Physical Therapy Billing- using Modifiers with a signed ABN

[barrie]

Billing from a physical therapy office-
Patient is Medicare and approaching the $3700 cap
Have been coding GP 59 KX since the $1900 cap
Now that the ABN is signed do I bill GP 59 KX GA as long as the services are medically necessary?

[Merry]

And here is the unanswer to your question. Some states have a pre approval process when you go over the $3700. Some you do at your own and the patient's risk. What state are you in and I will try to help you.

[barrie]

In VA- DC metro area so we are Novitas and we do not have the pre approval process- we take the risk....

[Merry]

I would bill with the modifiers if your MAC says to. I think it is important to check with them as you are in one of the states that you have to take the risk. Really tough situation to be in. I would not assume that Novitas in another area has the same "rules". If any of your therapists belong to the APTA I would call them. They have are an excellent resource but you will need to identify the member to get information.

Merry