PT Billing Questions

[lbd122]

Hello Everyone,

TIA for you help!

1. I recently billed an insurance company for PT services.  I have been billing a combo of services provided (i.e. 2 units of manual therapy and 1 unit of therepeutic exercise) w/o using modifiers and have not run into any issues however recently the insurance companies have been saying there is a physical medicine reduction b/c more than one service was billed.  Am i supposed to always use a modifier?  If so which one?

2. We are OON provider.  Do I have to go with the insurance companies' allowed amounts?  That is can i not bill them the difference between the allowed amt and our cash rates?

thank you so much for helping this lost soul!   

[Anne]

I haven't had any problems billing those two codes together 97140 and 97110 seems to be ok.  But 97530 and 97140 together, they'll deny everytime, and 97530 with 97116 also deny.   But supposedly if you use modifier 59 it might be ok.  I read that in the coding forum today. 
I've billing for OT, PT and ST several years, but seldom use modifiers.  We just try and stay away from cetain code combos, but maybe I should be using them.  Wish I had some definite rules on when to use them and for which codes.  Anyone know a website where I could read more about them?

[Michele]

I have billed my share of PT, and I've always found the need for the 59 modifier.  Like Ryanne said, it is not needed on all codes, or all code combos, but it is needed on some, like the 97140 & 97530 if billed together. 

If you are out of network you can charge the patient your regular fees.

Michele

[lbd122]

hmmm...how odd.  i have been getting physical medicine reductions b/c they say more than one service was provided on the same day.  but usually that is 97410 and 97110. 

thank you for your help!

[Michele]

I'm assuming you meant 97140, and I would put the 59 modifier on that if billed with the 97110.

Michele