To minimize physical therapy denials, ensure accurate coding, detailed documentation, and compliance with payer rules. Use the correct CPT codes (97161-97163 for PT, 97165-97167 for OT) based on evaluation complexity (low, moderate, high). Document measurable data, standardized tests, and a clear plan of care to justify complexity levels.
Specify treated body regions (muscles/joints) to support multi-area CPT codes. Follow time-based coding rules, adhering to the “eight-minute rule” for 15-minute units. Confirm payer-specific requirements for lumped or individual billing (e.g., Medicare vs. commercial).
Apply Modifier 59 correctly for distinct procedural services in separate time blocks. Bill electrical stimulation accurately: CPT 97032 for attended (timed) and 97014 for unattended (untimed) services. Ensure therapist presence for timed procedures.
Verify referrals and medical necessity by aligning diagnoses with treatment plans. Avoid prolonged, unnecessary treatments to maintain compliance. By prioritizing precise documentation, accurate coding, and payer-specific rules, practice managers and providers can reduce denials and optimize reimbursement.