I received a call from a
MediGraph subscriber that may be of benefit to other subscribers. The
MediGraph subscriber with
whom I spoke was discussing purchasing an expensive piece of equipment to
perform therapeutic exercise, and asked if I had ever used this type of tool.
I had experience with the equipment and did not recommend the purchase. Allow
me to explain.
CPT codes help to identify the interventions that we provide to our patients,
standardizing and facilitating the billing process for insurance providers. A
fact that often goes unrecognized is that CPT codes also control costs. Despite
the use of modifiers and other administrative-billing adjustments, there is
limited reimbursement that one will receive for a specific CPT code. This fact
should influence your equipment purchasing decisions, because CPT codes
restrict reimbursement, regardless of the equipment employed. For example,
let us assume that CPT 97110 (therapeutic exercise) receives a hypothetical
maximum reimbursement of $35. If we employ a piece that costs $35,000, a
therapist would have to perform 1,000 visits on that piece of equipment prior to
breaking even on this expenditure. I understand that the long view would
suggest that the equipment would supposedly be adding to the revenue stream
after 1,000 patients have use that item but one must ask if there are effective
alternatives. For example, an entire circuit of Nautilus or Keiser, etc. can
be purchased for the cost of one piece of exotic equipment ($35,000), If
code 97110 does not distinguish payment between the exotic and the less
esoteric, and the benefits to the exotic are , at best marginal (if any), the
cost benefit, return on investment that is restricted by CPT coded payment must
be a consideration when purchasing equipment.
Regards,
Tom Kane, PT
MediGraph Software