Wiki Physical Therapy

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aksilvis

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Nampa, ID
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In regards to Medicaid- I have searched everywhere and I cannot seem to find my answer. I am trying to bill three codes together 97110, 97112, & 97150. Every time we add the 97150 (group Therapy) Medicaid will deny the claim. Can someone help? I've appended modifiers to what I thought was correct, and then Medicaid will pay on one line and deny the remaining lines. I cannot figure it out.
 
I see you are in ID. For Medicaid you have to always check the provider manuals. Not sure if this is the plan you're billing or what the situation is but:

Attention Therapy Providers – Group Therapy IDAPA 16.03.09.732.03.g, “Idaho Medicaid Basic Plan Benefits” excludes group therapy except for school-based services and the infant toddler program (ITP). ITP no longer provides this service due to changes in their contract effective 7/01/18. Therefore, only school-based services are currently allowed to provide group therapy. Providers outside of school-based services will not be reimbursed for these services. Providers submitting claims for group therapy services under general therapy codes to circumvent system edits are committing fraud. If ineligible providers have previously billed Medicaid they are subject to recoupment. See your therapy provider handbook for additional information on allowed services.
 
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