PHYSICAL THERAPISTFEESIN THEHOSPITAL SETTING

While Medicare allows hospitals to allocate their costs, and separately report professional fees performed by physicians and non-physician practitioners like PAs and ARNPs, there is no evidence they will allow this same allocation for physical therapists.

This may be the most efficient approach, because the cost of the therapist would usually be 100%allocated to the cost report anyway. With the exception of these nerve conduction study interpretation codes, all other services that PTs perform in the hospital setting are reimbursed on facility fees

If 101%of the cost of the physical therapist is reimbursed via the cost report anyway, then it seems inefficient to go through the cost allocation procedure for a relatively small number of separately payable services ? the difference in overall reimbursement is unlikely to be worth the effort to carve the associated salary cost out of the cost report

Incidentally, we also surveyed our Medicare claims database for 2022 claims from other CAHs (Method II) which reported 95866, 95910, or 95911 with modifier 26 on their claims We found none were reported with the NPI of a physical therapist in the ?attending?field; all reported a physician neurologist or other physician/non-physician practitioner. There is no evidence that any CAH has billed or been paid by Medicare for a physical therapist reporting 95866-26, 95910-26, or 95911-26.

We recommend clients consult with their cost report accountant to verify whether they concur with our interpretation of the situation.

Addit ional Resources

For further information regarding charging and documenting physical therapy services in the hospital setting, please see the following PARA Papers available in the Advisor tab of the PDE:

Q&A ? Physical Therapy Documentation

?Incident-To?Billing in the Clinic and Hospital Settings