How to Bill for Virtual & Telehealth Physical Therapy
Telehealth for physical therapy has become a safe and efficient option in addition to traditional physical therapy. This alternative to in-person therapy allows patients to continue to benefit from physical therapy in times of social distancing and business closures.
Telehealth has also become a major financial resource for physical therapy practices. In order for physical therapists to bill for telehealth correctly, providers need to stay up-to-date with guidelines and regulations. Negotiating billing and insurance can be an arduous process.
In this article, we cover key points that physical therapists need to know in order to successfully submit billing for telehealth physical therapy.
Benefits of Telehealth for Physical Therapy
Offering telehealth physical therapy sessions serves as a benefit for patients as well as practitioners. Telehealth allows providers to continue to help patients progress in their physical therapy journey while staying socially distant. Financially, many large insurance companies including CMS have announced that they will provide coverage for telehealth visits. Expansions to coverage for telehealth via The Cares Act have also led to positive financial impacts on physical therapy practices. Physical therapists can maximize reimbursement and increase their overall revenue. This additional source of income can help compensate for the recent increase in expenses on PPE, sanitation equipment and decreased patient visits. In order for telehealth to financially benefit a physical therapy practice, practitioners need to understand the billing process for telehealth physical therapy. Understanding the telehealth billing process can reduce insurance claim denials and increase the ability for physical therapists to get reimbursed for the services they provide.
Billing for Telehealth Physical Therapy
Telehealth is here to stay, and with that comes questions about documentation, billing, and insurance coverage. Providers should know that virtual physical therapy is billable by providers. Below is information regarding different types of telehealth for physical therapy and how to document and bill for it appropriately.
CMS states that the three main types of telehealth services that are covered under Medicare include:
- Telehealth Visits
CMS describes telehealth visits as a visit between a patient and their provider where telecommunication is used as the primary means of communication. These visits can include: initial evaluations, re-evaluations or regular treatment sessions.
E-visits are when a provider and their patients use an online patient portal to communicate between each other. They can be used for many reasons such as patient questions or updates from providers.
- Virtual Check-ins
These types of appointments are typically short in duration (5-10 minutes) and done on a phone or “telecommunication device.” The purpose of these visits is to determine if a full in-person visit, telehealth visit or other specialty is needed. CMS includes videos and images taken and sent from patient to provider as a type of virtual check-in as well.
Billing Codes for Physical Therapy
The services listed above are all beneficial and can add as a financial resource for practices if billed correctly. Each service has different codes associated with it for billing purposes. Below we identify the different CPT/HCPCS codes, the payment rate for each code and modifiers required for billing and reimbursement.
*Due to continual alterations and modifications to guidelines regarding billing, readers should refer to their contract with insurance payers and the CMS website for questions and updates. The national payment rates for non-facilities per CMS are from the years 2020 and 2021.
For Medicare Telehealth visits, the main CPT codes physical therapists should use are:
This range of codes include office or outpatient services that require varying degrees of complexity. The codes range in terms of national payment rates from $46.56-$211.12. For telehealth visits the reimbursement rate under Medicare is the same as it would be with in-person visits. Physical therapists will not lose out financially by offering their services remotely under Medicare. To learn more about the individual treatment codes that can be used and for more information on telehealth check this blog post.
There are three CPT codes that CMS will reimburse for when providing physical therapy E-visits:
All three CPT codes have a similar definition stated by CMS as “ Qualified non-physician healthcare professional online assessment and management for an established patient, for up to seven days, cumulative time during the 7 days.” The main difference between the codes is the amount of time the visit requires. Code G2061 is used for 5-10 minute visits, G2062 is for 11-20 minute visits, and G2063 is for visits that are longer than 21 minutes. E-visits can not be used with a new patient, they can only occur with patients that are currently “established” patients, per CMS. As of 2020, the national pay-out rate for non-facilities by CMS for code G2061: $12.27, for code G2062: $21.65 and for G2063: $33.92.
Lastly, Virtual Check-In physical therapy visits have two HCPCS codes used by physical therapists:
CMS defines HCPCS code G2010 as a “Remote evaluation of recorded video and/or images submitted by an established patient (ie. store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.” As of 2021, the national payout rate for non-facilities by CMS for this code is $12.21.
CMS describes HCPCS code G2012 as a “Brief communication technology-based service (ie. virtual check-in, by a physician or other qualified healthcare professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.” As of 2021, the national payout rate for non-facilities by CMS for this code is $14.66.
More information on the CMS national payment rates for non-facilities can be found here. All of these services vary in description and reimbursement. The national payment rates for non-facilities per CMS used are from the years 2020 and 2021. Staying informed and billing correctly, can increase the financial success of a physical therapy practice.
Modifiers used with Telehealth for physical therapy
When using modifiers, it is important to remember that due to the Covid-19 pandemic, a CR modifier is required when billing for telehealth. Physical Therapists then must use a GP modifier for the services provided prior to billing. The place of service code that indicates that telehealth was utilized is (02).
Place of service codes for the clinic (11) and home (12) can be used to signify where the service was provided. Physical therapists should stay informed on changes to modifiers required for telehealth billing.
Understanding billing for physical therapy and maximizing on reimbursement will increase a clinics financial stability. It is important to note that guidelines and regulations are constantly changing. Physical therapists should stay up-to-date with these changes in order to reduce errors with billing for telehealth.
Healthie For Virtual & Telehealth Billing
Healthie offers a cloud-based EHR and telehealth platform that is quick to implement while supporting compliance with HIPAA regulations — while being customizable to meet your business needs. In addition, the Healthie platform integrates with insurance billing tools, so that you can quickly create Superbills and CMS 1500 claims, send invoices, and collect payments for out-of-pocket services.
Here’s what you gain when working with your physical therapy or occupational therapy clients via Healthie:
- Have a HIPAA and PCI compliant platform: prioritize the security and privacy of your clients while working together remotely.
- Immediate access to video calls: schedule and launch 1:1 and group virtual sessions, in-platform or through our Zoom integration — no additional fees required
- Transition your in-person appointments to virtual sessions: receive support from our team to import/transfer your data.
- Create message blasts + group chats with clients: streamline client communication.
- Remote patient monitoring: for clients that sync their wearables like Fitbit + iHealth.
- Ability for clients to log images and journal entries: for you to assess their progress between sessions.
We have seen physical therapists and occupational therapists that use Healthie find success with reimbursement for virtual services. Whether you’re a solo practitioner or part of a multi-provider group or organization, our flexible membership plans adapt to meet your business needs. Let us help you launch your practice.
Stay Updated with Healthie
Sign-up to our newsletter.