Marked Rise in Physical Therapy Services Provided to Medicare Beneficiaries

by | Last updated Jul 4, 2023 | Published on Jul 11, 2014 | Healthcare News

Physical Therapy
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Physical therapy is a dynamic treatment method that helps individuals to overcome disabilities and achieve optimal function and pain relief. As per a new U.S. Government Accountability Office (GAO) report, physical therapy services offered to Medicare beneficiaries increased by about 30% during the period 2004 to 2010. Unlike other healthcare service-utilization increases, self-referring physicians were not responsible for the rise.

It was found that around 4.3 million Medicare beneficiaries had received outpatient physiotherapy treatments worth $4.1 billion in the year 2011. The number of services offered per 1,000 Medicare beneficiaries recorded an increase from 1,223 in 2004 to 1,595 in 2010. The amount of services generated by self-referring family physicians, orthopedic surgeons and internists was 320; the non-self-referred services recorded a significant growth of 41% from 903 in 2004 to 1,275 in 2010.

As part of the study, the Medicare Part B claims (for the year 2004-2010) for orthopedic surgeons, family physicians and internists were examined. These specialties accounted for more than 75% of service referrals. The total number of services referred per provider, the number of services received per beneficiary and the number of beneficiaries referred were also identified. The main findings of GAO report include –

  • Self-referring physicians (for all three specialties) referred higher number of patients for physiotherapy.
  • The total expenditure related to self-referred services reported an increase of 10% from $389 million to $428 million. Non-self referred services showed a dramatic increase of about 57% from $ 1.2 billion – $ 1.9 billion.

Non–self referred PT services can be performed by therapists who can directly influence the amount, duration and frequency of PT services through the detailed written plan of care required by Medicare. This is cited as one of the prime reasons for an increase in non-self referred services.

Physical Therapy Billing Codes

Physical therapy services are reimbursed when the correct CPT codes are used to report the services and medical necessity is established. With a reliable physical therapy billing service, physicians can streamline the claim submission and reimbursement process. Moreover, accurate knowledge of CPT codes may help physicians secure reimbursement of their claims on time with minimum denials. The current physical therapy CPT codes include –

  • 97001 – Physical therapy evaluation
  • 97002 – Physical therapy re-evaluation
  • 97028 – Application of a modality to one or more areas, ultraviolet
  • 97112 – Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and /or proprioception for sitting or standing activities
  • 97750 – Physical performance test or measurement, with written report, each 15 minutes
  • 97140 – Manual therapy techniques, one or more regions, each 15 minutes

Further, the American Academy of Family Physicians (whose specialties were examined in the report) regards physical therapy as one of the most cost-effective and minimally invasive pain management methods when compared to surgery or opioids.

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