Author Topic: PT billing  (Read 1699 times)

Trisha Reyes

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PT billing
« on: October 19, 2008, 10:47:22 PM »
Hi Michelle,

I have your book for chiropractic billing, it mentions that medicare will only pay for 98940 and 98942 with the correct primary and secondary diagnosis codes. It that the same for physical therapy?  I work for a family practice dr. that also does physical therapy, he used manipulation cpt code 98925 will this be covered by medicare if yes with what specific ICD 9 codes? he also does pain management and always bills 20610 injection when he does manipulation, are the payable  together for medicare?

Thank you,


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Re: PT billing
« Reply #1 on: October 20, 2008, 07:01:33 AM »
I strongly suggest you purchase the Coding and Payment Guide from Ingenix the information in that booklet is like a bible especially when you have doubts.


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Re: PT billing
« Reply #2 on: October 20, 2008, 06:38:52 PM »
The Medicare rules do not apply to PT or to osteopathic manipulations (98925-98928).  Medicare only allows chiropractors (DC's) to bill the 98940-98942 codes and they require specific diagnoses. 

If an MD or a DO bills PT charges, or osteopathic manipulation the same rules do not apply.

If you are going to bill the 20610 with other charges, you just need to make sure you have the diagnosis for the 20610, and the diagnosis for the other charges, and you should use the 59 modifier to indicate separate procedure.

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