Does G0151 require prior authorization?

Yes, G0151 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for G0151?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0151`, Services performed by a qualified physical therapist in the home health or

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation for CPT 97010, 97018, 97022, and 97026 must reflect medical necessity and be made available to the MAC upon request.
When billing a Z-code as the diagnosis, documentation must include the orthotic/prosthetic device name, date patient received the device, and date training/teaching began.

Key Coverage Criteria

CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
Home health physical therapy services are appropriate when based on impairments of body structure/function and demonstrable functional limitations consistent with the related LCD.
Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
Beneficiary is under the care of a physician.
Beneficiary is receiving services under a plan of care that is established and periodically reviewed by a physician.

16 Active Policies

HUMANA-HOME-HEALTH-LA-MEDICAID, Home Health

ANTHEM-CG-REHAB-12, Rehabilitative and Habilitative Services in the Home Setting: Physical Medicine/Physical Therapy, Occupational Therapy and Speech-Language Pathology

ANTHEM-CG-MED-23, Home Health

ANTHEM-CG-MED-101, Home Hospice

EVICORE-HPLAN-AETNA-EEDE1D947485, Aetna Home Health Code List - Effective 01/01/2026

EVICORE-HPLAN-CIGNA_MEDICARE-7E679040BEBB, Cigna Medicare Advantage Home Health Code List - Effective 01/01/2025

EVICORE-HPLAN-THE_HEALTH_PLAN-E178D78B53BA, The Health Plan MSK PTOT Code List - Effective 01/01/2026

A53058, Billing and Coding: Home Health Physical Therapy

A57311, Billing and Coding: Physical Therapy - Home Health

AETNA-CPB-0062, Burn Garments

AETNA-CPB-0107, Chiropractic Services

AETNA-CPB-0665, Constraint-Induced Therapy

BCBSIL-THE803.010, Physical Therapy (PT) and Occupational Therapy (OT) Services

BCBSMT-THE803.010, Physical Therapy (PT) and Occupational Therapy (OT) Services

BCBSNM-THE803.010, Physical Therapy (PT) and Occupational Therapy (OT) Services

BCBSOK-THE803.010, Physical Therapy (PT) and Occupational Therapy (OT) Services

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G0151, Services performed by a qualified physical therapist in the home health or