|
24.5.9 Physical Therapy/Occupational Therapy Procedure Codes
The procedure codes listed above for PT and OT are only payable to Home Health Agencies. Independently enrolled occupational therapists are not paid under Home Health Services.
Therapy services that can be designated either as PT or OT must be requested and billed with the correct procedural modifier.
PT and OT 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 and OT services are to 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. Plateauing is the point at which maximal improvement has been documented and further improvement ceases.
|
