CPT Coding Requirements for a PT

Current Procedural Terminology (CPT) codes are five-digit descriptors for procedures performed in a medical setting. The American Medical Association oversees CPT codes and revises them on an annual basis. The association provides a yearly update of the user manual that lists all codes and related procedures. Physical therapists who are billing a third-party payer, such as a patient's insurance company or Medicare, are required to use CPT codes to describe services that were performed. CPT is not typically an exact representation of the services provided by a physical therapist; however, these codes provide a framework for billing that is acceptable.

Basic CPT Codes

• CPT provides a series of codes known as the Physical Medicine and Rehabilitation series. These codes are provided in the CPT 97000 series. A physical therapist will find most of the necessary codes within this series. However, physical therapists are allowed by law to provide services outside of the scope of therapy. For that reason, therapists must also have an understanding of codes outside the 97000 series in order to correctly bill for these services. Yearly revisions are made to CPT codes and the American Physical Therapy Association (APTA) assists with this process. APTA staff and members take part in meetings to guide the process of code development and revisions. Payment policies are determined by each third-party payer and vary according to specific benefits packages. Not all payers reimburse for all provided services. The American Medical Association website provides a comprehensive analysis of the CPT process.

Necessity and Paperwork

• Physical therapists must be sure that any service that is provided is medically necessary. Determining the patient's diagnosis as well as plan and duration of care ensures that services will be reimbursed. In order for the therapist to collect payment, the referring physician must provide a written treatment plan that states services from a physical therapist are medically necessary. This plan must be renewed and resubmitted to the physical therapist every 30 days that the patient continues to receive physical therapy.

Common Errors

• When billing physical therapy services, avoid mistakes that will delay reimbursement. For example, the proper number of units for timed services should be entered on the claim forms, as well as the referring physician's information. In the case of Medicare, payment will not be made if the submitted form does not include the referring physician. A written treatment plan, also provided by the referring physician, must accompany the form. Therapists should also be careful to include complete medical documentation of services rendered.