Physical Therapy CPT Code Analysis for 2015

Top 10 PT CPT codesThe U.S spends more on Healthcare than other countries. Does spending more per capita result in better outcomes?

We currently work off (FFS) Fee for service plans. The problem with this method of reimbursement, providers are not be held accountable.

What’s next in the future of Healthcare? Introducing Pay-for-Performance.

  • New commercial payer contracts with alternative payment methods based on performance to be in place by 2020.
  • CMS moving to ‘value-based’ or ‘quality based’ reimbursement
  • Medicare to have 55% of fee-for-service payments shifted to quality based payments by the end of 2016 through pay for performance (P4P)

Based on the new rules, your practice may experience a change in coding to meet new performance guidelines.  Will the trends in 2017 change where we see an increase in re-evals (97002) or Self Care Management Training (97035)? As the CMS and the private payers work on their ‘New’ pay structures it’s a good idea to monitor your yearly trends and monitor outcomes early.

225 different CPT codes were reported in 2015 for Physical Therapist, yet, the top 10 CPT codes constitute 90% of all reporting. While we noticed a slight reduction in use for 97110 and 97140, other codes e.g. 97530 slightly increased. The increase of the use of 97530 is due to a better understanding of how to use and when to use this code.

Top 10 physical therapy CPT codes

These are the top 10 PT CPT codes

The 10 most paying CPT codes generated over 96% of all pay in 2015!

Compare the top 10 CPT codes for Physical Therapists. top 10 PT CPT codes

We see high similarity to previous years trend with some reduction for 97110 and some increase for 97530.

CPT 97110 was reported in most of the visits (28.9%) and generates the most of the pay (33.9%) – pay to claims ratio 117%. CPT 97113 was reported only in 0.2% of the visits, yet generated 0.7% of the pay – pay to claims ratio 326%. On the other hand, CPT G0283 was reported in 2.9% of the visits, yet generated only 0.9% of the pay – pay to claims ratio 29%

Top 10 CPT codes for PTs.

The average CPT collections per unit was $22.51 in 2015, which is 3% less than 2013 average pay.

Paid per unit CPT codes

Most of the CPT pay in 2015 is lower than previous years by almost 3%, the few exceptions are lead by 97113 Aquatic Exercises which is almost 9% higher.

CPT code reimbursement change from 2014 to 2015.

Dollar value of PT CPT codes.

Pay per unit for the top 10 CPT codes for physical therapists.

Physical Therapy is one of the hardest and less appreciated professions and we do see only the most dedicated providers surviving. This is why we do our utmost to get the money you deserve – so that you can stay open and keep on helping people.