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CMS Allows PTs in Private Practice to Provide Services Via Telehealth

The Basics

  • Physical therapists in private practice are eligible to bill Medicare for certain services provided via telehealth. [Editor’s Note: APTA is seeking confirmation as to whether services furnished by PTAs via telehealth are eligible for reimbursement.]
  • Services that started as of March 1, 2020, and are provided for the duration of the public health emergency are eligible.
  • These CPT codes are eligible to be billed: 97161- 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, and 97761.
  • Patients may be either new or established.
  • These visits are for the same services as would be provided during an in-person visit and are paid at the same rate.
  • Patients may be located in any geographic area (not just those designated as rural), and in any health care facility or in their home.

Here are the codes you can use.
These codes are eligible to physical therapists to furnish and bill under the Medicare Physician Fee Schedule when provided via telehealth:

ICPT codes 97161- 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, and 97761. See the full list of codes eligible to be furnished and billed via telehealth under Medicare.

When billing claims for telehealth services provided on or after March 1, 2020, and for the duration of the public health emergency, bill with:

  • IPlace of Service code equal to what it would have been had you furnished the service in person;
  • IModifier 95, indicating that you did indeed perform the service via telehealth; and
  • IThe GP modifier.

APTA is seeking clarification from CMS regarding institutional billing of telehealth services.