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PT Codes to Use When Billing for Patient, Family or Caretaker Education

Teaching caregivers and patients is important in maintaining and managing rehabilitation progress: care plan, wellness or fitness regimen, functional enhancement, minimizing or managing risks from current problems, etc.

What do insurance companies and payers consider ‘PT patient education’?

The American Physical Therapy Association (APTA) defines it as “the process of informing, educating, training patients/clients, families, significant others, and caregivers with the intent to promote and optimize physical therapy services.

How do Physical Therapists Bill for Caregiver/Patient Teaching Hours?

PT Practitioners should bill for the hours spent teaching patients or caregivers under the CPT code that best suits or matches the performed intervention, purpose of and intent for treatment or related demonstration.

For patient self-management of conditions such as asthma, arthritis or COPD, insurance companies require healthcare professional prescription, qualified caregiver and use of standard teaching curriculum to provide such training and education.

Here is the table of CPT Codes for commercial payers:
cpt codes

Before using the above codes, we recommend verifying the payer’s insurance policy.

These codes don’t include unsupervised instruction (example, videos being sent to patients).

PT Practitioners and Clinicians can also submit supporting documentation:

  • Handbook or detailed set of instructions given to the patient or the caregivers
  • Record of evaluation of patients’ and caregivers’ adherence or compliance with steps outlined in the handbook
  • Record of therapists’ time spent conducting the treatment, education (or demo and coaching session)

Source: https://health.mil/News/Articles/2018/09/04/Improving-Patient-Safety-by-Improving-Health-Literacy-Transparency?type=Policies

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