A few coding reminders for physical and occupational therapists that are effective as of 1/1/2020:
NCCI Edits for Evaluations:
97530 and Evaluations
97530 cannot be billed on the same day as physical or occupational therapy evaluations. This was buried deep in the NCCI coding edits changes and it is a major change to how evaluations will be billed moving forward.
97140 and Evaluations
Modifier 59 is required on the evaluation CPT code or on 97140 when you bill manual therapy on the same date of service as a physical or occupational therapy evaluation.
*Please note on changes above, Medicare is considering manual therapy as part of the evaluation CPT code.
Biofeedback Edits
90912: Cannot bill with 90901
90912: Use modifier 59 on the following CPT codes when used on same day: 97032, 97110, 97112, 97530, 97535, 97750
90913: Cannot bill with 90901
90913: Use modifier 59 on the following CPT codes when used on same day: 97032, 97110, 97112, 97530, 97535, 97750
You can review other NCCI changes directly through CMS.
PTA/OTA Modifiers for Medicare:
All therapy services provided by a Physical Therapy Assistant (CQ) or Occupational Therapy Assistant (CO) must be reported with the associated modifiers on the claim line(s) representing the services they provided.
The PTA/OTA modifier must FOLLOW the GP or GO professional modifiers.
All other modifiers are to go after any additional modifiers that are necessary on the claim.
Just as a reminder, Part B Threshold for 2020 for OT is $2080 and for PT/SLP is $2080 (combined).
As always, if you have any questions about these changes or any other 2020 updates, contact us at hello@lincolnrs.com to set up a strategic evaluation meeting.
