Does G2168 require prior authorization?

No, G2168 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G2168?

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

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`G2168`, Services performed by a physical therapist assistant in the home health setting

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without 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.

Documentation for CPT 97542 wheelchair propulsion training must relate the training to expected, attainable functional goals for the patient and/or caregiver.

Physical therapists must report patient contact time in 15-minute increments and bill using G0151 for physical therapy time reporting.

Clinical notes must be written and dated entries describing signs/symptoms, treatments, patient's reaction, and changes in condition as defined in 42 CFR §484.2.

Progress notes must be dated, signed summaries of care furnished and the patient's response during the given period as defined in 42 CFR §484.2.

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.
Physical therapy, occupational therapy, or speech-language pathology services in the home setting are consideredmedically necessarywhen both of the criteria below are met:
The individualâs therapy request meets medical necessity criteria under the physical, occupational, or speech-language pathology guidelines used by the plan;and
The request meets medical necessity criteria for home health care outlined inCG-MED-23 Home Health.

3 Active Policies

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

A53058, Billing and Coding: Home Health Physical Therapy

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G2168, Services performed by a physical therapist assistant in the home health setting