2014 Billing and Coding Primer for Therapy Services

The release of the 2014 Physician Fee Schedule Final Rule in late November, coupled with the scheduled expiration of certain provisions of the American Taxpayer Relief Act (ATRA) threatens to add a lot of confusion to how you bill for therapy services in 2014.

We’re here to help. First, the therapy caps will remain in place for 2014. The caps go up slightly. There are two, one $1,920 cap for occupational therapy services and a separate $1,920 cap for physical therapy and speech language therapy combined.

The first change is that CMS is using its regulatory powers to apply the caps to therapy services provided in critical access hospitals. ATRA had a provision that temporarily applied the cap to CAH services, but CMS will make that permanent as of Jan. 1, 2014, despite objections from providers.

You may still use modifier KX when billing therapy services over the cap amount, when you believe that these services are medically necessary. Any therapy services against either cap that go over a spending limit of $3,700 will be subject to medical review – likely delaying your payment.

To further confuse matters, ATRA had temporarily applied the therapy caps to services done in outpatient hospital settings. Outpatient hospital therapy has long been exempt from the therapy caps. This provision of ATRA will also expire on Dec. 31, 2013, but CMS says it lacks the authority to extend it.

As a result, outpatient hospital therapy services won’t be covered by the cap in 2014, unless Congress acts to reinstate that provision.

Finally, the multiple procedure payment reduction for therapy services will continue to be in place in 2014. Whenever a therapist rendered services on the “always therapy” list, payment for any additional services after the first one will be reduced by 50 percent. This applies to services on the same date of service by the same provider or facility, as measured by the National Provider Identifier (NPI).

Here are the “always therapy” codes for 2014:
Code    Short Descriptor
92507    Speech/hearing therapy
92508    Speech/hearing therapy
92521&nbsnbsp;   Evaluation of speech fluency
92522    Evaluate speech production
92523    Speech sound lang comprehen
92524    Behavral qualit analys voice
92526    Oral function therapy
92597    Oral speech device eval
92607    "Ex for speech device rx, 1hr"
92609    Use of speech device service
96125    Cognitive test by hc pro
97001    Pt evaluation
97002    Pt re-evaluation
97003    Ot evaluation
97004    Ot re-evaluation
97012    Mechanical traction therapy
97016    Vasopneumatic device therapy
97018    Paraffin bath therapy
97022    Whirlpool therapy
97024    "Diathermy eg, microwave"
97026    Infrared therapy
97028    Ultraviolet therapy
97032    Electrical stimulation
97033    Electric current therapy
97034    Contrast bath therapy
97035    Ultrasound therapy
97036    Hydrotherapy
97110    Therapeutic exercises
97112    Neuromuscular reeducation
97113    Aquatic therapy/exercises
97116    Gait training therapy
97124    Massage therapy
97140    Manual therapy
97150    Group therapeutic procedures
97530    Therapeutic activities
97533    Sensory integration
97535    Self care mngment training
97537    Community/work reintegration
97542    Wheelchair mngment training
97750    Physical performance test
97755    Assistive technology assess
97760    Orthotic mgmt and training
97761    Prosthetic training
97762    C/o for orthotic/prosth use
G0281    Elec stim unattend for press
G0283    Elec stim other than wound
G0329    Electromagntic tx for ulcers