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Did you know that CMS has recently changed some correct coding methodologies that can prevent PTs from billing an evaluation and therapeutic activity and/or group therapy services delivered on the same day?  

It was previously announced that PTs, OTs and ATCs will no longer receive payment when CPT codes 97530 (Therapeutic Activities) or 97150 (Group Therapy) are billed on the same visit as an Evaluation code.

PT Evaluation Codes: 97161, 97162, 97163 

OT Evaluation Codes: 97165, 97166, 97167 

Athletic Training Evaluation Codes: 97169, 97170, 97171, 97172


Recent Reversal Announced On NCCI Coding Changes 

However, there has been a new update to the rule change. APTA has communicated that the recent change will be reversed. What does this mean for PTs, OTs and ATCs? It means that you can continue to bill with these codes combined and will receive reimbursements. There currently is no update in regards to whether or not that the change is retroactive allowing for therapist to recoup payments in the time frame of the change. An update will be made soon regarding this matter to see how therapists can move forward. 

Even though the biggest reversal has been eliminated and the most problematic parts of the January 1st edits have been reversed, a few restrictions still remain 

CMS will continue to require the 59 modifier/X modifier to be applied. According to APTAs announcement this means that a physical therapist will receive payment for furnishing both Manual Therapy (97140) and an evaluation using any of the physical therapy evaluation codes (97161, 97162, 97163) on the same day for the same patient, or if billing for therapeutic activities (97530) or group therapy (97150) delivered on the same day as a physical therapy reevaluation (97164).  

Practice Pro will be following this development and applying the changes to our software as it occurs to best keep you up to date with coding edits that apply. To learn more about this recent rule reversal visit APTAs announcement here 

Do you want to know more about Practice Pro and our ability to offer the right Physical Therapy Software and Practice Management Software Solutions? Schedule a demo today here and find a better way to empower your practice and patients.