APTA Wins Battle for Private Practice PTs

APTA wins

New CMS guidance allows PTs to make full use of telehealth after APTA wins battle with6

CMS

The Centers for Medicare and Medicaid Services (CMS) will now include PTs in private practice among the providers able to bill for services provided through real-time face-to-face technology after APTA wins battle, allowing a strongly advocated shift towards telehealth accessibility. 

However, the new system will require new CMS guidance allowing PTs in private practice to make full use of telehealth with their patients under Medicare Part B. Previously, only limited e-visits and other “communication technology-based services” were allowed; the change now includes PTs among the health care providers permitted to bill for real-time face-to-face services using telehealth. This policy change follows a robust advocacy campaign by APTA members and staff.

Aside from telehealth, the revised guidance and accompanying interim final rule contain other provisions relevant to PTs and PTAs. APTA will share these details in subsequent PT in Motion News articles. Also, there are multiple details of the telehealth and other provisions that haven’t been fully explained by CMS. APTA is working to find answers that fill in the gaps.

Physical therapists in private practice are eligible to bill Medicare for certain services provided via telehealth. Services that started as of March 1, 2020, and are provided for the duration of the public health emergency are eligible.

  • Patients may be either new or established.
  • These visits are for the same services as would be provided during an in-person visit and are paid at the same rate.
  • Patients may be located in any geographic area (not just those designated as rural), and in any health care facility or in their home.

When billing claims for telehealth services provided on or after March 1, 2020, and for the duration of the public health emergency, PTs are instructed to bill with:

  • IPlace of Service code equal to what it would have been had you furnished the service in person;
  • IModifier 95, indicating that you did indeed perform the service via telehealth; and
  • IThe GP modifier.

APTA is seeking clarification from CMS regarding institutional billing of telehealth services.

SOURCE: APTA

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