Plan N Question

[Travis Price]

Medigap: Physical Therapy Coverage Explained - Senior65

Dude, read the comment. First comment says, depends on how it's coded. Not usually requiring co-pay

 

[hockeyday]

Medigap: Physical Therapy Coverage Explained - Senior65

Lol, taken from some knock off web site,

 

[Travis Price]

Exactly, it depends on how it is coded. If it is coded as an office visit the copayment is due. I don't see any reason that would prevent this from being coded as an office visit. Plus, we are talking about Cardiac Rehab, not just physical therapy.

Which I gave you the Cardiac Rehab codes. They do not fall within the OV codes.

I mean, not to be harsh, but this conversation has become repetitive. Every piece of information you give points in the exact opposite direction.

It's okay to be incorrect. It's how we learn.

 

[hockeyday]

Exactly, it depends on how it is coded. If it is coded as an office visit the copayment is due. I don't see any reason that would prevent this from being coded as an office visit. Plus, we are talking about Cardiac Rehab, not just physical therapy.

So you think a doctor is performing cardiac rehab, not ever close, Probley a person with a master degree in exercise science, not even close to a doctor

 

[Chazm]

I’ve had clients ask me about PT and they never had to pay a copay. It’s not supposed to be coded as an office visit. But Vic’s problem is, this facility is going to code it as an office visit and will owe the copay.

Now, if he calls the insurance company and they said it should not be coded that way, I would inform the client that it shouldn’t be coded that way but his Dr. refuses to code it the correct way.

 

[Travis Price]

Even on Medicare.gov it says:

It only says some office visits, it never says doctor.

Except CMS, which you pointed out, gives the codes that should be used. I get it, you didn't nerd out and look up PT and Cardiac Rehab codes.

I did. In both instances, the codes aren't considered OVs for Plan N. Can weird stuff happen? Totally. Is possible that Cardiac Rehab is wrong? Totally.

 

[vic120]

See my above post that pulls the codes from that guidance.

Medicare cardiac rehab code is 93797, 93798

PT is 97032, 97032-33, 97035, 97039

Or non supervised 97010, 97012, 97014, 97024, 97026, 97028

Or 97110, 97112, 97116, 97124, 97139, 97140, 97530

I am going to give him these codes, If they refuse to apply the correct codes I will contact Cigna afterwards

Thank you very much

 

[hockeyday]

I’ve had clients ask me about PT and they never had to pay a copay. It’s not supposed to be coded as an office visit. But Vic’s problem is, this facility is going to code it as an office visit and will owe the copay.

Now, if he calls the insurance company and they said it should not be coded that way, I would inform the client that it shouldn’t be coded that way but his Dr. refuses to code it the correct way.

He is not going to a doctor, it cardiac rehab, pt, ot, speech therapy, if the bill using doctor office codes it is fraud, call medicare and turn them in..

 

[jbage007]

Is the $20 copay standard, or is it variable UP TO $20?

Can a doc charge a copay of $5? or $7? or anything else they want, up to $20?

Anyone know?

Plan N is about to skyrocket!

 

[vic120]

Is the $20 copay standard, or is it variable UP TO $20?

Can a doc charge a copay of $5? or $7? or anything else they want, up to $20?

Anyone know?

Plan N is about to skyrocket!

its the 20% up to $20 as max pay, I do have some clients that say their doc hasn't even charged that However that is not the norm