As a patient, it is so easy to get lost when reading one’s medical bills. For physical therapy patients, deciphering the physical therapy billing codes might be simpler but challenging nonetheless.
Although an insurance company usually pays for medical bills, it is not uncommon for patients to get billed for the balance. To ensure that you are not being billed excessively, here are some physical therapy billing codes to be aware of:
The most common physical therapy billing codes are 97001 and 97002 which are for initial evaluation and re-evaluation respectively. Getting billed for a re-evaluation only happens in certain circumstances when it is really called for.
When measurement tests are required but do not form part of an initial evaluation, physical therapy billing codes 97750 – 97755 are used. Specialized tests required by insurance companies are also billed with these codes.
When doing therapeutic procedures with the therapist, you can expect to see physical therapy billing codes 97110 – 97546. These codes are used for timed services that also require the direct supervision of the therapist. Examples of procedures with these codes are manual therapy, gait training and aquatic therapy.
Modalities, which are very common procedures, also have their own set of physical therapy billing codes. Modalities can be timed and not timed services. For supervised but untimed procedures, the codes used are 97010 – 97028. Examples of procedures under this category are ultrasound, iontophoresis and electric stimulation. Codes 97032 – 97039 are used for timed procedures and are billable in increments of 15 minutes. Timed procedures are normally billed per unit, within 8 – 15 minutes time frame. They be billed in more than 1 unit as necessary.
There are also cases wherein assistive tools like prosthetics are required to help the patient get back on his or her feet. When therapists provide special training on the use of prosthetics and orthotics, physical therapy billing codes 97760 – 97762 are applied.
In special situations, modifiers might be added to the usual physical therapy billing codes. Knowledge of these modifiers is important since they can add to the billing amount. These modifiers are 21, 22, 25, 51 and 52 modifiers. These modifiers are used by physical therapists only when called for since it can easily subject them to fraud if and when overused.
Although the patient may or may not be paying for the bill out of his or her pocket, knowledge of the physical therapy billing codes should not be underestimated to prevent any unnecessary medical expenses.