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Therapy Evaluation and Treatment on Same Day of Service

Published on 

Tuesday, October 8, 2019

 | RAC Information 
 | FAQ 

Q:

Is it appropriate to bill Medicare for a therapy evaluation and therapy treatment on the same day of service?



A:

Yes, it is appropriate to bill these services on the same day as long as they are separate and distinct – that means each service is provided separately in its own time period.

Here is wording from Section 220.1.2 A of Chapter 15 of the Medicare Benefit Policy Manual (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf) - see page 163.

 “Treatment under a Plan.  The evaluation and treatment may occur and are both billable either on the same day or at subsequent visits.  It is appropriate that treatment begins when a plan is established.”

 The therapy evaluation must be done first and a plan of care established. Then it would be appropriate to provide and bill for the treatment. There are usually no CCI edits for these combinations of codes, but check to be sure, and only use a modifier if required.

Article Author: Debbie Rubio, BS MT (ASCP)
Debbie Rubio, BS MT (ASCP), was the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc. Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.