Physical Therapy CPT Codes in the same 15 minutes time period

1. Billing – CPT Codes:

Not Permitted In the same 15-minute (or other) time period, a therapist cannot bill any of the following pairs of CPT codes for outpatient therapy services provided to the same, or to different patients. Examples include:

a. Any two CPT codes for “therapeutic procedures” requiring direct one-on-one patient contact (CPT codes 97110-97542);

b. Any two CPT codes for modalities requiring “constant attendance” and direct one-on-one patient contact (CPT codes 97032 – 97039);

c. Any two CPT codes requiring either constant attendance or direct one-on-one patient contact – as described in (a) and (b) above — (CPT codes 97032- 97542). For example: any CPT code for a therapeutic procedure (eg. 97116-gait training) with any attended modality CPT code (eg. 97035-ultrasound);

d. Any CPT code for therapeutic procedures requiring direct one-on-one patient contact (CPT codes 97110 – 97542) with the group therapy CPT code (97150) requiring constant attendance. For example: group therapy (97150) with neuromuscular reeducation (97112);

e. Any CPT code for modalities requiring constant attendance (CPT codes 97032 – 97039) with the group therapy CPT code (97150). For example: group therapy (97150) with ultrasound (97035);

f. Any untimed evaluation or reevaluation code (CPT codes 97001-97004) with any other timed or untimed CPT codes, including constant attendance modalities (CPT codes 97032 – 97039), therapeutic procedures (CPT codes 97110-97542) and group therapy (CPT code 97150)

Medicare/Medicaid Credentialing

Before providers can bill for Medicare or Medicaid services, they must become credentialed. The application process includes filling out several forms, which are lengthy and can be confusing especially if applying for group or corporate entities.

PECOS revalidation – One of the recent Medicare requirements is for physicians to be enrolled in PECOS (Provider Enrollment Chain Ownership System). PECOS is an electronic system in which Medicare contractors enter provider Medicare enrollment information. If a physician is enrolled in Medicare or has updated his/her Medicare enrollment information within the past five years, this information may or may not be stored in PECOS. If a physician enrolled more than five years ago and have not submitted any updates to Medicare, he/she will need to update his/her Medicare enrollment information and may actually need to revalidate your provider information.

We can take care of this entire process from beginning to end. Providers simply need to provide us with information regarding their practices (tax id, NPI, License, etc).