The Centers for Medicare & Medicaid Services (CMS) play a critical role in setting the guidelines and policies for physical therapy billing. Understanding recent updates from CMS is essential for therapists and practice managers to ensure compliance and optimize reimbursement rates. This blog will highlight the key changes for 2024 and their implications for physical therapy practices, providing clear insights into how these updates impact billing procedures.  

What is Physical Therapy and Who Comes Under It  

Physical therapy (PT) is a healthcare discipline focused on helping individuals restore, maintain, and promote optimal physical function and mobility. It is designed for patients of all ages who suffer from physical impairments due to injury, surgery, illness, or chronic conditions. The primary aim of physical therapy is to enhance quality of life through exercises, manual therapy, education, and various therapeutic interventions. 

Physical therapy services are provided by licensed physical therapists, often working with physical therapist assistants (PTAs). PT involves a wide range of interventions, such as strengthening exercises, flexibility training, balance coordination, and modalities like electrical stimulation or ultrasound. Patients who benefit from physical therapy include those recovering from orthopedic injuries, neurological conditions like stroke, pediatric developmental disorders, and elderly individuals needing assistance with age-related functional decline. PT can also be used for sports rehabilitation, pain management, and injury prevention.  

CMS update for Physical Therapy  

1. Updated KX Modifier Thresholds for 2024 

The KX modifier is a key part of the billing process for physical and speech therapy services. It indicates that a patient's treatment is medically necessary and has exceeded a certain monetary threshold. For 2024, CMS has set the new threshold for combined Physical Therapy (PT) and Speech-Language Pathology (SLP) services at $2,330, with the same threshold for Occupational Therapy (OT) services. This means that once a patient reaches $2,330 in services, the KX modifier must be applied to indicate continued medical necessity. Practices should ensure that their documentation supports this need, helping to avoid audits and claim denials. 

2. Introduction of New CPT Codes for Caregiver Training Services 

CMS has introduced new CPT codes — 97550, 97551, and 97552 — which are used for caregiver training services. These codes are designated as "sometimes therapy" services, meaning they are not exclusively therapy-related and may be billed in various settings. This is a significant addition for practices, allowing more flexibility to involve caregivers in the treatment process, especially for patients requiring ongoing home-based support. To ensure smooth billing, therapists should document the specific training provided, including its relevance to the patient’s treatment plan.  

3. Changes in Supervision Requirements for Remote Therapeutic Monitoring (RTM)  

The supervision requirements for Remote Therapeutic Monitoring (RTM) have been adjusted, allowing physical and occupational therapists in private practice to provide general supervision of therapy assistants for RTM services starting January 1, 2024. This update provides an opportunity to expand the scope of services delivered by assistants under less restrictive supervision conditions, helping practices improve workflow and better allocate resources while ensuring that patients receive comprehensive care. 

4. Removal of Functional Reporting Requirements 

 CMS has officially removed the requirement for functional reporting using G-codes for outpatient therapy services. Previously, G-codes were used to indicate the patient's functional status during therapy, adding an extra layer of documentation to the billing process. This removal simplifies both the billing and documentation procedures, allowing therapists to focus more on patient care rather than administrative requirements. Practices should ensure they update their internal procedures to reflect this change, as it can significantly reduce time spent on paperwork. 

How MedQuik Helps Physical Therapists  

MedQuik is a medical billing and coding company dedicated to helping physical therapy practices navigate these recent CMS changes seamlessly. By providing comprehensive billing support, automated coding tools, and streamlined documentation features, MedQuik ensures that your practice stays compliant and maximizes reimbursement. MedQuik helps therapists manage the updated KX modifier thresholds, understand new CPT codes, and adjust to the latest Medicare Physician Fee Schedule changes. With MedQuik, you can focus more on patient care while we handle the complexities of billing and regulatory compliance. 

Physical Therapy Billing - Common Pitfalls 

 Navigating the complex landscape of physical therapy billing can be challenging, and there are several common pitfalls that practices often encounter: 

Incorrect modifier usage 

Incomplete or inaccurate documentation 

Underutilizing updated codes 

Insufficient understanding of supervision requirements 

Awareness and proactive management of these common pitfalls can prevent claim denials and maximize reimbursement potential for your practice.  

What to Follow in Physical Therapy Billing and Coding for the New Update  

Updated KX Modifier Thresholds:  

Ensure that the KX modifier is applied once a patient exceeds the new $2,330 threshold for combined Physical Therapy and Speech-Language Pathology services. Proper documentation supporting medical necessity is crucial. 

Utilization of New CPT Codes:  

Correctly apply the new CPT codes (97550, 97551, and 97552) for caregiver training services. Make sure to document the caregiver's role in the treatment process and its relevance to the patient’s care. 

Compliance with Supervision Requirements:

Adjust to the updated supervision requirements for Remote Therapeutic Monitoring (RTM), allowing for general supervision of therapy assistants. Make sure that all RTM services are properly supervised as per CMS guidelines. 

Adapt to Medicare Physician Fee Schedule Changes:  

Be mindful of the reduced conversion factor in the 2024 Medicare Physician Fee Schedule. Practices should adjust their billing approach to mitigate the financial impact, such as improving efficiency in service delivery and coding accuracy. 

Update Internal Procedures:  

Reflect the removal of G-code reporting requirements in your billing and documentation procedures to reduce administrative workload. 

Conclusion  

The 2024 CMS updates bring significant changes to physical therapy billing and coding, making it crucial for practices to stay compliant and optimize their processes. These new requirements can be challenging to navigate, and ensuring accuracy in coding, documentation, and reimbursement takes significant time and expertise. 

Outsourcing your billing and coding needs to experts like MedQuik is the most effective way to handle these complexities. MedQuik specializes in medical billing and coding for physical therapy, ensuring compliance, reducing claim denials, and maximizing revenue. By letting MedQuik manage your billing, you can focus on what you do best—providing high-quality care to your patients—without the stress of administrative challenges. 

Take the burden off your shoulders and ensure your practice thrives. Contact MedQuik today to learn how our services can streamline your billing operations and enhance your financial performance.