Guest guest Posted April 25, 2005 Report Share Posted April 25, 2005 Diane, If billing 97150 on the same day as you bill 97110 97112 97113 97116 97140 97530 97002 97004 97124 97504 97520 97532 97533 97535 97537 97542 you must append modifier 59 to these CPT codes in order to be reimbursed. Documentation must also show that the services were provided at separate and distinct times from 97150. Refer to the CCI edits at: http://www.cms.hhs.gov/physicians/cciedits/ Rick Gawenda, PT Director PM & R Detroit Receiving Hospital www.gawendaseminars.com --- Diane Skaff wrote: > > > > Are others having the same problem that we are, > getting payment from > Medicare when 97150 Group Therapy is used? The odd > thing is...97150 is paid > but all other codes that we use with that code, are > denied. Do you find > that you have to use the 59 modifier with " ALL " > other codes used with the > 97150? Example: 97140 GP 59, 97116 GP 59, 97035 GP > 59, etc? Or, do you put > the 59 modifier on the 97150 code? > > Thanks > Diane Skaff > Valley Rehabilitation > > > > > > > Looking to start your own Practice? > Visit www.InHomeRehab.com. > Bring PTManager to your organization or State > Association with a professional workshop or course - > call us at 313 884-8920 to arrange > PTManager encourages participation in your > professional association. Join and participate now! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 25, 2005 Report Share Posted April 25, 2005 Diane, If billing 97150 on the same day as you bill 97110 97112 97113 97116 97140 97530 97002 97004 97124 97504 97520 97532 97533 97535 97537 97542 you must append modifier 59 to these CPT codes in order to be reimbursed. Documentation must also show that the services were provided at separate and distinct times from 97150. Refer to the CCI edits at: http://www.cms.hhs.gov/physicians/cciedits/ Rick Gawenda, PT Director PM & R Detroit Receiving Hospital www.gawendaseminars.com --- Diane Skaff wrote: > > > > Are others having the same problem that we are, > getting payment from > Medicare when 97150 Group Therapy is used? The odd > thing is...97150 is paid > but all other codes that we use with that code, are > denied. Do you find > that you have to use the 59 modifier with " ALL " > other codes used with the > 97150? Example: 97140 GP 59, 97116 GP 59, 97035 GP > 59, etc? Or, do you put > the 59 modifier on the 97150 code? > > Thanks > Diane Skaff > Valley Rehabilitation > > > > > > > Looking to start your own Practice? > Visit www.InHomeRehab.com. > Bring PTManager to your organization or State > Association with a professional workshop or course - > call us at 313 884-8920 to arrange > PTManager encourages participation in your > professional association. Join and participate now! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2005 Report Share Posted April 26, 2005 Diane, According to the mutually exclusive CCI edit list, which can be found at www.cms.hhs.gov/physicians/cciedits, 97150 is bundled with the following: 97110, 97112, 97116, 97140, and 97530. You can bill 97150 with any of these codes as long as the 59 modifier is on each one of them. The second column code(s) are the ones that need the modifier, not 97150. I don't know of any reference that limits the number of modified codes that can be used per date of service. As far as I know, you are correct in modifying all the above listed codes when billing 97150. Diane Skaff wrote: Are others having the same problem that we are, getting payment from Medicare when 97150 Group Therapy is used? The odd thing is...97150 is paid but all other codes that we use with that code, are denied. Do you find that you have to use the 59 modifier with " ALL " other codes used with the 97150? Example: 97140 GP 59, 97116 GP 59, 97035 GP 59, etc? Or, do you put the 59 modifier on the 97150 code? Thanks Diane Skaff Valley Rehabilitation Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 27, 2005 Report Share Posted April 27, 2005 regarding group therapy on acute inpt rehab units, I had heard that Medicare specifies that not more than 25% of the total treatment time each day may be a group treatment. Does anyone have a reference for this regulation? thanks >>> amiller_cpc@... 04/26/05 10:08 AM >>> Diane, According to the mutually exclusive CCI edit list, which can be found at www.cms.hhs.gov/physicians/cciedits, 97150 is bundled with the following: 97110, 97112, 97116, 97140, and 97530. You can bill 97150 with any of these codes as long as the 59 modifier is on each one of them. The second column code(s) are the ones that need the modifier, not 97150. I don't know of any reference that limits the number of modified codes that can be used per date of service. As far as I know, you are correct in modifying all the above listed codes when billing 97150. Diane Skaff wrote: Are others having the same problem that we are, getting payment from Medicare when 97150 Group Therapy is used? The odd thing is...97150 is paid but all other codes that we use with that code, are denied. Do you find that you have to use the 59 modifier with " ALL " other codes used with the 97150? Example: 97140 GP 59, 97116 GP 59, 97035 GP 59, etc? Or, do you put the 59 modifier on the 97150 code? Thanks Diane Skaff Valley Rehabilitation Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
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