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Insurance and Reimbursement Regarding Bike Fit

Erik Moen, PT

December 22, 2014

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Question

Any trouble with insurance issues with reimbursement regarding bike fit?  Do you bill the same CPT codes as with regular PT?

Answer

How we deal with this issue is if a person has a diagnosis, and you will have to kind of deal with this from a State by State issue, for example of anterior knee pain and it is coming from their physician that the best way you can educate your patients and referral resources is that this is a biomechanical evaluation of function or dysfunction.  The most efficient and effective way of managing this as supported in literature is looking at bike fit or bike function.  When you look at reimbursement, as long as you can diagnose or have a diagnostic code you are working on and demonstrate that there is support, and oftentimes people will need support from the primary care physician, if the primary care physician is on-board with this and understands its effective means, then it is not a problem.  You are doing an evaluation and therapeutic activities with this person or neuromuscular re-education to get them to pedal more effectively, efficiently and to remove irregular pathomechanics.  It is really no different than how we look at the injured runner and evaluate their function and dysfunction, or the injured thrower who you have to look at how they are throwing in order to best understand how they became injured.  There should not be any problems as long as you are focusing on the function, dysfunction, and diagnosis code with regards to the evaluation of this bicyclist.  


erik moen

Erik Moen, PT

Erik Moen PT is the owner of Corpore Sano Physical Therapy (www.CorporeSanoPT.com) and BikePT (www.BikePT.com) in Kenmore, WA.  BikePT is the definitive education source on bicycling related injuries, treatment, and bicycling biomechanics, for healthcare professionals and all bicyclists. Erik holds degrees from Pacific Lutheran University (Biology) and the University of Washington (PT).  Erik is an active member of the American Physical Therapy Association, USA Cycling, and North American Spine Society.  Erik’s bicycle background includes; athlete, coach, soigneur for 2008 Paralympic games (USA Paracycling), educator and current Classifier for Paracycling.


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