Medical Billing Practices for Physical Therapy Telehealth Services for 2023
Telehealth services have been blooming ever since covid-19 due to their convenience and reliability. In physical therapy centers, telehealth began at the beginning of the pandemic on the account of the public health emergency. New services were included under the telehealth services as a part of Medicare in the year 2020 by the Centers for Medicare & Medicaid Services (CMS).
There are potential substantial changes to telemedicine in the Calendar Year 2023 Medicare Physician Fee Schedule (MPFS) finalized rule published by CMS, which will affect how physical therapy services are billed. As a medical billing service provider, we at Practolytics take great interest to stay informed on new developments so that we could handle the billing services more effectively.
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Key Points for Billing Online Physical Therapy for CY 2023
The physical therapy providers and physicians within the Medicare Part B delivered real-time telehealth services, which were reimbursed by Medicare during the pandemic public health emergency. Once the PHE expires, physical therapists can provide telemedicine services for a period of 151 days following the end of the PHE. The following is the list of fundamental guidelines for charging for these services that continue to hold:
The beneficiary’s home is just one example of an originating site where telehealth services could be provided. Up to the end of CY 2023 or the end of the year that the PHE expires, whichever comes first, the claims can still be paid with the POS of the telehealth service code that could have been utilized even when the service was provided in person.
When provided by a PT, telehealth appointments will still need the proper therapy modifier. To designate services provided as telehealth services, modifier 95 – Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System, must be added.
Online E&M services or e-visits: These are services initiated by the patient that must occur on a safe, HIPAA-compliant platform with digital communication capabilities.
Online or virtual digital E&M services are invoiced once every seven days, starting from the moment the patient’s inquiry is first reviewed. The total time allotted for the given services includes the time needed by the therapist to carry out the following:
- Evaluate the first inquiry.
- Determine the patient’s issue
- Discuss the patient’s issue with more healthcare experts
- Create management plans, such as ordering prescriptions or tests, and
- Engage with patients using HIPAA-compliant digital communication platforms.
Physical Therapy CPT Code Updates
The list of “category III” codes under which PTs could be compensated when providing care using telehealth throughout 2023 has had several new additions. Once the public health emergency and contribute days are through, PTs will no longer be able to charge these codes in connection with telehealth until midnight on December 31, 2023, whichever date comes first.
By using medical devices to gather non-physiological data, Remote Therapeutic Monitoring or RTM, enables clinicians to charge for the remote therapeutic patient care with musculoskeletal problems. Five new CPT codes were added for remote treatment monitoring as part of the 2022 billing rule. Two of the codes—98980 and 98981—were for RTM treatment management services. Physicians, physical therapists, and occupational therapists are just a few of the qualified professionals who could charge CPT codes 98980 and 98981 for treatment management services and get paid at the same rates.
RTM services could well be billed under general oversight or supervision. The RTM services provided a physical therapy assistant must be done so within the physical therapist’s oversight.
Audio-only patient care services are typically not similar to in-person PT services as per CMS in the Final Rule and hence they would not be individually recognized under the Medicare Telehealth Services List post the 151-day extension period of the PHE.
Physical Therapy CPT Codes that are qualified for telehealth
The telehealth codes are not specific to Physical therapy and hence when billing a telehealth session it is recommended to specify the recognized service, select the relevant CPT code, and enter the necessary modifier and POS code based on the payer’s requirements. The following is the list of CPT codes that can be utilized to charge for telehealth PT services:
| CPT | Code Description |
| 97161 | Physical Therapy evaluation low complex 20 min Accessible until December 31, 2023 |
| 97162 | Physical Therapy evaluation mod complex 30 min Accessible until December 31, 2023 |
| 97163 | Physical Therapy evaluation high complex 45 min Accessible until December 31, 2023 |
| 97164 | Physical Therapy re-evaluation est. plan care Accessible until December 31, 2023 |
| 97110 | Therapy procedure using exercise |
| 97112 | Neuromuscular re-education |
| 97116 | Therapeutic procedure, 1 or more areas, every 15 minutes, gait training |
| 97530 | Therapeutic activities |
| 97535 | Self-care/home management training |
| 97542 | Wheelchair management |
| 97750 | Functional capacity evaluation |
| 97755 | Assistive technology assessment |
| 97760 | Orthotic training |
| 97761 | Orthotic, prosthetic training |
Following the pandemic, Medicare Part B started to cover real-time face-to-face telehealth services which were provided by physical therapy practitioners and physical therapy assistants. Other payers could, however, use different billing procedures than Medicare. It is recommended that clinicians carefully examine each payer’s policy to ascertain their preferences for billing for telehealth as well as other online services.
To assist trained health professionals in accurately charging for the services provided, companies that offer medical coding and billing services stay up to date on industry developments. In order to keep up with the changing circumstances and assure appropriate claim submission in 2023 and beyond, the billing and coding specialists will use resources offered by the APTA, CMS, and various payers.
Practolytics is a medical billing company that delivers end-to-end revenue cycle management solutions for healthcare clinics. We help our clients in attaining maximum reimbursements for the services rendered.
Reach out to us for more industry updates.
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