Coding Guidelines: Part A Outpatient Therapy Billing at a Glance
Medicare Part A outpatient therapy claims require the appropriate use of occurrence codes to identify the dates and circumstances that impact claims processing. Important information, such as, the therapy plan of care start date or other required billing events are communicated.
Accurate reporting of occurrence codes, along with complete documentation support timely reimbursement and demonstrates compliance with Medicare guidelines.
Occurrence Codes
| Physical Therapy (PT) Occurrence Codes | Occupational Therapy (OT) Occurrence Codes | Speech Language Pathologist (SLP) Occurrence Codes |
|---|---|---|
|
11 - Onset symptom/Illness 29 - Date PT plan of care was established or last reviewed 35 - Date PT began |
11 - Onset symptom/Illness 17 - Date OT plan of care was established or last reviewed 44 - Date OT began |
11 - Onset symptom/Illness 30 - Date SLP plan of care was established or last reviewed 45 - Date SLP began |
Comprehensive Outpatient Rehabilitation Facilities (CORFs) only
Occurrence code 28 – Date a plan of treatment was established or last reviewed for care
Required Data Elements for Revenue Codes
| Revenue Code | HCPCS | Modifiers | Units | Line Item Dates of Service |
|---|---|---|---|---|
| 042X | Required | Required | Required | Required |
| 043X | Required | Required | Required | Required |
| 044X | Required | Required | Required | Required |
Modifiers
- GP - PT plan of treatment
- GO - OT plan of treatment
- GN - SLP plan of treatment
Reference