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