Plan N Physical Therapy

vic120

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It has been my understanding in the past that Physical therapy on plan N is not a copay but fully covered part B service and not a doctors visit.

I have had 3 clients as of recently tell me that, they have been charged $20 per visit for PT Have I been wrong is it supposed to be $20 copay for PT?
 
My understanding is that the $20 copay is only involved with a visit to an actual doctor (or his PA), so no. I would think something is being billed incorrectly.
 
My understanding is that the $20 copay is only involved with a visit to an actual doctor (or his PA), so no. I would think something is being billed incorrectly.


this is what I thought the first time but 2 more and I think maybe I'm wrong
 
The issue is that the card shows a $20 copay so the PT facility thinks they need to charge it. I'd tell the client to wait for the EOB from both Medicare and the supplement. I suspect it will show a zero charge.

Rick
 
It has been my understanding in the past that Physical therapy on plan N is not a copay but fully covered part B service and not a doctors visit.

I have had 3 clients as of recently tell me that, they have been charged $20 per visit for PT Have I been wrong is it supposed to be $20 copay for PT?
The PT biller is coding the treatment as a doctor visit rather than as a PT treatment, which has no copay. Worse, they're using the doc visit code with the highest reimbursement, a long visit for a moderate to high severity condition. Even with Plan N most doc visits should be less than $20. The client needs to have them resubmit the claims correctly.
 
Plan N is not a $20.00 co-pay per se, But it is UP to the first
$20.00 for outpatient medical and surgical services and supplies, physical and speech THERAPY , diagnostic tests, durable medical equipment, with that being said a client would pay as an example, PT visit was Medicare part B approved at the amount of $55.00 than the amount the client would owe should be $11.00 TOTAL ,assuming one has already met the part B deductible. ... Also remember that Plan N requires the Part B deductible to be met 1st.
 
You need to take note of the claim coding comments earlier in the thread.
 
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