Reimbursement Resources

Resources from APPT:

    • APTA template letter re: Medicaid work requirement
      • A number of states are pursuing or intend to pursue CMS Section 1115 Demonstration Waivers that include community engagement requirements as a condition of continued Medicaid eligibility, and APTA developed a resource that assists state chapters and other individuals in responding to such proposals when opportunities to submit written comment arises. You can access APTA's template letter, specific to Medicaid work requirements (Download Here!).
    • Information on New Physical Therapy Evaluation and Reevaluation CPT Codes
      • Pediatric Case Study
      • New Physical Therapy Evaluation and Reevaluation CPT Codes: The 2 familiar CPT codes for physical therapy evaluation and reevaluation will disappear beginning January 2017. In their place, PTs must begin using 3 new evaluation codes and a new reevaluation code. Now is the time to become familiar with them. The final CMS physician fee schedule for 2017 introduced the 3 new CPT codes for physical therapy evaluation and 1 new code for reevaluation. The new evaluation codes reflect 3 levels of patient presentation: low-complexity (97161), moderate-complexity (97162), and high-complexity (97163), and will replace the current 97001 code. The new reevaluation code (97164) replaces the current 97002. CMS failed to adopt tiered payment values for the 3 evaluation codes, as was recommended by the American Medical Association (AMA) Relative Update Committee. APTA's comments in response to the proposed rule had reiterated its recommendations for stratified payment for different levels of complexity in physical therapist evaluations. However, CMS held in the final rule to its original proposal for a single payment value, which did not change from the 1.20 value for the old 97001 code. CMS did adjust the value of the new code for reevaluation, raising it from 0.60 to 0.75. The agency also acknowledged APTA's concerns for adequate time to educate PTs on the use of the new coding system by making no changes to the Medicare benefits policy manual for 2017, meaning medical reviewers won't be able to penalize providers regarding the medical necessity for the new evaluation requirements. As part of APTA's longstanding efforts to pursue a new payment system that fairly reflects the expertise, skill, and responsibility of physical therapists in caring for their patients and clients, the association and its collaborators developed this 3-tiered system of CPT evaluation codes to replace the current single code that covered all physical therapist evaluations. The new CPT evaluation and reevaluation codes are a step in the right direction toward overall payment reform, and APTA continues to work with AMA and other provider groups in seeing value-based payment evolve. For more information on APTA's efforts to reform payment, view our resources below or email [email protected].

      • Get Started

        Use this visual guide to become familiar with the new CPT evaluation codes.

        September 22, 2016 free webinar.

        Review handouts from the September 22, 2016 webinar on the Medicare Payment and Coding System.

        This webinar is scheduled for Thursday, January 19 at 1:00 pm, ET, and is FREE to APTA members!

        PT in Motion Magazine (September 2016)

    • Pediatric PT & Medicaid Advocacy Agenda

Resources from APTA:

For up-to-date information on nationwide reimbursement issues, also visit the Reimbursement Section of the APTA website.

Topics include:

    • Top Issues in Reimbursement
    • Getting Started
    • Managed Care
    • Coding and Handling Denied Claims (Members)
    • APTA Reimbursement Article Reprints List
    • Medicare
    • State Insurance Regulators (NAIC)
    •  Workers' Comp Programs (state contacts)
    • Seminars and Workshops
    • Consumer Information

If you have a reimbursement question, your State Representative may be able to help you and can provide you with a variety of contacts, including Health Insurance Billing & Reimbursement, Medicaid, IDEA Part B, IDEA Part C, etc.

To contact your State Representative, visit the Academy's leadership page.


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