TMPPM 2010 >4.3.7.1 Physical Therapy Billing Table

4.3.7.1 Physical Therapy Billing Table


POS*	Procedure Code	Individual or Group	Therapist or Licensed/Certified Assistant
1, 2, or 9	97001	Individual	Licensed therapist
1, 2, or 9	97110 with modifier GP	Individual	Licensed therapist
1, 2, or 9	97110 with modifier GP and U1	Individual	Licensed/certified assistant
1, 2, or 9	97150 with modifier GP	Group	Licensed therapist
1, 2, or 9	97150 with modifier GP and U1	Group	Licensed/certified assistant
*Place of Service: 1=office or school; 2=home; 9=other locations

Providers must use a 15-minute unit of service for billing.

Refer to: Subsection 4.5.1.2, "Billing Units Based on 15 Minutes" in this handbook.

The recommended maximum billable time for PT evaluation is three hours, which may be billed within a 30 day period. The recommended maximum billable time for direct therapy (group or individual) is a total of one hour per day. Providers must submit documentation of the reasons for the additional time, if more than the recommended maximum time is billed.

Texas Medicaid & Healthcare Partnership
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