Understanding the nuances of team therapy and group therapy—and how to bill for each—presents some challenges; based on the ol’ English language, you’d think these analogous terms are virtually the same. But, when it comes to rehab therapy billing, these two phrases are non-interchangeable—and treating them the same could put your practice at risk of claim denials or audits.
So, how do know if you’re billing the right codes for treatment scenarios involving multiple patients—or multiple therapists? Can you still bill for one-on-one therapy in a group therapy situation—and if so, which conditions must be met? We want to provide you with these answers—because even if you have 99 problems (we hope not), incorrectly billing for team therapy and group therapy shouldn’t be one. Ready? Let’s get started.
According to CMS, group therapy is the simultaneous treatment of two or more patients “who may or may not be doing the same activities.” With this type of care, the PT divides his or her time between two or more patients on a brief, intermittent basis. Essentially, therapists conducting group therapy must be constantly overseeing all patients simultaneously—without providing any extra level of care (or offering one-on-one services) to any specific patient. Otherwise, that would be cheating (i.e., it would no longer be considered group therapy).
Here’s an example: Let’s say you’re working with two patients—we’ll call them Wayne and Garth—over one 25-minute period. Let’s also say you are conducting treatment on a group therapy basis. In this case, while you’re allowed to spend a minute or two offering one-on-one assistance or modifications (excellent!) when necessary, you ultimately must provide equal levels of treatment to each of the biggest rock-and-roll fans from Aurora, Illinois. After all, Wayne and Garth have two separate plans of care. In this example, you would bill one unit of group therapy (97150) per patient.
One-on-One Therapy in a Group
Now, stay with me here: even if you’re providing care to more than one patient during the same time period, it’s possible to bill for one-on-one services if this one-on-one treatment takes place “continuously (15 minutes straight), or in notable episodes (for example, 10 minutes now, five minutes later).” Let’s say you work with three patients—let’s call them Steph Curry, Kevin Durant, and Klay Thompson—over a 45-minute period. Each receives 8 minutes of one-on-one therapeutic exercise for the first 24 minutes. Then, you work directly with Steph for an additional 10 minutes, KD for 5 minutes, and Klay for 6 minutes. So, the total amount of direct one-on-one time for the Splash Brothers and KD is:
- Steph: 18 minutes
- KD: 13 minutes
- Klay: 14 minutes
Thus, per the 8-minute rule, you’re allowed to bill each warrior—er, patient—for one unit of 97110 (therapeutic exercise).
Then, there’s team therapy, which, though similar in name to group therapy, is actually referring to a scenario in which more than one therapist is treating a patient—or a group of patients—at the same time. Essentially, this allows for therapists or therapy assistants to collaborate in their treatment as long as doing so is in the patient’s best interest. However, it’s important to note that the billing protocol for this type of therapy doesn’t allow for double-dipping. According to CMS, teams of therapists “cannot each bill separately for the same or different service provided at the same time to the same patient.” Although a PT and OT can both provide services to one patient simultaneously, only one therapist can call dibs and bill for the entire service. Alternatively, they can go halfsies and divide the service units accordingly.
Let’s look at some examples from CMS: a PT and an OT work together for 30 minutes with one patient on transfer activities. Because billing is broken down into 15-minute increments, the PT and OT could each bill one unit of direct one-on-one activity (97530). Or, one of the two therapists could bill both of 97530, while the other therapist billed no units. Similarly, if two physical therapist assistants (PTAs) provide services to the same patient at the same time, only one PTA can bill for those services. Or, the service units can be split between the two assistants and billed by the supervising therapist(s). Phew. Got that?
Medicare billing is, to put it lightly, a bit of a whirlwind—something that can seem straightforward one minute and totally confusing the next. But hopefully this post put some of your questions about group therapy and team therapy to rest.
Still have questions about group therapy and/or team therapy? Which information has been most helpful to you as you try to unpack and navigate these billing practices? Share your thoughts in the comment section below.