|
24.5.8.2 Limitations
PT services must be billed with the AT modifier and must be provided according to the current (within 60 days) written orders of a physician and must be medically necessary. PT must be billed with CPT procedure codes.
The AT modifier is described as representing treatment provided for an acute condition, or an exacerbation of a chronic condition, which persists less than 180 days from the start of therapy. If the condition persists for more than 180 days from the start of therapy, the condition is considered chronic, and treatment is no longer considered acute. Providers may file an appeal for claims denied as being beyond the 180 days of therapy with supporting documentation that the client's condition has not become chronic and the client has not reached the point of plateauing.
Use procedure code C-97001 for Physical Therapy evaluation codes. PT evaluations are payable once every 180 days for any provider. Use procedure code C-97002 for Physical Therapy re-evaluations. PT re-evaluations are payable one time per month for any provider. Procedure codes C-97001 and C-97002 are not payable on the same day as the following procedure codes:
To request wheelchair evaluations, use procedure code 1-97001.
|
