CPT Code for Physical Therapy Evaluation and the Functional Limitation G Codes for Medicare Claims
CPT Code for Physical Therapy Evaluation is CPT Code 97001 Remember your CPT Code for Physical Therapy Evaluation 97001 must only be billed once per condition, per episode and per problem with 1 unit. It is a Faced-to-Faced Encounter, non-time based and no matter how long you spent time with the patient, you will still bill one unit for CPT Code for Physical Therapy Evaluation. I wrote this article about the PT Evaluation code plus the Functional Limitation G Codes that you must submit with your claims for Medicare. This article is based on Medicare Processing Manual Revised 2859 Issued 01-17-2014, Effective 01-01-2014 and with an Implementation Date of 01-31-2014. As of this writing, the guideline is still the same. Functional Reporting ( see reference – Rev. 2859, Issued: 01-17-14, Effective: 01-01-14, Implementation: 01-31-14) Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) amended Section 1833(g) of the Act to require a claims-based data collection system for outpatient therapy services, including Physical Therapy (PT), Occupational Therapy (OT) and Speech-Language Pathology (SLP) Therapy services. WHY? I think that this is going to be a big help in research and data gathering. Because what it does is that, the system will collect and gather data on beneficiary function during the course of therapy services in order to better understand beneficiary conditions, outcomes, and expenditures. These Functional G Codes are being reported using 42 NON-Payable functional G-codes and seven severity-complexity modifiers on claims for PT, OT, and SLP services. Meaning, they are only used for data gathering. And that is functional reporting on one functional limitation at a time is required periodically throughout an entire PT, OT, or SLP therapy episode of care. The nonpayable G-codes and severity modifiers are used for information gathering purposes about the patient or beneficiary’s functional status at the outset of the therapy service episode of care, including the status of projected goals, at specified points during treatment, and at the time of discharge. I honestly like these functional limitations reporting! These G-codes, along with the associated modifiers, are required at specified intervals on all claims for outpatient therapy services, not just those over the cap. Therapy Billing Services covered with this new rule Date of Service on or after July 1, 2013, that does not have the required functional G-code and modifier information will be returned or rejected. Date of Service prior are in testing phase. So as I am writing this post, rest assured that anything after July 1, 2013 must have your G-codes appended. I make sure my CPT Code for Physical Therapy Evaluation must be reported with G-codes on...
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