Navigating Medicare reimbursement for physical therapy can be complex, but understanding the basics is key for ensuring your practice gets compensated properly. Here’s a quick overview:
Coverage Criteria: Medicare Part B covers medically necessary outpatient physical therapy if it’s prescribed by a doctor and aimed at treating an injury or improving mobility.
Therapy Cap Limits: While the therapy cap was technically removed, Medicare still monitors the cost of services. Physical therapy costs exceeding a certain threshold may be reviewed to confirm medical necessity.
Billing Codes: Proper billing is essential. Use the correct CPT codes, such as those for therapeutic exercise or neuromuscular re-education, to avoid denials and ensure accurate reimbursement.
Documentation Requirements: Thorough documentation, including progress notes and updated treatment plans, is critical. Medicare requires evidence of continued need and improvement to approve ongoing coverage.
Patient Copayments: Medicare typically covers 80% of approved therapy costs, leaving the remaining 20% to the patient or supplemental insurance.
Understanding these guidelines can help physical therapy practices streamline the reimbursement process, avoid claim denials, and focus on delivering quality patient care.
