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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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Physical Therapy Services

Order

For IHCP reimbursement, physical therapy services must be ordered by a physician or (effective February 1, 2017) by one of the following providers:

    • Chiropractor
    • Dentist
    • Nurse practitioner
    • Physician assistant
    • Podiatrist
    • Psychologist

Physical Therapy Assistants

Physical therapy services must be performed by a licensed physical therapist or a certified physical therapist assistant (PTA) under the direct supervision of a licensed physical therapist or physician.

The PTA is required to meet with the supervising physical therapist each working day to review treatment, unless the physical therapist or physician is on the premises to provide constant supervision. The consultation can be either face-to-face or by telephone.

When these services are performed by a PTA, providers must them with the modifier HM – Less than a bachelor’s degree. These services, when billed with the HM modifier, are priced to reimburse at 75% of the reimbursement level for a physical therapist.

Evaluations and Reevaluations

The IHCP limits evaluations and reevaluations to three (3) hours of service per member evaluation.

Services that May not be Billed Separately

The IHCP allowance for the modality provided by the licensed therapist includes payment for the following services, and providers may not bill the IHCP separately for these services:

    • Assisting patients in preparation for treatment and, as necessary, during and at the conclusion of treatment
    • Assembling and disassembling equipment
    • Assisting a physical therapist in the performance of appropriate activities related to the treatment of the individual patient
    • Following established procedures pertaining to the care of equipment and supplies
    • Preparing, maintaining, and cleaning treatment areas and maintaining supportive areas
    • Transporting patients, records, equipment, and supplies in accordance with established policies and procedures
    • Performing established clerical procedures

The IHCP does not reimburse separately for physical therapy services provided by a nursing facility or large private or small ICF/IID. These services are included in the facility’s per diem rate and do not require PA.

Hippotherapy

The IHCP covers hippotherapy for physical therapy. To be covered, a licensed physical therapist must provide the services, and providers must bill for the services using the appropriate Current Procedural Terminology (CPT®1 ) code from the following list:

    • 97110 – Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility
    • 97112 – Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
    • 97530 – Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
    • 97533 – Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes.

CPT code 97533 can be used only for patients with a diagnosis of traumatic brain injury (TBI).

A physician must order the hippotherapy services and include them in the patient’s treatment plan. Existing PA requirements for physical therapy apply to hippotherapy.

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