Brace Health resources
Practical guidance authored by the people who work on billing and practice operations every day.
8 resources
Medicare’s therapy evaluation code families distinguish physical therapy from occupational therapy: commonly, 97161–97163 are PT evaluations and 97165–97167 are OT evaluations. Confirm the code, discipline, documentation, and payer-specific billing rules for the service; a code family alone does not establish coverage or payment.
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The CQ modifier identifies applicable Medicare outpatient physical therapy services furnished in whole or in part by a PTA. It is not required automatically for every PTA-involved visit; apply the current CMS threshold, service-unit rules, exceptions, and claim-line requirements for the date of service.
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A paid claim may warrant underpayment review when the remittance is lower than the amount expected under the applicable contract and claim facts. Verify the benchmark, explain the variance, and then decide whether to correct, appeal, contact the payer, or close the review.
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For Medicare outpatient therapy, CPT 97014 is not a Medicare-recognized code. A CMS Medicare Coverage Database article for specified contractor jurisdictions describes HCPCS G0283 for certain unattended electrical-stimulation services under a therapy plan of care; confirm the current MAC policy for the service date and location.
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For Medicare outpatient therapy, the 8-minute rule helps determine billable units for timed services measured in 15-minute units. Apply the current Medicare method to documented timed minutes; do not assume that commercial plans use the same method or include untimed services in the calculation.
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The cost of outsourced PT billing depends on the proposal’s fee basis, included work, exclusions, practice volume, and contract terms. Compare providers using the same scope and period; do not assume a generic “standard” rate applies to every practice.
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A new PT location needs its own billing-readiness check. Confirm how the site is represented in systems and payer records, how claims and payments route, and how the team will monitor location-level work rather than assuming the existing clinic’s setup carries over.
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Some Medicare claims can cross over electronically to a participating secondary payer after Medicare processes them, but crossover is not universal. Check the Medicare remittance and the secondary plan’s instructions; the practice may need to submit or follow up separately.
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