Therapy

Inpatient Claims 

Therapy modalities do not need to be billed separately with a HCPCS code. Bill all charges for therapy provided during the hospital stay with one charge applicable to the appropriately assigned revenue code(s).

Professional Claims

Blue Cross and Blue Shield of Nebraska (BCBSNE) reimburses contracted therapists for all medically necessary covered physical therapy, occupational therapy and speech therapy services when provided in a non-facility setting according to the member’s contract/benefit plan.

• BCBSNE covers short-term rehabilitation services to meet the functional needs of patients suffering from physical impairment due to disease, trauma or prior therapeutic intervention 

General benefit information services and subsequent payments are based on the member’s benefit plan and provider agreement.

• Amount, frequency and duration must be reasonable under accepted standards of practice
• Duration is identified as time in and time out or total time for each therapy 

BCBSNE does not reimburse:

• Application of hot or cold packs
• Unattended electrical stimulation will not be considered for reimbursement except for G0281 and G0282 for wound treatment and G0283 for electrical stimulation
• All other electrical stimulation for all other conditions is considered inclusive

Multiple Procedure Payment Reduction (MPPR) for Therapy 

Effective Dec. 1, 2022, BCBSNE will apply a payment reduction to eligible therapy procedures when more than one unit or procedure is provided to the same patient on the same day. Aligning with the Centers for Medicare & Medicaid Services (CMS), the primary procedure will allow 100% of reimbursement. All secondary and subsequent procedures will have the Practice Expense RVU reduced by 50%. MPPR applies to professional and outpatient institutional claims, excluding EAPG payment. Procedures subject to MPPR can be identified on the CMS Physician Fee Schedule with a multiple procedure indicator of “5.” 

Therapy procedures for professional and outpatient institutional services should be submitted with a single date of service on each line.