Medicare therapy caps require careful tracking of services and proper use of KX modifiers for medical necessity exceptions.
Functional Assessment Coding
ADL evaluations and functional outcome measurements require specific G-codes that many practices struggle to apply correctly.
Work-Related Injury Documentation
Workers compensation claims require different documentation standards, fee schedules, and authorization processes than traditional insurance.
Medicare Threshold Requirements
Understanding when medical review is triggered and properly documenting medical necessity for services exceeding threshold amounts.
Evaluation vs Re-evaluation Billing
Distinguishing between initial evaluations, re-evaluations, and progress reports with appropriate CPT codes and timing requirements.
Time-Based vs Service-Based Codes
Mixing timed codes requiring 8-minute rule calculations with untimed codes causes billing complexity and compliance issues.
Our Solutions
OT-Certified Billing Specialists
Our team includes certified coders with specialized training in occupational therapy, functional assessments, and therapy cap management.
Expert CPT coding for all OT procedures
G-code functional reporting expertise
KX modifier application for therapy caps
8-minute rule compliance for timed codes
Therapy Cap Management System
Advanced tracking technology monitors therapy cap thresholds and ensures proper KX modifier application for medically necessary services.
Automated cap threshold monitoring
Medical necessity documentation guidance
KX modifier optimization
Manual medical review preparation
Workers Compensation Expertise
Specialized knowledge of workers comp billing requirements, state-specific fee schedules, and authorization processes for work-related injuries.
State-specific workers comp compliance
Authorization management
Fee schedule optimization
Faster workers comp payment collection
Functional Outcome Reporting
Comprehensive support for G-code functional reporting requirements including initial assessments, progress tracking, and discharge coding.
Accurate G-code selection and reporting
Functional limitation documentation
Progress measurement tracking
Discharge status reporting
Specialized Services
Therapeutic Services Billing
Expert billing for therapeutic activities, exercises, neuromuscular re-education, and functional training with proper time-unit calculations.
Therapeutic activities (97530)
Neuromuscular re-education (97112)
Therapeutic exercises (97110)
8-minute rule compliance
Evaluations & Assessments
Specialized billing for initial evaluations, re-evaluations, and functional capacity assessments with appropriate complexity levels.
OT evaluations (97165-97167)
Re-evaluation billing (97168)
FCE assessments
ADL documentation
Work Rehabilitation Programs
Comprehensive billing for work-related injury treatments, ergonomic assessments, and return-to-work programs.
Work injury rehabilitation
Ergonomic evaluations
Job site analysis
Return-to-work coordination
Specialized OT Procedures
Expert billing for hand therapy, sensory integration, adaptive equipment training, and home modification assessments.
Hand therapy procedures
Sensory integration therapy
Adaptive equipment training
Home assessments
Client Testimonial
Managing billing for our occupational therapy clinic was overwhelming with therapy caps,
G-code reporting, and workers compensation claims. Medtransic's team has specialized OT
billing expertise and has helped us navigate therapy cap thresholds while maximizing our
reimbursements. Their automated cap tracking and KX modifier management has increased our
revenue by 29% without any compliance issues.