Some things go better together: peanut butter and jelly, chips and salsa, fish and chips. Likewise, rehab therapists often perform certain procedures that are similar to one another—but they might not know that two or more specific therapy types form “edit pairs.” Subsequently, they’re left in the dark about collecting a bigger portion of Medicare’s payment pie. So how can you, the rehab therapist, determine which therapy services are mutually exclusive? It’s as simple as identifying one primary CPT code and checking to see if another corresponds, or “matches,” with it. If both codes match, you can bill for modifier 59; if the codes don’t match up, then you shouldn’t bill the CPT code in combination with the primary one. Make sense?

 

We’ve created a comprehensive table that makes forming edit pairs as simple and enjoyable as milk and cookies. Want it in a printable, easy-to-reference PDF? Enter your email address, and we’ll send it your way!

Download: Most Commonly Used CCI Edits for PT, OT, and SLP Private Practice Settings

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  • When Should I Use Modifier 59? Image

    articleJul 28, 2017 | 7 min. read

    When Should I Use Modifier 59?

    In a PT’s paradise, the billing process wouldn’t exist. Therapists would simply provide treatment and receive payment accordingly, no explanation—or coding—required. In the real world, though, claims—and the codes and modifiers you submit with those claims—are your ticket to getting paid. And in many situations, one little modifier could have a big impact on your bottom line. Such is the case with modifier 59. Not sure of the rules governing proper use of this much talked-about modifier? …

  • Modifier 59 Flowchart Image

    downloadDec 22, 2016

    Modifier 59 Flowchart

    To bill for modifier 59 or not to bill for this very tricky modifier—that is the (burning) question. If you find yourself asking this question time and again—while also thinking back to high school English class—you’re not alone. Few modifiers cause as much consternation for PTs or wreak as much havoc on their payments as modifier 59. But knowing when to accurately apply one of the most misused modifiers is your ticket to getting paid by Medicare—and …

  • The PT's Guide to Billing Image

    downloadJun 7, 2016

    The PT's Guide to Billing

    When it comes to physical therapy billing, you have to know your stuff—because even the simplest mistakes can cause denials. Of course, knowing billing backwards and forwards doesn’t have to be complicated. That’s why we created a comprehensive billing resource specifically for PTs. Take the guesswork out of billing. Enter your email address below, and we’ll send your free guide.

  • 5 Things Physical Therapists Need to Know About Modifier 59 Image

    articleMay 5, 2016 | 12 min. read

    5 Things Physical Therapists Need to Know About Modifier 59

    One of the primary reasons medical providers depend on certified coders is that coders know how to maximize practice revenues. That’s because certified coders understand how and when to use modifiers—and there are a lot—to indicate anything from laterality (e.g., right [RT] and left [LT]), to separate and distinct procedures. With the latter, I’m of course referring to the very tricky—and very challenging—modifier 59. Physical therapists aren’t certified coders, and yet, when it comes to modifier 59, …

  • The Definitive Medicare Part B FAQ for Outpatient PT, OT, and SLP Image

    articleOct 27, 2016 | 33 min. read

    The Definitive Medicare Part B FAQ for Outpatient PT, OT, and SLP

    In October, we hosted a webinar dedicated to the most common Medicare misconceptions . We received a lot of questions from the audience—so many, in fact, that we’ve organized them all into one huge FAQ. Scroll through and check them out, or use the link bank below to skip to a particular section. The Therapy Cap ABNs Modifiers Supervision Prescriptions and Certifications Cash-Pay Rules and Regulations Re-Evaluations Everything Else   The Therapy Cap If a patient reaches …

  • PT Billing Secrets: 5 Things Payers Don’t Want You to Know Image

    webinarApr 1, 2016

    PT Billing Secrets: 5 Things Payers Don’t Want You to Know

    You’ve probably heard the saying, “Don’t hate the player; hate the game.” It’s a go-to hip-hop lyric, but its relevance isn’t limited to rap artists. The same holds true when it comes to insurance companies. Sure, payment rates for physical therapy services are on the decline, but the payer isn’t necessarily the problem. After all, in health care—as in any business—cutting costs is the name of the game. And in an effort to bolster their bottom lines, …

  • 9 Most Common Medicare Misconceptions for PTs, OTs, and SLPs Image

    webinarSep 8, 2016

    9 Most Common Medicare Misconceptions for PTs, OTs, and SLPs

    To say that Medicare regulations are confusing is an understatement. But, it’s not just the barely-readable government gobbledygook that throws providers for a loop; it’s also the fact that the rules are always changing. If you treat Medicare patients, we’re willing to bet you’ve been tripped up by at least one of these common misconceptions—maybe without even knowing it. And that could leave a nasty bruise on your practice’s bottom line—especially if you ever find yourself at …

  • Do You Know Your Modifiers? [Quiz] Image

    articleJul 29, 2015 | 1 min. read

    Do You Know Your Modifiers? [Quiz]

    It’s a mad, mad, mad, mad Medicare world, and unfortunately, just about every regulation requires a modifier. If you apply the wrong modifier—or forget one entirely—then your clinic suffers decreased payments or flat-out denials. Even worse, if you amass enough modifier mistakes, you make your practice vulnerable to an audit. Worried you’re miserable at modifiers or want confirmation that you’re actually a modifier master? Take our 10-question quiz below to test your modifier know-how.    

  • The 7 Deadly Sins of PT Billing Image

    webinarMar 30, 2015

    The 7 Deadly Sins of PT Billing

    Billing for physical therapy services is tricky, time-consuming, and riddled with ever-evolving rules—which means mistakes are bound to happen. But how many mistakes are you truly making? The occasional oops is one thing, but what if you’re unknowingly flubbing up left and right? That’s a scary thought. Even scarier: you could be flubbing on purpose, because “everyone’s doing it.” Whether accidental or intentional, actions have consequences, and when it comes to billing for the services you provide, …

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