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PT Billing/Modifiers

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lacycr:
I have done Chiropractic billing for several years but my office is expanding and has hired a physical therapist as well. Billing for PT is new to me. I know there has been some changes to PT new patient visits CPT codes last year. Can anyone clarify for me what codes you bill for the different levels of new patient visits? Are any modifiers needed for PT exams? If so, what ones? Thank you! (Not for medicare billing, this will be for commercial insurance plans)

Michele:
The PT evaluation codes are

97161  20 mins
97162  30 mins
97163  45 mins

They are always billed as one unit.  You can find full descriptions of each code at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM9782.pdf.  Ignore the part about the GP modifier since you stated it was not for Medicare billing.  The codes are based on the time spent on the evaluation.

It would be impossible to answer if a modifier would be needed as that would depend on the other services performed that day/visit. 

lacycr:
Thank you Michelle! If the other codes billed that same day were 97140 and 97110, would a modifier be needed?

Michele:
The evaluation should not need a modifier with those two codes.  Without access to the notes I cannot state for sure that the 97140 may need a modifier if it is a completely separate service from the 97110.

ErickVA65:
I recommend you to check NCCI on https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html. it will help you if it is modifier for both.

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