If you have submitted a physical therapy claim, occupational therapy claim, or speech language pathology claim and receieve any of the following denial codes please keep reading:
119 – Benefit maximum for this time period or occurrence has been reached.
236 – This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
Reopen a Claim
According to CGS:
Submit a Reopening when a claim that was either paid or denied was processed with minor errors or omissions. Examples include:
- Date of service correction (within the same year) that do not result in an overpayment
- Place of service corrections/changes
- Fixing a transposed CPT/HCPCS code
- Correcting the number of services (Units)
- Diagnosis code changes
- Add, change, or remove some modifiers
- Correct the billed amount
Use a Redetermination for:
Submit a Redetermination when a claim is denied or partially denied. Examples include:
- Medical necessity
- Frequency limitations
- Review of medical records for claim decision
- Services submitted with the incorrect YEAR of service
- Anything that CANNOT be handled as a Reopening
More coming soon!
Anthony Maritato, PT
Private Practice Owner / Physical Therapist
After starting a private practice physical therapy clinic in 2022 with his wife Kathy Maritato, PT, Tony and Kathy grew their practice to five locations across two states.
Now, Tony and Kathy enjoy spending time treating patients in the morning, coaching therapists in the evening, and being home to play with their dog Tucker and 4 boys.