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Physical Therapy billing & coding tips to increase revenue

GP Modifier

Every line item on every claim that you submit should include the GP modifier. The GP modifier states that the “services [were] delivers under an outpatient physical therapy plan of care.” Failure to attach this modifier to a line item will result in that line item not being paid.

KX Modifer

The KX modifier is used when a patient has reached their Physical Therapy Cap for the year. Every claim you submit after that cap requires the KX modifier on each line item. The KX modifier is used to indicate that “your claim has met specific documentation requirements in the [patient’s] policy,”.

Non Payable codes

CPT Code 97014 (Electric Stimulation Therapy – Unattended) – Medicare, and many other insurance carriers, do not pay for Code 97014, unattended electric stimulation therapy. On the other hand, Medicare and most other insurance carriers do pay for Attended E-Stim, CPT Code 97032. If you performed the e-stim with the patient, we recommend you bill 97032 and clearly document the procedure in your notes.

CPT Code 97010 (Hot/Cold Packs) – Medicare considers 97010 a bundled service and does not pay for the code. We recommend you don’t bill this code as you will not be paid for it.

One Unit Max

The following codes Medicare & other insurance carriers will generally only reimburse for up to one unit per visit. When billing any of these codes, you must clearly document their medical necessity. Additionally, if you are attempting to bill greater than one unit of any of these codes, you must clearly document why, although in general, that will not get you paid for more than one unit.

CPT Code 97012 (Mechanical Traction)

CPT Code 97018 (Paraffin Bath)

CPT Code 97028 (Ultraviolet)

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