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11 Part B Billing Scenarios for PTs and OTs (Individual vs. Group Treatment)

This page is designed to clarify existing therapy policy and to provide guidance on current Part B billing issues relevant to physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) and to the services they provide. Because we have received numerous requests to restore the previously published 11 Frequently Asked Questions (FAQs) resulting from the 9/13/02 Open Door Forum on Group Therapy, we have chosen to reformat these FAQs into "billing scenarios" to appear below. As a result, the 11 Part B Billing Scenarios are specific to PTs and OTs. We will update this Web Page to reflect changes in policy (for example, CCI edits, new codes, new coverage determinations) that impact therapy billing and/or to provide clarification on billing policy for PTs, OTs and/or SLPs.

Check the manuals first.

Therapy Manual References

  • Medicare Claims Processing Manual, 100-4, Chapter 5, Sections 10, 20, 30, 40, 100
  • Medicare Benefit Policy Manual, 100-2, Chapter 15, sections 220 and 230

The Medicare contractor who pays your claims is the best source of answers to specific Medicare questions.  Medicare Contractors (Carriers/ Intermediaries/ A/B Medicare Administrative Contractors) interpret Medicare laws, develop local policies, and educate providers.  Contractor websites list local policies. To find local coverage policy and other general instructions, contact your Medicare Contractor using the Provider Call Center Toll-free Numbers Directory which includes phone numbers and website addresses (See Downloads section below).You may also contact your Medicare Regional Office for assistance (See Related Links Inside CMS below).

See the document titled "11 Part B Billing Scenarios for PTs and OTs" in the Downloads section below.