How To Use HCPCS Code G2168

HCPCS code G2168 describes the services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes. This code is used to identify and bill for the specific services provided by a physical therapist assistant in the home health setting.

1. What is HCPCS G2168?

HCPCS code G2168 is a specific code used in medical coding to identify and bill for services performed by a physical therapist assistant in the home health setting. It is used to describe the delivery of a safe and effective physical therapy maintenance program, with each session lasting for 15 minutes.

2. Official Description

The official description of HCPCS code G2168 is “Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes.” The short description for this code is “Svs by pt in home health.”

3. Procedure

1. The physical therapist assistant assesses the patient’s condition and develops a physical therapy maintenance program tailored to their specific needs.
2. The assistant performs various physical therapy techniques and exercises as prescribed by the supervising physical therapist.
3. During each 15-minute session, the assistant closely monitors the patient’s progress and adjusts the therapy program as necessary.
4. The assistant ensures the safety and well-being of the patient throughout the therapy session.
5. At the end of each session, the assistant documents the services provided and any changes in the patient’s condition.

4. When to use HCPCS code G2168

HCPCS code G2168 should be used when a physical therapist assistant provides services in the home health setting as part of a physical therapy maintenance program. This code is specifically for non-emergency situations where the patient requires ongoing physical therapy to maintain their functional abilities and manage their condition.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G2168, healthcare providers need to document the following:

• The patient’s medical record, including their diagnosis and any relevant medical history
• The specific services provided during each session, including the duration of the session
• The goals of the physical therapy maintenance program and the patient’s progress towards those goals
• Any changes in the patient’s condition or response to therapy

Providers should also ensure that the documentation supports the medical necessity of the services provided and complies with any additional requirements set forth by Medicare or other insurance payers.

6. Historical Information and Code Maintenance

HCPCS code G2168 was added to the Healthcare Common Procedure Coding System on January 01, 2020. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G2168 is determined by the carrier judgment, indicated by the coverage code C. This means that the coverage and reimbursement for this code may vary depending on the specific policies of Medicare or other insurance payers.

The pricing indicator code for HCPCS code G2168 is 00, which indicates that the service is not separately priced by Part B. This means that the reimbursement for this code may be bundled or included as part of a larger payment for other services.

The multiple pricing indicator code for HCPCS code G2168 is 9, which means that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are some examples of when HCPCS code G2168 should be billed:

1. A physical therapist assistant provides a 15-minute physical therapy maintenance session for a patient with chronic back pain in their home health setting.
2. A physical therapist assistant delivers a 15-minute physical therapy maintenance session for a patient recovering from a stroke in their home health setting.
3. A physical therapist assistant performs a 15-minute physical therapy maintenance session for a patient with arthritis in their home health setting.
4. A physical therapist assistant provides a 15-minute physical therapy maintenance session for a patient with mobility issues due to a neurological condition in their home health setting.
5. A physical therapist assistant delivers a 15-minute physical therapy maintenance session for a patient with a musculoskeletal injury in their home health setting.