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Administrative Burden & Fair Payment

Tuesday, July 9, 2019   (0 Comments)
Posted by: Matthew Nicholas
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Administrative Burden & Fair Payment

APTA members report that medically necessary physical therapist services are delayed because of the amount of time and resources they must spend on documentation and administrative tasks.

The shift towards the use of third party administrators to process claims have led to changes in policies that have drastically effected payment. When BCBS IL contracted with one such company, their first strategy was to flag all claims using the -59 modifier. Providers were tasked with submitting documentation to support claims, and then surprised when BCBS IL then changed how payment of timed codes was calculated, effectively reducing payment to health care providers by $10’s of millions of dollars in Illinois alone.

The IPTA took swift action this spring, working with legislators to pass SB 653 that regulates the calculation of payment for timed codes. This legislation requires insurers to follow AMA’s long-established CPT code billing guidelines with only an exception for federally funded patients (such as Medicare). This legislation did not just impact physical rehabilitation, but all areas of medicine that utilize timed code billing.

While we wait for the Governor to sign SB 653 into law, APTA is urging policymakers and third-party payers to advance policies that streamline documentation requirements, standardize prior authorization and payer coverage policies, and eliminate unnecessary regulations.

APTA's infographic highlights the results of a recent survey of clinicians who provide direct patient care. Download the full-sized infographic in Adobe PDF.

To learn more about APTA's efforts, visit:



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