group therapy

[Guest guest]

Question for the group with regard to charging/billing for group therapy (CPT

97150). Am I correct in that the use of this code (whether for aquatic or gym

patients) can only be used when all participants are receiving the exact same

exercises at the same time and NOT for when you have 2-5 patients doing their

individual programs but at the same time under the supervision of one clinician?

It has always been my understanding that individual exercise programs done in a

group setting can only be billed as therapeutic exercise (97110) or aquatic

therapy (97113) and only for the actual one on one minutes spent with the

therapist.

Thanks,

Jeff Brown PT

Director of Rehabilitation

Decatur Memorial Hospital

2300 N. St.

Decatur, IL 62526

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[Guest guest]

Hi Jeff,

First are you talking about an outpatient clinic or in a SNF setting? Are

you talking about Medicare or all insurances? Those things will help

narrow down the responses.

From the APTA page on Group Therapy:

" Pay for outpatient physical therapy services (which includes

speech-language pathology services) and outpatient occupational therapy

services provided simultaneously to two or more individuals by a

practitioner as group therapy services. The individuals can be, but need not

be performing the same activity. The physician or therapist involved in

group therapy services must be in constant attendance, but one-on-one

patient contact is not required. "

If you are a APTA member, there is a complete and thorough page of

information on Group Therapy with scenarios that should answer your

questions. The page under the " Payment " section and " Coding and Billing "

subsection.

I will speak to part of your question:

Bottom line for anyone billing Medicare clients in an outpatient setting:

if you have more than one Medicare patient in the clinic at one time under

your supervision as a PT and you are billing any code designated that you

are in attendance or one-on-one with that patient, then you should be

billing only the time that you spend with them one-on-one. Past that the

group code comes into play. If you have more than one Medicare patient in

the clinic at one time under your supervision, you must bill a group therapy

code.

I have witnessed a clinic that provided free transportation to Medicare

patients, bring 6 Medicare clients to an outpatient clinic, have them all

being " treated " together under the supervision on one PT and then billing 3

- 4 units of timed codes per patient. It is unbelievable that this still

goes on. I am not saying that I agree with all the Medicare regulations

but they are very clear and very specific about group therapy.

If you are talking about a SNF setting the group therapy regulations are

different, so let us know which one.

M.Howell, P.T., M.P.T.

IPTA Payment Specialist

Meridian, Idaho

thowell@...

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From: PTManager [mailto:PTManager ] On Behalf

Of JEFF BROWN

Sent: Friday, April 06, 2012 7:52 AM

To: PTManager

Subject: group therapy

Question for the group with regard to charging/billing for group therapy

(CPT 97150). Am I correct in that the use of this code (whether for aquatic

or gym patients) can only be used when all participants are receiving the

exact same exercises at the same time and NOT for when you have 2-5 patients

doing their individual programs but at the same time under the supervision

of one clinician? It has always been my understanding that individual

exercise programs done in a group setting can only be billed as therapeutic

exercise (97110) or aquatic therapy (97113) and only for the actual one on

one minutes spent with the therapist.

Thanks,

Jeff Brown PT

Director of Rehabilitation

Decatur Memorial Hospital

2300 N. St.

Decatur, IL 62526

CONFIDENTIAL: This email message and any attachments are for the sole use of

the intended recipient(s) and may contain HIGHLY CONFIDENTIAL PERSONAL

HEALTH INFORMATION. It is to be used only to aid in providing specific

healthcare services to this patient. Any unauthorized review,use,

disclosure, or distribution is a violation of Federal Law (HIPAA)

and will be reported as such.

If you are not the intended recipient or a person responsible for

delivering this message to an intended recipient, please contact the sender

by reply email and destroy all copies of the original message immediately.