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In today’s podcast, Meghann Drella, one of our Senior Solutions Managers, discusses about Physical therapy services delivered via Telehealth during the public health emergency and tips to bill for these services.

In This Episode

  • 00.16 - Introduction about CMS Guidance

A new guidance issued by the CMS that came into effect with a retroactive effective date of March 1, 2020 expanded the types of health care professionals eligible to furnish and bill for Medicare telehealth services.

  • 00.48 - Basics of CMS Guidance for PTs

The basics of CMS guidance for PTs during the public health emergency (PHE) involve several guidelines along with CPT codes.

  • 01.39 - HCPCS G-codes used by PTs

Medicare requires PTs to use three HCPCS G-codes to indicate when they provided an online digital E/M service.

  • 02.23 -Place of Service (POS) code and modifiers

All claims for PT services delivered via Telehealth services (on or after March 1, 2020, and for the duration of the PHE) must be billed using the appropriate Place of Service (POS).

  • 02.50 - PT services using Audio, video assessment

PT services on the Medicare telehealth services list must be provided at minimum, audio and video equipment.

  • 03.44 -Documentation of Telehealth visits – 03.44

A comprehensive documentation of telehealth visits as for in-person visits by must be provided by PTs.

Hello and Welcome to our Podcast series. My name is Meghann Drella and I am a Senior Solutions Manager here at Outsource Strategies International.

Today I will be discussing Physical therapy services delivered via Telehealth during the public health emergency and how to bill for these services?

  • CMS Guidance for Medicare Telehealth Services

New guidance issued by the Centers for Medicare and Medicaid (CMS) that came into effect with a retroactive effective date of March 1, 2020 through the end of the emergency, expanded the types of health care professionals eligible to furnish and bill for Medicare telehealth services. Physical therapists (PTs) and physical therapy assistants (PTAs) are among the private practitioners who can bill for services provided through real-time face-to-face technology. There are specific codes to bill PT services furnished via telehealth during the COVID-19 pandemic.

  • Six Basic CMS Guidelines for PTs

The basics of CMS guidance for PTs during the public health emergency (PHE) are as follows:

  • PTs in private practice are eligible to bill Medicare for certain services provided via telehealth.
  • Services that started as of March 1, 2020, and are provided for the duration of the PHE are eligible.
  • Services may be provided to both new and established patients
  • The same services can be provided as would be provided during an in-person visit and are paid at the same rate.
  • Services can be provided to patients in any geographic area and in any health care facility or in their home.
  • There are specific CPT codes under the Medicare Physician Fee Schedule that PTs can use to bill services provided via telehealth

The allowable CPT codes for PT services will be listed in the document attached.

  • HCPCS G-codes To be Used By PTs

Medicare requires PTs to use the HCPCS G-codes to indicate when they provided an online digital E/M service.

  • G2061 – It’s a qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
  • G2062 – Is a non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 -10 days; a 11–20 minutes
  • G2063 – Which is a qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes
  • Billing Using Place of Service (POS) code and Modifiers

All claims for PT services delivered via telehealth services on or after March 1, 2020, and for the duration of the PHE, should be billed using the appropriate Place of Service (POS) code and modifiers:

  • POS code equal to what it would have been if the PT had furnished the service in person
  • Modifier 95, confirming that the services were provided via telehealth and
  • The GP modifier (that indicates that a physical therapist’s services were provided)

PT services on the Medicare telehealth services list should be provided using, at a minimum, audio and video equipment that allows two-way, real-time interactive communication between the therapist and the patient. Medicare also pays separately for audio-only telephone assessment and management services described by CPT codes 98966-98968.

  • Use of Audio, Video Applications

During the PHE, the HHS offices for Civil Rights has relaxed enforcement and is waiving penalties for HIPAA violations against clinicians who in good faith use video chat applications such as Apple FaceTime and Skype. Providers should however, take care to adhere to any state laws governing privacy and security of patient data. The American Physical Therapy Association (APTA) recommends that providers consider providing video-based telehealth services through technology vendors that offer HIPAA business associate agreements with their video communication products.

  • Guidelines for Documentation of Telehealth Visits

PTs need to provide comprehensive documentation of telehealth visits as for in-person visits. Medicare guidelines for defensible documentation should be followed. In addition to documenting informed consent, the type of technology used for the evaluation or treatment should be specified. Furthermore, as federal/state and third-party payer regulations govern provision of telehealth services and e-visits, and how they are reimbursed, providers should clearly understand their state practice act, all applicable administrative telehealth rules, and payer’s telehealth policies and documentation requirements.

I hope this helps but always remember that accurate documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank You for joining me and Stay tuned for my next podcast.