• E-mail
• Print
• RSS

CPT code 97001

Compliance Monitor, December 1, 2006

Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!

Q: Is it appropriate to report CPT code 97001 when a physical therapist does an inpatient consult that has been ordered by the patient's physician? Would it be appropriate to report 92506 for a speech therapy consult that has been ordered by a physician?

A: No, consults are not billable. Review the following Medicare benefit policy:

To be covered PT, OT or speech-language pathology services, the services must relate directly and specifically to an active written treatment regimen established by the physician or non-physician practitioner after any needed consultation with the qualified PT, OT, or speech-language pathologist and must be reasonable and necessary to the treatment of the individual's illness or injury. The physician, non-physician practitioner or the qualified therapist providing such services may establish a plan of treatment for outpatient PT, OT, or speech-language pathology services.

Reasonable and Necessary

To be considered reasonable and necessary the following conditions must be met:

The services must be considered under accepted standards of medical practice to be a specific and effective treatment for the patient's condition; The services must be of such a level of complexity and sophistication or the condition of the patient must be such that the services required can be safely and effectively performed only by a qualified PT, OT, or speech language pathologist or under the therapist's supervision. Services which do not require the performance or supervision of a therapist are not considered reasonable or necessary PT, OT or speech-language pathology services, even if they are performed or supervised by a therapist. (When the carrier determines the services furnished were of a type that could have been safely and related to the maintenance of function (see subsection D) do not require the skills of a qualified physical therapist.

Thanks to Jodee E. Collins, charge description master director at UCLA Healthcare, for answering this question.

Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!

• E-mail to a Colleague
• Print
• RSS
• Archive