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Written by: Darlene D'Altorio-Jones (1959-2015) on Sunday, October 13, 2013 Posted in: Outpatient Rehab

On the horizon and newly named PTCPS (Physical Therapy Classification and Payment System), is the proposed new billing and coding recommendation for the future of physical therapists nationally. If it’s foreign to you, now is the time to become familiar.

Presently, outpatient therapy services are identified at the claim line by the 5-digit Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes for each procedure furnished on each date of service. The outpatient therapy discipline furnishing the services is identified at the claim line by the GP, GO or GN modifier representing PT, OT or SLP services respectively. Often, disciplines share the same CPT code that describes the level of skilled care provided.

The proposed system will instead be based on one code that defines the level of professional service provided within the visit for an individual.

Unfortunately, our present payment system is often scrutinized. In fact, in the past CMS and its contractors have implemented a severe amount of utilization edits as they perceive over utilization and or misuse occurs in the use of CPT coding. Implementation of Correct Coding Initiative (CCI) edits, Multiple Procedure Payment Reduction (MPPR), Medically Unlikely Edits (MUE), Local Medical Review Policies (LMRP), limited use thresholds, Therapy CAPS and Claims-Based Outcomes Reporting (CBOR), also known as Functional Reporting, have all been layered over and over to the billing and payment model we must presently enforce. These are all processes that have added complexity and costs for every provider working diligently to employ rightful and correct usage.

The American Physical Therapy Association (APTA) proposes this layer of madness in billing and coding can stop if a new system that applies evaluation and management coding is implemented for part B outpatient billing specifically.

If recently you have seen or would like to review this proposed education, a presentation has been releaseddiscussing the newest recommended payment and coding for outpatient physical therapy. If you believed this was something that will be occurring in just a few short months it’s OK to sigh a sigh of relief; it’s not happening just yet, however, it is in the proposal stages from what we can gather. The proposed change would move physical therapy billing from one CPT coding to a dozen or so evaluation and management codes structured very similar to a physician’s billing practice. Anyone viewing this presentation needs to pay special attention to slide two.


During the course of this year and the next, APTA members are to review and educate others on this proposed process. The concept was developed in early 2011 with stages of discussion, refinement, feasibility and proposal, taking us up through to this implementation education time frame.

This is HUGE, so don’t sweep the idea under the rug. If adopted, there will be a lot of work to align charge masters, billing processes, budgeting and the like into a new arena of change process modeling. Even though it appears very simplistic with complexity, severity and intensity level code descriptors, the concept is so new to the profession of physical therapy that the time to start review, education and possibilities for your use should begin NOW.

As with all processes, there is an overwhelming amount of education, transformation and then software and billing items that would need overhauling should this proposal become reality. The questions after that would be, “will Medicare stop at just Physical Therapy?” and “does it make sense to align all therapies as there are co-treats between disciplines that occur now?” Everything is up for discussion but if you haven’t even begun to think about the possibilities, start your education here!  

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