How to Bill Medicare for Patient Education

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

 

Physical therapists, speech language pathologists, and occupational therapists often find themselves dealing with more than just the patient themselves. Sometimes the healthcare provider needs to work with a patient’s parent, guardian, caregiver, or spouse and teach them how to assist the patient when the therapist isn’t around. This is called patient education, and yes, there is a way to bill Medicare for it.

 

It’s very common for a patient to be prescribed daily exercises to help restore strength or their range of motion. But these simple exercises can be really difficult for patients to complete on their own. So what does a therapist do? They instruct the teach the patient’s parent, guardian, caregiver, or spouse how to assist with the exercise.

 

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The therapist will then provide instruction to patient’s parent, guardian, caregiver, or spouse, and have the spouse demonstrate that they know how to assist with the exercise. If all goes well, they will be deemed competent. They will also note that the patient no longer requires the assistance of the therapist for this particular activity, because there’s already someone at home that can handle it. But the question remains—how does the therapist bill Medicare for the time spent providing this patient education?

 

When it comes time to send the bill to Medicare, you ought to use the CPT code that is most relevant to the activity. For example, if the goal of the exercise is to increase strength, then you should bill CPT 97110 (therapeutic exercise). Conversely, if the activity aims to improve balance and coordination, then you should bill CPT 97112 (neuromuscular re-education). The takeaway here, though, is that the CPT code you bill needs to accurately reflect the instruction provided.

 

And that’s how you bill Medicare for patient education!