How Do You Bill Medicare for Services Provided by a PTA or OTA?

Please note that this article contains information that is only relevant to American clinics.


Billing Medicare insurance carriers can be tricky business—especially when it comes to billing Medicare for services rendered by a physical therapy assistant (PTA) or an occupational therapy assistant (OTA). But luckily there is a rule of thumb that helps make these situations a little less complicated. So in this article, we’ll be discussing how you bill Medicare for services provided by a PTA or an OTA.


If you work in a private practice setting, you’re very familiar with the HCFA 1500 claim form. But what you may not be aware of is how you can bill insurance carriers for services rendered by a PTA or OTA. The main thing here is that you must bill the service under the national provider identification number of the managing therapist who is supervising the PTA or OTA on that date, and not just the one who initially established the plan of care.


Click here to watch our video about how to include PTAs and OTAs on invoices.


It’s very important to note that the supervising provider must be on the premises when the treatment is taking place. But what happens with other non-Medicare insurance carriers?

The rules tend to vary from insurance carrier to insurance carrier. In many cases, they don’t care whether the managing provider is present, and the PTA or OTA is fine to go at it alone. But it’s the responsibility of the clinic to follow up with the insurance carriers and figure out what’s required.


We hope you found this article helpful. For more information about Medicare billing, check out the Gawenda Seminars and Consulting website.

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