Coding > Coding

I need to know if I need a modifier code?

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gbonomo:
I will be billing cms 1500 medicare for physical therapy procedures. I will be using codes 97110, 97112, and 97140 togther for one treatment session. Do I need a modifer code for proper medicare billing to get reimbursed?
Also, do I need a modifer code if I bill an evaluation 97001 and 97110 together on the clients initial visit?
Thanks;-)
Greg

Merry:
First of all..I need to ask you. Are you the therapist or are you the biller? Are you familiar with the caps, the use of special modifiers, all the new codes that you must use for evaluating progress etc.

Please please please, if you are the PT, please go to your Medicare website and get the information for therapy. It is VERY complex to bill and you need to do this exactly right. Many new rules and guidelines for 2013.

If you are the biller, please do get all of this information from the practice.

gbonomo:
Actually, I am a therapist and I have a unique situation. I work as a contractor for California corrections. My new contract requires me to bill the state for each individual inmate, using the Medicare 1500 healthcare form. I will be using the 97110, 97112, and 97140 exclusively for 45 minute treatment sessions for each pt. so I need to know if I need a modifier to bundle these codes? The caps will not apply in my situation

Merry:
I am also in CA so I would check with Medi-Cal as they sometimes have unique rules and even more unique modifiers. See if you can get the PT specialist. Each state is different so I really do suggest that you contact them. And let us know please.

Good luck

shanbull:

--- Quote from: gbonomo on June 21, 2013, 02:10:40 AM ---Actually, I am a therapist and I have a unique situation. I work as a contractor for California corrections. My new contract requires me to bill the state for each individual inmate, using the Medicare 1500 healthcare form. I will be using the 97110, 97112, and 97140 exclusively for 45 minute treatment sessions for each pt. so I need to know if I need a modifier to bundle these codes? The caps will not apply in my situation

--- End quote ---

I can only speak from my own experience, and I work for PT's in Minnesota. But the answer in my case to this question would be yes. There are most likely two types of modifiers you'll need to use. One is to designate that the service is provided by a credentialed PT. We use the GP modifier for every procedure on every claim for our PT's. Not sure if this will be the same in your case. Additionally, with multiple procedures, we use the 59 modifier for each distinct service performed. Every insurer is different regarding what they will pay for, and some will bundle procedures regardless of how they're coded. There are even CPT codes that are mutually exclusive, or if two incompatible codes are sent, only the cheaper one will be paid. I'm sure there is a set of guidelines for persons under incarceration in California specifically as well; try to find that and laminate it because it'll be your best friend. Also make sure you're familiar with the Medicare guidelines because almost all insurers follow them now in addition to their own policies, and the Correct Coding Initiative's directions on PT codes. I also keep an updated list of which codes are tricky or shouldn't be billed together.

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