Insurance companies are covering services conducted via telehealth at an unprecedented scale and expanding Parity Laws to allow for providers to be reimbursed for virtual services. This scope extends to physical therapists and occupational therapists who are seeking to bill for services rendered virtually, via a HIPAA-compliant telehealth platform like Healthie.

Insurance payors including Medicare, UnitedHealthCare, and others are beginning to reimburse physical therapists and occupational therapists for certain telehealth services, particularly remote assessment and management services that do not require in-person, face-to-face treatment. Here’s what you need to know about physical therapy telehealth services.

Basics of Telehealth for Physical Therapy

Telehealth is the providing of care remotely, typically over a video call or phone call. Broadly speaking, telehealth refers to the use of technology to conduct care. Quality telehealthcare has been shown to improve health care access and outcomes. Not only does telehealth reduce demands on crowded facilities, but it also creates cost savings and makes the health sector more resilient. Interested in transitioning your practice to telehealth? Learn how you can set up a free Starter account with Healthie’s EHR + telehealth platform by clicking here.

While insurance reimbursement for telehealth services was primarily provided to medical doctors, there has been a dramatic rise in the reimbursement for virtual specialty services, including physical and occupational therapy.

Benefits of Providing Tele Physical Therapy or Virtual Occupational Therapy Services

For physical therapists, offering virtual services can be a cost-effective way to expand your practice reach, retain clients and generate additional income for your business.  Our patients and clients are becoming increasingly more interested in telehealth as time progresses, and it is important to consider offering telehealth within your practice.  

Late cancellations and no-shows cost your business money and waste your time as a practitioner. Cancellations and no-shows often occur due to transportation, child-care, or work-related issues. Offering telehealth physical therapy is a much more flexible alternative to canceling for both you and your patients.  You are still able to provide the necessary care but at the convenience of your client.  In addition, telehealth is more cost-effective due to the low cost of entry.  While some telehealth technologies are expensive, there are plenty of options with different plans that will allow you to introduce telehealth for your patients, without breaking the bank. CTA: Try Healthie free for 14 days to see if telehealth is right for your practice. Whether your practice is large or small, Healthie’s free starter plan can work for you. Click here to get started.

Not only is telehealth convenient, but it is also accessible.  While we are usually focused on the patients who come to us for care, there are patients who are homebound or who live in underserved areas and need help.  Offering telehealth to these patients not only expands your client base but also allows those in dire need of care to get it.  Additionally, when you (the practitioner) are traveling or out of office, you can still get in contact with clients or patients, provide care, and generate income.  

Telehealth physical therapy also helps provide education and engagement to your clients in-between face to face sessions.  This will help you build a strong relationship with your clients, leading to better client outcomes.  Checking-in more often, but more conveniently, helps clients stay accountable and on track with their program.  

Is Telehealth Physical Therapy Legal?

Within the United States, each state maintains its own jurisdiction with respect to the administration of telehealth services, including that by physical therapists and occupational therapists. We recommend reviewing your state laws and regulations, as well as the guidance of your state practicing body, before implementing telehealth services in your care.

Moreover, we recommend confirming with your liability insurance provider that your professional liability insurance covers telehealth services.

Insurance Billing Codes for Tele Physical Therapy and Virtual Occupational Therapy

Note:  As of the publication of this post, United Healthcare has temporarily expanded telehealth services to include the following codes, valid at least through June 2020.

Physical Therapy

• 97161 – Physical therapy evaluation – low complexity
• 97162 – Physical therapy evaluation – moderate complexity
• 97163 – Physical therapy evaluation – high complexity
• 97164 – Physical therapy re-evaluation
• 97110 – Therapeutic procedure, one or more areas, each 15 minutes
• 97116 – Gait training
• 97530 – Therapeutic activities, one-to-one patient contact, each 15 minutes
• 97112 – Therapeutic procedure, one or more areas, each 15 minutes
• 97535 – Self-care / home management training, each 15 minutes

Occupational Therapy

• 97165 – Occupational therapy evaluation – low complexity
• 97166 – Occupational therapy evaluation – moderate complexity
• 97167 – Occupational therapy evaluation – high complexity
• 97168 – Occupational therapy re-evaluation
• 97110 – Therapeutic procedure, one or more areas, each 15 minutes
• 97530 – Therapeutic activities, one-to-one patient contact, each 15 minutes
• 97112 – Therapeutic procedure, one or more areas, each 15 minutes
• 97535 – Self-care/ home management training, each 15 minutes

Verify Your Client’s Insurance Coverage for Telehealth Services

You will still need to call an insurance company on behalf of each individual client, in order to confirm that telehealth services for your PT services will be covered.

Here are some steps to take:

1. Call each insurance company you are credentialed with to confirm that telehealth services are reimbursable (by client)

You’ll need to specify a client’s insurance plan, CPT-codes, and other information required for a typical eligibility check. There will be dependencies based on: State, Physician approval required, ICD-10 diagnoses, etc.

2. Use a telehealth place of service code when completing the CMS 1500 form (E.g., Location 02 – Telehealth) – in almost all instances, the rest of the CMS 1500 form will be the same as a session conducted in person.

Other Guidelines For Telehealth and E-visit Sessions

In March 2020, CMS released a set of guidelines that provide recommendations and restrictions for e-visits that you can see here. Key highlights include:

• Services can be reported when billing practice has an established relationship with the patient
• This care is not limited to only rural settings. There are no geographic or location restrictions for these visits
• Patient must generate the initial inquiry and communications can occur over a 7-day period
• Patient must verbally consent to receive virtual check-in services
• Coinsurance and deductibles would generally apply to these services

How Physical Therapists are Using Healthie’s EHR and Telehealth Platform

If you are interested in treating patients remotely, Healthie offers a cloud-based EHR and telehealth platform that is quick to implement while supporting compliance with HIPAA regulations — while being customizable to meet your business needs.

In addition, the Healthie platform integrates with insurance billing tools, so that you can quickly create Superbills and CMS 1500 claims, send invoices, and collect payments for out-of-pocket services. Our free Starter plan provides all of this and more. To learn more or sign up for our services, click here. 

Here’s what you gain when working with your physical therapy or occupational therapy clients via Healthie:

• Have a HIPAA and PCI compliant platform: prioritize the security and privacy of your clients while working together remotely.
• Immediate access to video calls: schedule and launch 1:1 and group virtual sessions, in-platform or through our Zoom integration — no additional fees required
• Transition your in-person appointments to virtual sessions: receive support from our team to import/transfer your data.
• Create message blasts + group chats with clients: streamline client communication.
• Remote patient monitoring: for clients that sync their wearables like Fitbit + iHealth.
• Ability for clients to log images and journal entries: for you to assess their progress between sessions.

We have seen physical therapists and occupational therapists that use Healthie find success with reimbursement for virtual services.

We are optimistic that virtual care and offering telehealth is here to stay. The core foundation of having telehealth reimbursement and coverage for wellness services mainstream in our country is strengthening by the week, and we look forward to watching this transformation unfold.

Whether you’re a solo practitioner or part of a multi-provider group or organization, our flexible membership plans (including a free starter plan) adapt to meet your business needs. Let us help you launch your virtual practice.

Join one of our upcoming Live Classes to learn more about the Healthie platform, and to explore all of our telehealth features.