CMS Auditing Physicians Billing for PT | Modern Manual Therapy Blog

CMS Auditing Physicians Billing for PT

Real quick snippet from my supervisor at the Utilization Review company I work for. It's about time! This is a problem we see, particularly in upstate NY. MDs, particularly pain management centers employ PTAs without PTs to supervise, and bill for PT. It's no surprise they overutilize. PTAs can only be supervised by PTs. The other less problematic scenario is similar offices employing several PTs, but not credentialing them as par providers, viewing them as automatons

CMS is going to audit physicians that are billing for PT for Medicare Part B and state the following:

According to the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-2, Medicare Benefit Policy Manual, Chapter 15, Sections 230.1 the services of a physical therapy assistant (PTA) cannot be billed as services incident to a physician/NPP’s service because they do not meet the qualifications of a therapist. However, if a physical therapist (PT) and PTA are both employed in a physician’s office, the services of the PTA when directly supervised by the PT may be billed by the physician group as PT services using the provider identification number (PIN) of the enrolled PT. The CMS IOM Publication 100-2, Medicare Benefit Policy Manual, Chapter 15, Sections 230.1 states that if the PT is not enrolled, Medicare will not pay for the services of a PTA billed incident to the physician’s service because they do not meet the qualification standards in 42 Code of Federal Regulations (CFR) 484.4.

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