G2251, Brief communication technology-based service, e.g. virtual check-in, by a
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.25
Facility
$10.69
Non-Facility
$14.03
Documentation Required
- The medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.
- Medical record must include relevant medical history, applicable comorbidities/medications, prior diagnostic imaging/testing results, prior therapy history for the same diagnosis, and results of pertinent tests/procedures.
- All services ordered or rendered must be signed and dated; a legible identifier (handwritten or electronic signature) of the person(s) who provided the service is required.
- Documentation must be legible, relevant, sufficient to justify medical necessity, and should paint a clear picture of impairments, functional limitations, prior functional level, and the skilled nature of treatment provided.
Key Coverage Criteria
- Therapy services are covered when the medical record and claim consistently and accurately document that the services are covered and medically necessary.
- Therapy is covered when the patient has impairments and functional limitations that require the unique skills of a clinician (therapist) to improve functioning.
- Coverage requires an initial evaluation performed by a clinician that documents objective findings, baseline functional testing using standardized scales, realistic goals, and expected rehabilitation potential.
- Services are covered when documentation provides objective measurements or assessment results that demonstrate clinical progress toward the patient's identified functional limitations.
- Therapy is covered when documentation justifies the type, frequency, and duration of skilled therapy as medically necessary for the individual patient's condition.
- Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
3 Active Policies
CGS-L34049, Outpatient Physical and Occupational Therapy Services
J15
A57067, Billing and Coding: Outpatient Physical and Occupational Therapy Services
A57311, Billing and Coding: Physical Therapy - Home Health
Related Codes
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