Reimbursement

CPT 2008: New Codes

Do you have questions regarding coding changes?  Can your office afford to not understand all of the latest changes and rulings?   The APTA website has the answers to your questions.  Just click on reimbursement and follow the links that meet your needs.  This is a member only benefit, so remember this is another reason it pays to be a member. 

The 2008 version of CPT includes new codes pertaining to Non Face-to-Face services including telephone assessment and management services, and online evaluation and management services. There are also new medical team conference codes. The following includes a description of each of the new codes and guidance in their use. Please note that the heading language for these new codes is extensive and provides considerable guidance as to the requirements for use of the codes.

It should be noted that the Centers for Medicare and Medicaid Services released the 2008 Physician Fee Schedule in the final rule published on November 1, 2007. The rule, which will be printed in the Federal Register November 27, 2007, includes Medicare's determination that they will not pay for any of the new services described below. The rule can be found at: https://www.cms.hhs.gov/center/physician.asp.

APTA was very active in both the interdisciplinary development of these new codes as well as the valuing of these codes through the AMA CPT process. It is unfortunate that Medicare's decision is not to pay for these services. It is unclear whether or not private payers will have the same coverage policies for these services. These codes, however, are available for physical therapists to report.

Physical therapists should become familiar with the new codes and their heading language.  APTA is interested in any feedback you can provide pertaining to payment of these services by private payers. Please forward any feedback to reimbursement@apta.org.

New ICD-9 Code Changes 

Please refer to the APTA website for new and invalid ICD-9 codes.  This is a member only benefit.

Physician Quality Reporting Initiative (PQRI)

Medicare will be implementing their PQRI on July 1, 2007.   The PQRI 1.5% bonus payment is available to all PTs in private practice who treat Medicare beneficiaries. You may read APTA’s summary of this program at: http://www.apta.org/AM/Template.cfm?Section=Coding_Billing&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=38481 .  The CMS website has a wealth of information on this program including practice tools (http://www.cms.hhs.gov/PQRI/01_Overview.asp#TopOfPage).  At this time, this program is not available to facility based therapists; however APTA is in discussion with CMS to see if the program can be expanded in future years

NPI: Common Billing Errors

CMS recently published a Medicare Learning Network article containing information related to common billing errors that should be avoided when billing Medicare carriers.  www.cms.hhs.gov/MLNMattersArticles/downloads/SE0712.pdf

The article aims to help providers correctly complete their claims so there are fewer denials or delays during claims processing.