Time to Act: Surprise Coding Complication Ignores Realities of PT Practice and Must be Changed

The US Centers for Medicare and Medicaid Services (CMS) unveiled an unwelcome New Year’s Day surprise for outpatient therapy providers, including private practitioners and facility-based settings, when it announced it will no longer allow two frequently used therapy billing codes to be used in combination with evaluation codes. It’s a decision that flies in the face of standard PT practice and effective patient care—and CMS and the National Correct Coding Initiative (NCCI) contractor need to hear that perspective loud and clear, from as many stakeholders as possible as soon as possible.

At issue are current procedural terminology (CPT) codes 97530 (therapeutic activities) and 97150 (therapeutic procedures, group, 2 or more individuals) which, until January 1, were allowed to be billed on the same day as physical therapy or occupational therapy evaluation. Under new CMS NCCI edits, however, that’s no longer allowed. And in a further complication, the latest NCCI edits also require use of the 59 modifier—the modifier that’s used to indicate that a code represents a service that is separate and distinct from another service to which it is paired—whenever code 97140 (manual therapy) is billed with an evaluation.

Full article at APTA

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