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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Eligible Providers

Providers must be enrolled as a Health First Colorado (Colorado's Medicaid Program) provider in order to:

    • Treat a Health First Colorado member
    • Submit claims for payment to Health First Colorado

Physical therapists must be licensed and may supervise up to four (4) individuals at one time who are not physical therapists, including certified nurse aides, to assist in the therapist's clinical practice. Supervision authority extends to the limits stated in the Physical Therapists Practice Act.

Physical therapist assistants (PTA) must be certified by and must work under the supervision of a licensed physical therapist.

  • PTAs cannot enroll with Health First Colorado and cannot place any identifying number on a claim form. Therefore, the supervising therapist's NPI number must be used as the rendering provider number on the claim form for services rendered by the assistant. Medical records must still indicate the assistant performed the services.

Occupational therapists must be licensed.

Occupational therapy assistants (OTA) must practice under the general supervision of a Colorado registered occupational therapist.

  • OTAs cannot enroll with Health First Colorado and cannot place any identifying number on a claim form. Therefore, the supervising therapist's NPI number must be used as the rendering provider number on the claim form for services rendered by the assistant. Medical records must still indicate the assistant performed the services.

Therapy may also be rendered by licensed and enrolled physicians, physician assistants, and advanced practice nurses as allowed by their respective scopes of practice.

Physical and occupational therapists not employed by an agency, clinic, hospital, or physician may bill Health First Colorado directly, otherwise it is the employer who bills directly for the services.

Reference

Colorado Department of Health Care Policy & Financing

Physical and Occupational Therapy Billing Manual

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