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Issue Number - Name
0124-Part B Therapies in a Hospital Setting
Review Type
Automated
Claim Type
Physical Therapist, Occupational Therapist, Speech Therapist
Region and State
RAC 1-4
All MACs
Date Approved
12/11/2018

Description

HCPCS/CPT Codes with a PC/TC Indicator “7” in the Medicare Physician Fee Schedule Data Base payment may not be made if the service is provided to a hospital inpatient by a physical therapist, occupational therapist or speech language therapist in private practice.

Affected Code(s)

HCPCS/CPT Codes with a PC/TC Indicator of "7" in the MPFSDB

(See Appendix D for complete list of HCPCS/CPT code and descriptions)

Applicable Policy References

Social Security Act: Section 1833(e)
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 5, Section 10
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, Addendum-MPFSDB File, Layouts, 2001-2018