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  1. Applying Physical Therapy Modifiers: Real-Life Scenarios. 1. The Scenario. During a patient’s appointment for patellofemoral pain, the clinic physical therapist assistant (PTA) provides 13 minutes of therapeutic exercise (CPT 97110), after which the PT provides manual therapy (CPT 97140) for 22 minutes. To close out the session, the PT leads ...

  2. For information regarding updates, please see 99202-99215: Office/Outpatient E/M Coding in 2021 and 2023 E/M Coding Changes. Evaluation and management (E/M) coding is the use of CPT® codes from the range 99202-99499 to represent services provided by a physician or other qualified healthcare professional. As the name E/M indicates, these ...

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  4. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.” Don’t use modifiers 59, XE, XS, XP, XU, and other NCCI PTP-associated modifiers, to bypass an NCCI PTP edit unless the proper criteria for use of the modifiers are met.

  5. Sep 25, 2023 · The most common CPT modifiers are nominated by letters or numbers. For example, the modifier -22 indicates increased services, while -52 means reduced fees. Other modifiers include -59 for distinct procedural service, -95 for telehealth, and -96 -97 for habilitative and rehabilitative services, respectively.

  6. There are several other modifiers used in PT billing, including: Modifier -22: Applied when the service provided is significantly above the average. Modifier -52: Used when the service is reduced or less than expected. Modifier -95: Applied when PT services are provided via telehealth. Modifiers -96 and -97: Used when the PT services are ...

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