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Taylor Posted Fri 26th of February, 2016 15:34:03 PM

When our therapist bills for an FCE with code 97750 is there a limit to the number of units that are reimbursable? We have had trouble getting reimbursed from some WC payers for anything over 4 hours. Our therapist is under the impression based on the training he received that the time he bills does not have to all be face to face with the patient, but should also include the time necessary to complete the FCE report. Is there an additional code or modifier we should be using to try to capture the full reimbursement/

SuperCoder Answered Mon 29th of February, 2016 08:05:50 AM

FCEs are billed with CPT code 97750 in 15-minute increments, so a 4-hour FCE would be billed as 16 units. Some states cap reimbursement for FCE testing. Additionally, clinics may work with insurance carriers and law firms on a negotiated rate to procure more referrals. So you need to check with payer policy as well.

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