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CarlaA

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Our facility owner, also one of our providers(DNP-C), is looking into expanding our services to include house calls including for OT & PT. My question is I have no idea how to bill this or can we bill this as a general practice facility. We have billed provider home visits with no issue, but never anything else. So can a general practice clinic bill for OT/PT home visits? If so how and which codes/modifiers?

Thank you for any assistance with this matter!
 
Speaking as a OT, I would bill the codes such as 97535, 97530, 97110, 97112, 97542 generally speaking. As far as modifiers I am not sure. I just got my CPB so still learning, but I have been an OT working in skilled nursing facility for 22 years and that is what I would be for a home visits
 
Mdpaules8 said:
Speaking as a OT, I would bill the codes such as 97535, 97530, 97110, 97112, 97542 generally speaking. As far as modifiers I am not sure. I just got my CPB so still learning, but I have been an OT working in skilled nursing facility for 22 years and that is what I would be for a home visits
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Thank you so much! I really appreciate the feedback.

:)
 
This is a pretty big question from the billing, coding, federal/state regulation and practice management standpoints. Below are some references:

220 - Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance (Rev.255, Issued: 01-25-19, Effective: 01- 01- 19, Implementation: 02-26-19)




 
I reviewed these references and do see if the OT is contracted with a hospital, SNF, or therapy center they cannot bill individually. I did not see anywhere that said they could not bill individually but it did mention incident to billing, and we do not do that at our facility, nor am I familiar with it. So long story short we are still looking for insight because an insurance company we attempted to credential with said they would not credential the OT, but Medicare and Medicaid (MS) did credential the OT. So, my question I guess remains the same, all help has been deeply appreciated. We just need some help with clarification. I have done billing and coding for a long time but strictly family or general practice, this is all new to all of us in the billing dept at our clinic. TIA
 
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