Wiki Athletic Trainers Billing for Services

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A51080

A51080

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Lake Waukomis, MO
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Does anyone out there have experience in coding services provided by Athletic Trainers and billing them to Commercial Carriers? If so are they facility or non-facility, what carriers are billed, and do they reimburse? Also what CPT/HCPCS are being billed? I have checked several websites including NATA, BOC and our state board of healing arts statutes trying to find information on this and cannot seem to come up with any clear answers. Any help is greatly appreciated.
 
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In our office we have a set fee billed under self pay for out ATC under code 91740. Some WC providers will cover with authorization and since Medicaid requires all services to be billed, we end up writing off those service. Hope this helps, thank you
 
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SharonCollachi said:
I asked what their LICENSE was, not their certification. Are they licensed by a state agency? If not, they are not billable services.
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The athletic trainers that work for our office are licensed through the board of healing arts in both Kansas and Missouri with their respective titles AT, ATC LAT etc.
 
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SharonCollachi said:
Kansas states that their licensed athletic trainers are NOT healthcare providers. More here: http://www.ksbha.org/faq/faqlegalat.shtml

"Since an athletic trainer is not licensed to practice medicine and surgery, they are not a health care provider as defined in the Act."
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Thank you, I have focused much of my attention on Missouri and there documents do not seem to be as clear as KS. Or it's possible that I have over thought everything at this point :) I appreciate your feedback.
 
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A51080 said:
Gait training, Therapeutic exercises, Evaluations/Re-evaluations
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Is this for treatment of an injury or illness? Or just a preventive service or to improve athletic performance?

Think the scope of practice question is kind of a separate issue. Assuming these are allowed under their license, the CPT codes that represent these services are in the physical therapy section, so there are codes you can bill. But an athletic trainer isn't a provider type that you can credential, which means that under normal circumstances the services would have to be performed 'incident to' a physician. Commercial payers may or may not allow this. So I think I have to go back to my original answer and refer you to the specific payers for guidance on this.

You're in an unusual situation and if you're going to be billing this to a payer, your best bet is to be up-front and speak with them ahead of time so you and the payer both have a clear idea ahead of time and there isn't a surprise down the road after a lot of services have already been billed. Sorry not to be of more help. You might want to consider reaching out to a consultant or someone with specialized experienced in this area. We on this forum are mainly just coders. :)
 
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thomas7331 said:
Is this for treatment of an injury or illness? Or just a preventive service or to improve athletic performance?

Think the scope of practice question is kind of a separate issue. Assuming these are allowed under their license, the CPT codes that represent these services are in the physical therapy section, so there are codes you can bill. But an athletic trainer isn't a provider type that you can credential, which means that under normal circumstances the services would have to be performed 'incident to' a physician. Commercial payers may or may not allow this. So I think I have to go back to my original answer and refer you to the specific payers for guidance on this.

You're in an unusual situation and if you're going to be billing this to a payer, your best bet is to be up-front and speak with them ahead of time so you and the payer both have a clear idea ahead of time and there isn't a surprise down the road after a lot of services have already been billed. Sorry not to be of more help. You might want to consider reaching out to a consultant or someone with specialized experienced in this area. We on this forum are mainly just coders. :)
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I totally agree with you. The services would be for the treatment of an illness or injury, however as you said these are PT codes and it's hard enough to get PT's credentialed with some payers. I appreciate the work the AT's do and the care they provide. They play a vital role in Orthopedic care. That being said, I just don't feel like we as an industry are there yet where AT's are recognized at the same level that a PT is (not saying that they should or shouldn't be). Look at how long it took us to get to the point that we could bill PA/NP's to payers without a supervising or "incident to". Hopefully this changes in the future. Reaching out on this forum was a last case scenario. I very much appreciate the feedback and time you have taken today to help me.

Thank you,
D. Parson, CPC, CEMC
 
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K8teg1987 said:
In our office we have a set fee billed under self pay for out ATC under code 91740. Some WC providers will cover with authorization and since Medicaid requires all services to be billed, we end up writing off those service. Hope this helps, thank you
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Yes, this is exactly the type of information I was looking for. Thank you so much! If you don't mind, may I ask what state the services are provided? I am coding for services provided in KS & MO.
 
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Is the evaluation and treatment plan being written up by the Athletic Trainer, or by a Physical Therapist?

I've seen reimbursement for athletic trainers when it's done under the supervision of a PT - in that case, the AT is functioning more as a PT aide or assistant, and the claims would be billed the same way.
 
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In Maine, Athletic trainers are 'billable' only as incident-to under a physician and no different from a nurse or medical assistant. Check with your payers, but Athletic trainers are not licensed, and therefore cannot act or treat independently as providers.
 
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sls314 said:
Is the evaluation and treatment plan being written up by the Athletic Trainer, or by a Physical Therapist?

I've seen reimbursement for athletic trainers when it's done under the supervision of a PT - in that case, the AT is functioning more as a PT aide or assistant, and the claims would be billed the same way.
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The patients the AT's would be seeing is in a physician office setting.
 
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