Upcoming Webinars 


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.

Log in

Log in

Vantage Health Plans Telehealth Policy PT and OT

Update: 4/19/2020

Physical Therapy (PT), Occupational Therapy (OT), and Speech Language Pathology (SLP) Telemedicine Visits for all patients:

Telemedicine visits must be performed in lieu of a face-to-face visit.

Telemedicine visits must be billed with the CPT codes and the appropriate modifiers traditionally billed for on-site face to face visits. CPT codes eligible for telemedicine include: 97161 97110 97530 97165 92507 92521 92524 92610 96105 97162 97112 97535 97166 92522 92526 97164 97116 97168 92522

These codes must be billed with a POS (place of service) of 02 instead of POS 11.

The limit on billable units previously stated in Notice #3 are no longer applicable.

Vantage will pay these telemedicine visit claims at the same rate as in-office visits with NO Patient Cost Share.

Physical Therapy (PT), Occupational Therapy (OT), and Speech Language Pathology (SLP) In-Home Encounters for all patients:

The following complex evaluation codes and hands-on CPT codes that require face-to-face encounters can now be performed in the patient’s home as an in-home encounter: 97014 97032 97035 97140 97163 97167

These in-home encounter claims must be billed with POS 12 (private residence).

The services listed in item (1) above may also be performed in-home and billed as POS 12.

Vantage will pay all in-home encounter claims at the same rate as in-office visits with applicable patient cost share.

Physical Therapy (PT), Occupational Therapy (OT), and Speech Language Pathology (SLP) General Information:

  • All claims should include all acute and chronic diagnoses.
  • Current pre-authorization requirements apply.
  • Documentation for all claims should be similar to that of face-to-face office visits with respect to medical necessity and treatment specifications. Encounters should be fully documented in the patient’s medical record.



Powered by Wild Apricot Membership Software