Medicaid Billing Module
Physical Therapy
Billing Form
Changes
• Services must be documented on the current IEP for
meetings held prior to August 1, 2015.
• Services must be documented on Service Care Plan for IEP
meetings held after August 1, 2015.
• As of August 1, 2015 PT specific ICD diagnosis codes are
required. ICD-9 codes are in effect through September 30,
2015. ICD codes must relate to the specific type of therapy
being provided. A global code such as Cerebral Palsy would
not be sufficient.
• As of October 1, 2015 PT specific ICD-10 diagnosis codes are
required. Think of these more as treating diagnosis codes.
Physician Authorization
• Physician Authorization is still required annually to
bill for physical therapy.
• PT suggested ICD-10 diagnosis (treating) code
should be included on this form. When the
Physician signs the form they are also confirming
the therapist’s code(s).
• Authorization can now be from a Physician's
Assistant or an Advanced Practice Registered
Nurse (APRN).
• Authorization is good for one calendar year from
the date signed.
Student Demographics
• Complete this section taking note of the
following issues
• The diagnosis code is to be an ICD 10
code that matches the need for physical
therapy.
• For provider name print the name of the
person providing the service.
Procedure Codes
• Complete beginning and end dates for
each procedure.
• List the total number of units for the month
for each procedure.
• The form is to be used for only one month.
Student Demographics
and Procedures Sample
Medicaid Number
Last Name
First Name
0000000000
Doe
Jane
WVEIS #
Diagnosis Code
Date of Birth
999999999
01-01-1900
County
1 Beginning Date
1 Ending Date
1 Procedure Code
Units
059
09/01/2015
09/30/2015
97110 GP
10
School
2 Beginning Date
2 Ending Date
2 Procedure Code
Units
203
09/01/2015
09/30/2015
97116 GP
5
Provider Name
3 Beginning Date
3 Ending Date
3 Procedure Code
Units
09/01/2015
09/30/2015
97002 GP
1
Explanation of Procedures
and Caps Part 1
97001 GP
Physical Therapy Evaluation
1 event per calendar year
97002 GP
Physical Therapy Re-evaluation
2 events per calendar year
97032 GP
Application of a modality to one or more areas; electrical stimulation
(manual), each 15 minutes
20 units per month
97110 GP
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic
exercises to develop strength and endurance, range of motion and flexibility
20 units per month
97112 GP
Neuromuscular reeducation of movement, balance, coordination, kinesthetic
sense, posture, and proprioception for sitting and/or standing activities, each
15 minutes
20 units per month
97113 GP
Aquatic therapy with therapeutic exercises, each 15 minutes
20 units per month
Explanation of Procedures
and Caps Part 2
97116 GP
Gait training (includes stair climbing) each 15 minutes
20 units per month
97140 GP
Manual therapy techniques (Mobilization/manipulation, manual lymphatic
drainage, manual traction), one or more regions, each 15 minutes
20 units per month
97150 GP
Therapeutic procedure(s), group (2 or more individuals), each 15 minutes.
20 units per month
97530 GP
Therapeutic activities, direct (one-on-one) patient contact by the provider (use
of dynamic activities to improve functional performance) each 15 minutes
20 units per month
97532 GP
Development of cognitive skills to improve attention, memory, problem
solving, (includes compensatory training), direct (one-on-one) patient contact
by the provider, each 15 minutes
20 units per month
97533 GP
Sensory integrative techniques to enhance sensory processing and promote
adaptive responses to environmental demands, direct (one-on-one) patient
contact by the provider, each 15 minutes
20 units per month
Start and Stop Times
• Enter the start and stop times for each service on
the corresponding date at the bottom of the form.
• These will be used to easily identify dates billable
services were conducted for students with
transportation services.
• If provide multiple procedure codes within a
session or day, each procedure code needs to
have a separate start and stop time. See the PT
sample form for an example of how to document
on the form.
Start and Stop Times
Date
Start
Time
End
Time
1
Date
Start
Time
End
Time
16
2
17
3
4
5
6
18
19
20
21
7
22
8
23
9
24
10
25
11
26
27
12
28
13
29
14
30
15
31
Physical Therapy Assistants (PTA)
• PTAs can only bill for therapy when a
Physical Therapist (PT) certified by the
WV Board of Examiners is directly
supervising.
• Directly supervising requires the Board
Certified PT to be on site when the therapy
is being provided.
• PTAs cannot bill for evaluations.
Additional Documentation
• Progress/therapy logs will also be required.
• Original copies of progress/therapy logs must
be on file in the special education central
office.
• PTA progress/therapy logs are to be cosigned by the supervising PT for therapy
dates that are billed for Medicaid
• There is not a required form for
documentation of progress/therapy logs.
Signature and Credentials
• Staff who provided the service will sign the
form and list credentials.
• For PTAs, the supervising PT must co-sign
the billing form.
Terry Riley – Coordinator
Office of Special Education
tjriley@k12.wv.us
304-957-9833 ext 53223
WVDE Medicaid Website:
http://wvde.state.wv.us/osp/medicaid.html