Specialty Physical Therapy Billing Company

What You Need to Know About Physical Therapy Services

Working as a physical therapist can be rewarding. You will be able to help people improve their strength, movement, and function every single day. But you should also keep in mind that you are running a business. That’s why you need to be mindful about the revenue that you are generating. Do you know how you should be charging your patients for the physical therapy services you offer? This is where this article on billing for physical therapy services can be helpful. We will share more details with you on how you can charge for your services and how to maximize your revenue.

Understanding Physical Therapy Billing Units

When understanding billing for physical therapy services, the very first thing you should learn is the billing units. A billing unit refers to the amount of time that you spend when treating a patient. However, the number of billing units would vary based on multiple factors, such as the nature of therapeutic activity and the complexity of treatment.


What Are The Different Types of Physical Therapy Billing Units?

The American Medical Association introduced a standard coding system for physical therapy billing units. It is known as the Current Procedural Terminology or CPT. When you are using CPT as the unit when billing for physical therapy services, you can accurately calculate the amount that you should be charging from your patients. You can further divide it into two different categories as follows:


– Service Based Time Codes

This is a one-time charge that you get from your patients. It doesn’t consider the amount of time that you spend on treating your patients. In most instances, service-based time codes are used when the physical therapist doesn’t require to be there by the side of patient at all times.


– Time-based Codes

You can use time-based codes when you are offering physical therapy services to a patient directly. For example, it becomes useful when you are offering manual therapy treatments. The service you offer would be billed based on 15-minute increments. But when you are offering treatments to a Medicare patient, you will need to offer services for a minimum of 8 minutes.


Ways to Determine the Billing Units for Physical Therapy Services

There are multiple factors that you can consider when determining the Billing Units for physical therapy services. Let’s explore them in detail.


· The type of service you offer.

As mentioned earlier, the services you offer are divided into two main categories as service-based and time-based. Below are the popular CPT therapy codes for time-based services.

  • Therapeutic services – 97110
  • Gait training – 97116
  • Manual therapy – 97140
  • Therapeutic activities – 97530

When it comes to service-based charging, you will need to determine the exact number of billing units based on the nature of therapy and complexity of it. Below mentioned are few popular CPT therapy codes for such service-based treatments.

  • Hot or cold packs – 97010
  • Mechanical traction – 97012
  • E-Stim or unattended electrical stimulation – 97014.


· Evaluation Codes for PT billing

When billing for physical therapy services, you should also be familiar with how to measure the complexity of your treatments. Here are the codes that you can follow when indicating the complexity of the treatment.

  • High Complexity – 97163
  • Moderate Complexity – 97162
  • Low Complexity -97161

When there is a re-evaluation, you may think about using the code 97164.


· Determining the Timed Units

While trying to ensure accuracy with billing for physical therapy services, you should also be familiar with how to calculate the timed units. A timed unit would refer to the number of minutes you spend treating a patient. Below table would help you to understand how to calculate the timed units.

Number of Units

Number of Minutes

1

8 – 22

2

23 – 37

3

38 – 52

4

53 – 67

5

68 – 82

6

83 – 97

7

98 – 112

8

113 – 127


· Determining Untimed Units

The approach for calculating untimed units is quite different. That’s because you don’t focus on the number of minutes where you spend on treatments. Instead, you will be getting a pre-calculated reimbursement fee. It will only be possible for you to submit just one billion units for every session. But you will still be able to record the in-time and out-time.


Read Also:-Guidelines for Physical Therapy Medical Billing


How to Properly Document the Physical Therapy Services You Offer

Accurate billing is essential when it comes to billing for physical therapy services. This will help you to overcome denials and claim errors. You need to ensure that you are including all the mandatory code components in documentation. The descriptions you include along with them need to be clear as well. Here are some additional tips that can help you with documentation:

  • When you are trying to explain the level of complexity, include all your personal factors that affect the treatment you offer.
  • Properly list all the body functions and structures that you address during a treatment session. Along with that, you need to justify the reasons why you went ahead with the therapies you offered.
  • You need to include supporting evidence for the assessment section under documentation.
  • Mention the level of complexity by using an appropriate evaluation code.
  • Clearly document the patient assessment results to support your clinical decisions.

Submitting Your Claims

The final stage of billing for physical therapy services is submitting your claims. But before you submit, it is better to take your time and carefully review everything. This can assist you to discover any mistakes that you may have made. You can consider points in the following checklist to make sure that everything is accurate.

  • Billing codes and billing units
  • The exact service you offered.
  • Insurance type and coverage
  • Patient information and demographics
  • Supporting documentation

Since insurance providers now have their electronics claims forms, you will be able to go ahead and easily submit your claims. Upon successful verification of the claim, the payer will go ahead and approve it. Then the final reimbursement will be offered to the physical therapy clinic.