Medical Billing Forum
Coding => Coding => : Alice Scott March 07, 2008, 08:46:21 AM
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Question
Are there special "home health" codes that should be used for physical therapists (non-contracted w/ ins. companies) who treat patients in their homes? I bill for PT and OT - same patients are being treated by a Speech Therapist (out of network also) and she is reimbursed almost 100%, but my providers are paid only as out of network providers. ST biller says they do not have any special negotiated fee agreements. These patients Dx's are usually conditions that need long term PT, OT and ST - like cerebral palsy, hypotonia, etc. I've looked for home health codes for PT and can't find any.
thank you,
Carol
Answer
Hi Carol,
The codes that you should use for home health PT and OT are the same cpt codes that should be used if the patients were being seen in the office, except that you would indicate the place of svc was the home. There are not any special codes just for treatment in the home. The ST is probably reimbursed higher since it is not a service that is usually received by patient’s in an office setting, and many insurance carriers do not have fee schedules for the codes. Also, many carriers do not credential ST’s since again, it is not a common service to receive in the office. Since they do have in network PT’s and OT’s and they have fee schedules for the services, the PT & OT (out of network) is paid based on those fee schedules.
The 97116 is often bundled with another code. In NY, it is seldom allowed separately, even with the 59 modifier (although that does work with some carriers.) It sounds like you are doing everything you can. It is one of the unfortunate parts of the insurance industry that we can’t do much about.
Hope that is helpful.
Thanks
Michele
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Try using G0151 and rev code 421 on ub04 1450
I bill from Ohio and get paid by MCR and MCD
G0152/431 rev or G0153 for occupational therapy You don't need a rev code for 1500 claims
Mike cardinal home health