PT and OT Eval Code Changes for 2017, among other updates

*Note these were quoted rates at the time of the original blog post on 1/4/17. I've reposted a lot of these outdated information blogs because they contain good information and reflections of issues in the past.

Medicare is reporting pricing for evals as follows:

PT:

97161 = 78.23

97162 = 78.23

97163 = 78.23

97164 = 52.95

(previously for Medicare in 2016, 97001 = 72.59)

OT:

97165 = 75.98

97166 = 75.98

97167 = 75.98

97168 = 50.02

(previously for Medicare in 2016, 97003 = 81.28)

Medicare always pays a higher price than Medicaid, but to give an idea what could be possibly coming for rates.

WebPT posted a great blog about the new codes. Here's the link: https://www.webpt.com/blog/post/farewell‐97001‐how‐to‐use‐the‐new‐pt‐and‐ot‐evaluation‐codes

It explains the time and definition behind each level of complexity and certainly a great reference when deciding which code to use for evaluations.

However for now, that's all that is being reported...

The following are changes found for the new Georgia manual for Children's Intervention Services for 01/2017:

Effective POC start and end dates along with the frequency and duration of services. The effective POC start date must be on or after the therapist completion date, PCP signature and date, and must be within thirty (30) calendar days of the therapist completion date. If the PCP’s signature date is after the effective date, then the POC will be valid from the signature date to the end date. However, the effective date still must be within 30 days of the therapist completion date.

Providers are required to provide standardized test results for ongoing therapy requests. Standardized testing is an important component to determine the nature and extent of any deficits relative to age appropriate norms. Standardized testing can help determine whether a child has a significant delay that requires correction or amelioration and shall be required once per year. Standardized testing may be conducted prior to one year as deemed appropriate. Standardized test results will not be used as the sole determinant as to the medical necessity of requested services.

Note: Procedure codes 97001­97004 have been discontinued effective 12/31/16. Note: As of 1/1/17, final rates for codes 97161 – 97168 have not been received from CMS. Rates will be updated upon receipt from CMS.

To find the manual, goto mmis.georgia.gov, link at the top "provider information", then drop down to "Provider Manuals". Look for Children's Intervention Services.

Also ­ Please note the following:

Please make sure the pediatrician is signing your POCs and not the PA or NP in the office. It's not stated in the policy manuals that I can see, but auths are being rejected for this reason

Please make sure notes state reason for each visit.

Hopefully we will hear an update soon about the upcoming changes that always keeps us on our toes!