Physical Therapy in a Telehealth World: What is Covered?

New CSM Guidelines Just Announced for Physical Therapy Services

If there is any silver lining to the COVID-19 pandemic, it is the rise of telehealth services to patients. Providers and patients benefit from the flexibility of care provided remotely. For physical therapists however, understanding what services will be covered by payers has been a particularly grey area.

The Centers for Medicare & Medicaid Services (CMS) announced last week they are now allowing Medicare Part B claims for outpatient therapy services provided over telehealth in both institutional and private practice. The latest clarification from CMS applies to settings that use institutional claims such as UB-04. This covers hospitals, skilled nursing facilities, outpatient rehab facilities and home health providers.

The most recent CMS update states “Outpatient therapy services that are furnished via telehealth, and are separately paid and not included as part of a bundled institutional payment, can be reported on institutional claims with the “-95″ modifier applied to the service line.” The statement provides assurance that PTs and PAs providing care through institutional settings can bill for telehealth therapy services.

According to CMS, telehealth for physical therapy includes “Two-way, real-time interactive communications, e-visits, virtual check-ins, remote evaluation of visual recordings, and telephone assessment and management services.”

Over the past few weeks, CMS has rolled out varying degrees of permissions and CPT codes to ensure reimbursement for telehealth therapy services. While these changes are set to expire when the pandemic is declared over, Medicare also announced last week that they are reviewing whether to make telehealth waivers permanent.

“We’re looking at all of the waivers we provided; we’re evaluating them to determine whether they should be extended past the coronavirus,” said Seema Verma, administrator of CMS.

PT Genie strongly supports making telehealth coverage permanent and encourages other supporters to make their opinions known through the American Physical Therapy Association (APTA) advocacy efforts website:

Since the start of the pandemic, telehealth visits in the US have increased from an average 12,000 per week to hundreds of thousands per week. With a large percentage of the PT patient population being in the especially vulnerable group of those aged over 65, coverage of physical therapy services is more important than ever.

Most commercial payers are following Medicare guidelines, but physical therapists should always check with individual payers before billing for telehealth or remote care services. To ensure the care is covered, all therapy sessions must be initiated by the patient. Eligible services must have occurred March 1, 2020 or after and coverage applies to the same services as would be provided in-person, at the same rate. Note that a second interaction within seven days of any other service provided to the patient cannot be billed.

PT Genie is a digital health company providing in-clinic and remote physical therapy that keeps patients connected with their providers to drive improved outcomes. A wearable device that keeps patients motivated, measures their progress, and enables providers to monitor outcomes more closely, PT Genie is advancing physical therapy to new levels. Through PT Genie, healthcare providers have a way to measure their patients — as well as their own — success.

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