PHYSICAL THERAPISTFEESIN THEHOSPITAL SETTING

"Incident -To" Billing In The Facilit y Set t ing

CMSdefines ?incident-to?services as those services that are furnished incident to physician professional services in the physician?s office (whether located in a separate office suite or within an institution) or in a patient?s home. The concept of ?incident-to?billing does not apply to services rendered in the facility setting The physician does not employ the PT; the hospital does, and the hospital is already receiving reimbursement for the PT?s services.

https://www cms gov/outreach-and-education/medicare-learning-networkmln/ mlnmattersarticles/downloads/se0441.pdf

Physical Therapistfeesin Thehospital Setting

EMG & Nerve Conduct ion St udies

Many Critical Access Hospitals have reported Medicare denials when billing a professional fee for EMG services rendered by a physical therapist who is employed by the hospital The codes in question are 95886, 95910, and 95911

In their denials, Medicare advises they will not pay 95886-26 on a professional fee claim with POS22 (outpatient hospital.)The acceptable POScodes are:

- 11 Office

- 15 ?Mobile Unit

- 20 ?Urgent Care Facility

- 32 ?Nursing Facility

- 49 ?Independent Clinic

Similarly, Medicare advises that CPT® 95910-26 is payable only when billed with one of the following POScodes:

- 11 ?Office

- 32 ?Nursing Facility

- 49 ?Independent Clinic

We note that POS22 ? Outpatient Hospital, is conspicuously absent from either list Medicare denials also indicate ?Modifier 26 is incorrect.?

Physical Therapistfeesin Thehospital Setting

Based on Medicare?s remarks, a qualified physical therapist in private practice (billing POS11 ? Office, for instance) could be reimbursed for the global or the professional component of these studies, but a physical t herapist w ho is w orking w it hin an out pat ient acut e care facilit y m ay not be paid a professional fee for t hese services.

Under Medicare?s cost-reimbursement methodology, a hospital is already fully reimbursed for the employment costs of physical therapists By billing a separate professional fee, the hospital is seeking reimbursement for a cost that is reimbursed through a different mechanism. For a CAH, the physical therapist?s employment costs are reimbursed under Medicare?s percent of-charges cost reimbursement methodology

Qualified physical therapists may be reimbursed by Medicare for furnishing these studies: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ PhysicianFeeSched/Diagnostic-Services-by-Physical-Therapists

Critical Access Hospitals are paid by Medicare on a cost-reimbursement basis, and the hospital?s cost report is used as the basis of the percent-of-charges reimbursement applied by Medicare to reimburse all covered facility fees. The cost report already includes the costs associated with its employed or contracted physical therapists