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CPT Codes and Reimbursement Rates

Tuesday, April 11, 2017   (0 Comments)
Posted by: Matthew Nicholas
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CPT Codes and Reimbursement Rates

The Illinois Department of Healthcare and Family Services has posted a new provider notice regarding Current Procedural Terminology (CPT) Codes and Reimbursement Rates for Physical and Occupational Therapy Evaluations Effective January 1, 2017.

The therapy fee schedule will be updated with the following new codes, short descriptors, rates, and maximum quantity amounts effective with dates of service on or after January 1, 2017.  Hospitals that bill physical therapy as fee-for-service will continue to be reimbursed at the same rate as CPT 97001, regardless of which new code is billed.

Click here to view the notice sent April 3rd from the Illinois Department of Healthcare and Family Services.  

Rates and maximum quantities for the new codes are based on the same therapy rate structure that was in place for the recently deleted codes. Maximum quantities billable continue to represent 15-minute increments and remain at two hours for children’s evaluations, and one hour for adult evaluations.

Due to changes in the PT and OT evaluation code definitions, and specifically the component requirements found in the long descriptors, providers must bill the code appropriate for the complexity of the evaluation with a unit quantity equal to the number of 15-minute increments that represents time spent. Note that key components and time spent should be documented in the participant’s medical record and must be produced as necessary for audit purposes.

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