1. Richard Soden
   Posted 5 months ago #
   

   how do you code maintenance therapy

2. SuperCoder
   Posted 5 months ago #
   

   New billing codes that address therapy personnel and the establishment of maintenance programs are outlined:

   G0151: Qualified PT – each 15 minutes
   G0152: Qualified OT – each 15 minutes
   G0153: Qualified SLP – each 15 minutes
   G-Code 1: PTA – each 15 minutes
   G-Code 2: OTA – each 15 minutes
   G-Code 3: Maintenance therapy by qualified PT – each 15 minutes
   G-Code 4: Maintenance therapy by qualified OT – each 15 minutes
   G-Code 5: Maintenance therapy by qualified SLP – each 15 minutes

   G-codes identify types of therapy personnel on a per visit basis as a means of tracking volumes of care provided by therapy assistants. When PPS was introduced, the High Therapy Threshold was based on the belief that approximately 80% of the care would be delivered by qualified therapists. Speculation would expect the tracking of assistant visits would preclude either limits on percentage of assistant care employed in Home Health episodes, or a reduction in therapy reimbursement based on the use of less costly assistant personnel.
   G-codes for Maintenance Therapy mark a shift in how CMS will define maintenance programs involving therapy-related areas. The 2011 Rule Maintenance G-codes identify the only areas of Home Health therapy coverage that don’t require a “reasonable expectation of improvement”. Under the new interpretation of the maintenance standard, these codes are used when a qualified therapist designs a program whose intent is to prevent loss of function. The therapist is to create and install a program designed to reduce the expected losses, and alternate personnel are to carry out the program on a non-reimbursable basis. The program developed should include instruction and re-evaluation parameters that may be addressed for results under separate G-coded visits. So, these Maintenance G-codes mark a significant turn in how maintenance therapy is addressed under the Home Health benefit. Many providers who currently provide ongoing maintenance programs supplied by licensed therapy staff (therapists, assistants) will undoubtedly experience a loss of business volume in this area.

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