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Telehealth in Physical Therapy: PT Visits From Home

Physical therapy is a healthcare profession that involves one-on-one care, personalized attention, and specific interventions to help you move better and feel better. Unlike many healthcare providers, historically, physical therapists have not been able to provide telehealth visits for their patients.

But now, the 2020 coronavirus global pandemic is prompting a shift. Physical therapists are seeing significant reductions in their patient load as people are staying at home, avoiding PT clinics and doctor's offices. Some PTs are also only evaluating and treating the most severely impacted patients, asking others to stay at home. While social distancing is important, opting out of PT altogether may have a negative impact on your rehab and therapy program.

To continue to care for patients who are at home practicing social distancing, many physical therapists have started using telehealth, or E-visits.

The Centers for Medicare and Medicaid Services (CMS) and the American Physical Therapy Association (APTA) are using the term "E-visit" to describe a PT session where the therapist and patient are communicating over digital or electronic means. The APTA's definition of E-visit is "non face-to-face, patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office."

E-visits are new to the PT world—CMS only started allowing them on March 17, 2020, and will only be allowing them temporarily. Since E-visits are so new, many questions surround their use, mainly: Do you qualify for an E-visit and will your insurance company pay for it?

Qualifying for a PT E-Visit

There are several stipulations for a physical therapy E-visit:

  1. You must be a current patient with an established plan of care with your physical therapist. You cannot be a new patient, so if you are newly injured or develop a problem that requires the services of a PT and are not a current patient, you cannot participate in an E-visit.
  2. The PT E-visit must be initiated by you. Your PT is allowed to tell you about the availability of E-visits and how to set up an appointment for the session, but you need to request such an appointment.
  3. If you request an E-visit, you may not then visit your PT in the clinic, if it is still open at all. The E-visit takes the place of an in-office visit, and it is used to bridge care between you and your physical therapist while you are unable to go to the clinic during the COVID-19 pandemic. Initially, the APTA stated that the patient must cancel all in-person clinical sessions with the PT before initiating the E-visit. This rule has not been confirmed by CMS.
  4. The E-visit must have a component of clinical decision making. You cannot simply contact your physical therapist and chat about your injury. You and PT should communicate about your injury and how it is changing, what you are doing about your injury, and what you should do to continue to manage your condition. A physical therapist assistant is not allowed to perform the E-visit.

PT E-Visit Frequency

The frequency of a physical therapy E-visit is once every seven days. Your PT may be in contact with you multiple times over the seven day period, but he or she should only bill your insurance once during that timeframe. The time for the seven day period begins when you make initial contact for the E-visit. Your PT cannot bill for the E-visit if you had an in-clinic session within seven days prior to initiating the E-visit or if you go to the clinic within seven days after the E-visit.

Your PT should document each and every communication that they have with you during the seven day E-visit period.

Video Platforms Used for Physical Therapy E-visits

In the past, telehealth E-visits for qualified professionals were only allowed over virtual protected networks and patient portals. This ensured privacy was maintained during the session and that no protected health information could be leaked.

During the coronavirus pandemic, CMS has loosened restrictions on communications and is allowing PTs (and other healthcare professionals) to use non-protected networks to communicate with patients. So, you may be able to have your E-visit video session with your PT over Skype, Zoom, or FaceTime.

When you contact your therapist's office about E-visits, he or she will tell you which video conferencing platform will be used. You will need to set up an account with that platform prior to your session.

Components of a Physical Therapy E-Visit

If you are currently under the care of a PT and feel you may need an E-visit, you should understand what will (and will not) happen during the session, as well has how to prepare.

Getting Ready

  • Make sure you test out the video conference platform that you will be using
  • Find an area of your home that is free from clutter so you can move around a bit if your PT wants to monitor your mobility
  • Wear comfortable clothing that allows you to move around and allows your PT to see the part of your body that is being treated

During Your Appointment

During your appointment time, your PT won't be able to mobilize joints or provide modalities such as dry needling or massage, but they can monitor several things:

Your PT may not be able to measure strength, tissue tension, flexibility, or pain to palpation. Still, your physical therapist should be able to have a good sense of how you are moving to be able to help you progress with your rehab program.

Follow Up

If changes are being made to your home exercise program, your PT may be able to deliver them to you via email or text. Two popular home exercise program websites are Medbridge Eduction and HEP2Go. Both of these allow your therapist to create and modify exercise programs and deliver them electronically to you.

How Much Will A PT-E-Visit Cost?

The big question for patients is how much will the E-visit cost. (Therapists are also wondering if they will be paid at all during the E-visit.) The provision of PT services electronically is so new that while they know how often they can bill, no one really knows what to bill, how to bill, or who will pay. We're all treading through murky waters when it comes to E-visits in physical therapy.

Medicare

If you have Medicare as your primary insurance carrier, your 20% deductible applies to E-visits, so you may have some out-of-pocket cost to cover for the E-visit if you have not met your yearly deductible. Secondary insurances may or may not cover this expense, so it is recommended you contact your carrier and ask about coverage.

Private Insurance

Many private insurance carriers are offering payment for E-visits. Since there are so many different plans available nationwide, you must contact your carrier and ask about coverage for physical therapy E-visits during the coronavirus pandemic. Some carriers are paying for the sessions in full, while others are paying partially while still requiring the patient to pay their co-payment. Others are offering no reimbursement for PT telehealth or E-visits.

Since so many physical therapists have been impacted by the coronavirus pandemic, many are simply providing E-visits and hoping for any form of payment. Therapists tend to be pretty caring people, and they simply want the best for their patients. So, providing E-visits is a way that they can care for their patients while still keeping everyone safe from spreading the COVID-19 virus. Payment for E-visits can be sorted out later.

The Future of PT E-Visits

While telehealth is nothing new to the healthcare community, provision of care electronically and digitally is new to the physical therapy community. So will it last once the COVID-19 pandemic has passed? No one really knows, and it will depend on how successful the provision of care via video conferencing is during this time.

The physical therapy profession is one that relies on personalized interaction, and often this requires the provision of manual techniques and help the patient move better and feel better. This cannot be accomplished over the telephone or via video. For now, it appears that PT E-visits are appropriate to bridge a gap in care during the coronavirus epidemic. The future of PT E-visits once the pandemic has passed remains to be seen.

A Note on Mental Health

Feelings of fear, anxiety, sadness, and uncertainty are normal during the COVID-19 pandemic. Telehealth also makes it possible to take care of your mental wellbeing from home. Learn about the best online therapy options available to you.

A Word From Verywell

If you are a patient in physical therapy and have had your PT session and rehab program come to a screeching halt during the coronavirus pandemic, you may be wondering how to progress with your rehab program. Reaching out to your PT to discuss the possibility of an E-visit may be just the thing you need to progress your rehab, check in with your PT, and ensure you are able to maximize your function and mobility during this unprecedented time.

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Article Sources
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  • Grona SL, Bath B, Busch A, Rotter T, Trask C, Harrison E. Use of videoconferencing for physical therapy in people with musculoskeletal conditions: A systematic review. J Telemed Telecare. 2018;24(5):341-355.

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