A Guide To CMS Telehealth For Physical Therapy

Integrating CMS telehealth into your physical therapy practice can be confusing. Learn about medicare physical therapy billing at Healthie.

With many Americans at home due to the Covid-19 pandemic, telehealth services have been a lifeline for those in need of medical care. Through messaging, phone calls, and video sessions, physical therapists and other healthcare providers are able to continue providing effective care to their patients. But does Medicare cover all this? And how do you bill for CMS telehealth  physical therapy? In this article, we have all the information about medicare physical therapy billing you need to help you seamlessly integrate CMS telehealth into your physical therapy practice.

Does CMS pay for telehealth physical therapy?

In a factsheet published in March 2020, CMS explained that the federal government has broadened access to telehealth services. All beneficiaries can now connect with their healthcare providers online, and providers will get the same reimbursement for these services as they would for in-person sessions. This medicare coverage includes telehealth for physical therapy and makes it easier for Americans to avoid unnecessarily coming into contact with Covid-19, while still receiving the healthcare they need.

For now, these changes remain temporary under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. However, many patients and healthcare providers are enjoying the flexibility that comes with telehealth. It looks likely that telehealth physical therapy, CMS coverage, is here to stay.

What virtual services does CMS cover?

Medicare for telehealth physical therapy covers three types of telehealth services. These are:

Telehealth visits

This is a video call between you and a patient, and may include initial evaluations, re-evaluations, or regular treatment sessions. 

E-Visits

E-Visits allow you to communicate with a patient via a secure online portal. Through the portal, you can answer questions, give updates about test results, set appointments, and more.

Virtual check-ins

Virtual check-ins are usually brief phone calls, which you can use to determine if you need to book a longer appointment with the patient.

How does CMS handle billing for telehealth physical therapy?

The three types of CMS telehealth physical therapy services are billed in different ways.

Telehealth visits

With telehealth visits, you can provide care to your patients as you normally would in your office. Due to the pandemic, CMS has added over 100 codes to the telehealth services list. As a physical therapist, the codes that you’re most likely to need are:

  • 97161; Physical therapy evaluation - low complexity.
  • 97162; Physical therapy evaluation - moderate complexity.
  • 97163; Physical therapy evaluation - high complexity.
  • 97164; Physical therapy re-evaluation.
  • 97110; Therapeutic procedure, one or more areas, each 15 minutes.
  • 97116; Gait training.
  • 97530; Therapeutic activities, one-on-one patient contact, each 15 minutes.
  • 97112; Therapeutic procedure, one or more areas, each 15 minutes.
  • 97535; Self-care/home management training, each 15 minutes.

When it comes to medicare physical therapy billing, you can use modifier 95 with the relevant code to indicate that the service was provided via telehealth.

E-Visits

E-Visits are billed over a seven-day period. Healthcare providers who independently bill Medicare for evaluation and management visits (such as physicians and nurses) usually use CPT codes 99421 - 99423. 

However, for physical therapy CMS , you likely don’t bill independently for these services. In this case, you can use the codes:

  • G2061; Qualified non-physician healthcare professional online assessment and management, for an established patient and for up to seven days. Cumulative time during the 7 days: 5-10 minutes.
  • G2062; Qualified non-physician healthcare professional online assessment and management service, for an established patient and for up to seven days. Cumulative time during the 7 days: 11-20 minutes.
  • G2063; Qualified non-physician qualified healthcare professional assessment and management service, for an established patient and for up to seven days. Cumulative time during the 7 days: 21 or more minutes.

Virtual check-ins

Virtual check-ins can help you decide if you would like to schedule a longer session with a patient. They are usually billed with code G2012, but sometimes G2010 is added.

  • G2012; This refers to a brief communication technology-based service, such as a phone call. It could also include email, secure text message, or a patient portal.
  • G2010; If your patient also sends you recorded video and/or images, you can use this code in addition to G2012 to bill for your interpretation and follow-up.

Healthie makes it easy to offer physical therapy online

This new CMS coverage for telehealth physical therapy has encouraged many therapists to try telehealth for the first time. If you’re looking to implement telehealth at your practice, consider using a comprehensive all-in-one platform, such as Healthie. With Healthie, you can enjoy: 

  • A secure and fully HIPAA-compliant platform.
  • High quality video calls, which can be recorded and uploaded for your patients to rewatch later.
  • An intuitive patient engagement portal, where you can share videos and other resources.
  • Easily tracking your patients’ progress between appointments, through journal entries and secure messaging.
  • Flexible, scalable membership plans to meet your unique business needs.

Try your free 7-day trial today.

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