FEP billing guidelines for physical, speech and occupational therapy at skilled nursing facilities

Health plan benefits for Federal Employee Program^® members include physical, speech and occupational therapy that’s provided in a skilled nursing facility.

What you need to know when billing for this:

The facility must bill each individual date of service.
Services with a date range will cause the claim to reject and will delay the claim process.
Visits will accumulate toward the physical therapy, speech therapy and occupational therapy maximum under the member’s Standard or Basic Option coverage.
The Standard Option visit maximum is 75 visits per person, per calendar year.
The Basic Option visit maximum is 50 visits per person, per calendar year.

If you have any benefits questions, call FEP Customer Service at 1-800-482-3600. To inquire about facility precertification, call 1-800-572-3413. If you have questions about case management, call 1-800-325-6278.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.