2014 Billing and Coding Primer for Therapy Services
December 10th, 2013 - Scott KraftThe release of the 2014 Physician Fee Schedule Final Rule in late November, coupled with the scheduled expiration of certain provisions of the American Taxpayer Relief Act (ATRA) threatens to add a lot of confusion to how you bill for therapy services in 2014.
We’re here to help. First, the therapy caps will remain in place for 2014. The caps go up slightly. There are two, one $1,920 cap for occupational therapy services and a separate $1,920 cap for physical therapy and speech language therapy combined.
The first change is that CMS is using its regulatory powers to apply the caps to therapy services provided in critical access hospitals. ATRA had a provision that temporarily applied the cap to CAH services, but CMS will make that permanent as of Jan. 1, 2014, despite objections from providers.
You may still use modifier KX when billing therapy services over the cap amount, when you believe that these services are medically necessary. Any therapy services against either cap that go over a spending limit of $3,700 will be subject to medical review – likely delaying your payment.
To further confuse matters, ATRA had temporarily applied the therapy caps to services done in outpatient hospital settings. Outpatient hospital therapy has long been exempt from the therapy caps. This provision of ATRA will also expire on Dec. 31, 2013, but CMS says it lacks the authority to extend it.
As a result, outpatient hospital therapy services won’t be covered by the cap in 2014, unless Congress acts to reinstate that provision.
Finally, the multiple procedure payment reduction for therapy services will continue to be in place in 2014. Whenever a therapist rendered services on the “always therapy” list, payment for any additional services after the first one will be reduced by 50 percent. This applies to services on the same date of service by the same provider or facility, as measured by the National Provider Identifier (NPI).
Here are the “always therapy” codes for 2014:
Code Short Descriptor
92507 Speech/hearing therapy
92508 Speech/hearing therapy
92521 Evaluation of speech fluency
92522 Evaluate speech production
92523 Speech sound lang comprehen
92524 Behavral qualit analys voice
92526 Oral function therapy
92597 Oral speech device eval
92607 "Ex for speech device rx, 1hr"
92609 Use of speech device service
96125 Cognitive test by hc pro
97001 Pt evaluation
97002 Pt re-evaluation
97003 Ot evaluation
97004 Ot re-evaluation
97012 Mechanical traction therapy
97016 Vasopneumatic device therapy
97018 Paraffin bath therapy
97022 Whirlpool therapy
97024 "Diathermy eg, microwave"
97026 Infrared therapy
97028 Ultraviolet therapy
97032 Electrical stimulation
97033 Electric current therapy
97034 Contrast bath therapy
97035 Ultrasound therapy
97036 Hydrotherapy
97110 Therapeutic exercises
97112 Neuromuscular reeducation
97113 Aquatic therapy/exercises
97116 Gait training therapy
97124 Massage therapy
97140 Manual therapy
97150 Group therapeutic procedures
97530 Therapeutic activities
97533 Sensory integration
97535 Self care mngment training
97537 Community/work reintegration
97542 Wheelchair mngment training
97750 Physical performance test
97755 Assistive technology assess
97760 Orthotic mgmt and training
97761 Prosthetic training
97762 C/o for orthotic/prosth use
G0281 Elec stim unattend for press
G0283 Elec stim other than wound
G0329 Electromagntic tx for ulcers
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