques. Physical therapy services are essential in the healthcare industry and are covered by various health insurance plans. However, billing for physical therapy services can be complicated due to the variety of services offered and the complexity of insurance policies. This blog post will discuss the guidelines for billing physical therapy services. 

Verify Insurance Coverage 

Before providing physical therapy services, verifying the patient's insurance coverage is important. This step ensures that the services provided are covered under the patient's insurance plan and you are aware of the insurance requirements.  

Some insurance plans require prior authorization before providing physical therapy billing services, and failure to obtain this authorization can lead to denied claims. 

Determine the Billing Code 

Physical therapy services are identified using Current Procedural Terminology (CPT) codes. CPT codes for physical therapy are used to describe medical, surgical, and diagnostic services provided by healthcare professionals. Physical therapy services are identified using codes from the 97000 series.  

Each code corresponds to a specific physical therapy service, and the code selected must accurately reflect the service provided. Time consumed on each CPT code determines the number of billable units for physical therapy.

Document the Service 

Documentation is a crucial part of physical therapy medical billing. It is important to maintain detailed records of the services provided, the length of the session, and the progress made by the patient. The documentation should also include the patient's diagnosis and therapy goals. This information is critical when submitting claims to insurance providers. 

Submit the Claim 

After the physical therapy session, the next step is to submit the claim to the insurance provider. The claim should include the CPT code corresponding to the service provided, the patient's diagnosis, and the documentation of the service. Depending on the insurance provider's requirements, claims can be submitted electronically or via mail. 

Follow up on the Claim 

After submitting the claim, it is important to follow up on its status. This step ensures that the claim is processed and paid correctly. If the claim is denied, it is important to identify the reason for the denial

and resubmit the claim if necessary. If the insurance provider requires additional documentation, it is important to provide the required information promptly. 

 

Use Appropriate Modifiers 

Modifiers are used to indicate that a service or procedure has been modified in some way but has not changed its definition. In physical therapy medical billing, modifiers can be used to indicate that multiple services were provided during a single session or that the service provided was above and beyond the standard service.  

Modifiers are essential when submitting claims to insurance providers as they provide additional information about the services provided. 

 

Know the Medicare Guidelines 

Medicare is a federal health insurance program that covers individuals over the age of 65 and those with certain disabilities. Physical therapy services provided to Medicare beneficiaries are subject to specific guidelines, which can differ from those of other insurance providers.  

It is important to understand these guidelines to ensure that physical therapy services are billed correctly and paid accordingly. 

Ending Notes 

In conclusion, physical therapy medical billing can be complicated, but following the guidelines outlined above can ensure that the process is smooth and effective. The guidelines include verifying insurance coverage, determining the billing code, documenting the service, submitting the claim, following up on the claim, using appropriate modifiers, and knowing the Medicare guidelines. By following these guidelines, physical therapy providers can ensure that they are paid correctly and promptly for the services they provide to their patients.

HMS USA LLC is the medical billing company providing its healthcare providers the best billing services for physical therapy and many more.