Physical Therapy Billing Coding – HRSA Policies

The complexity of physical therapy billing coding diminishes with constant and repeated use.  But for a beginner, it is so easy to make mistakes and interchange or use incorrect physical therapy billing codes.

Under the Health and Recovery Services Administration (HRSA), there are two providers who are eligible to render physical therapy.  They are duly licensed and board certified physical therapists and assistants supervised directly by certified physical therapists.

For physical therapy billing coding purposes, any patient can receive treatment for outpatient program in any of the following locations:

  • Home, office or outpatient medical facility
  • Home health agency as defined by Chapter 388-551 WAC
  • As part of Acute PM &R program
  • Neurodevelopment center
  • Any of the locations defined in WAC 388-537-0100
  • Any which complies with IDEA and provides services for early intervention for disabled kids up to two years old

To align physical therapy billing coding with the limitations of HRSA, any of the following conditions have to be present:

  • Within the defined scope for an eligible patient’s medical care coverage
  • Treatment is ordered by a certified physician and is medically necessary
  • Must begin within 30 days of the order date
  • Conditions are results of any injury and/or diseases and defects that are medically recognized
  • Adhere to physical therapy standards

To ensure reimbursement, the physical therapy billing coding covered should be as listed below:

  • Patients 20 years old and below are covered
  • HRSA will cover one visit for the instruction of how to apply TENS, per client and per lifetime.
  • HRSA will cover two DME needs evaluations for every calendar year.  For physical therapy billing coding purposes, two program units can be used per assessment.
  • HRSA will cover one wheelchair needs evaluations for every calendar year.  Each assessment can be charged four program units for physical therapy billing coding.

Each program unit is used according to the applicable CPT code.  For CPT timed codes, every 15 minutes is considered one unit.  For services that is not timed, physical therapy billing coding used is for one unit irregardless of actual time used.

For patients aged 21 years and older, HRSA will cover up to 96 physical therapy units.  This is added to the original 48 physical therapy units when certain physical therapy billing coding is used like Down’s syndrome and traumatic injuries.

Due to the number of codes and the guidelines on how the codes are to be used for physical therapy billing coding, extensive knowledge is a requirement.  This ensures quick reimbursement and avoids costly mistakes that could lead to denial of reimbursement claims.

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