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Practice Affairs → Practice

Practice strives to provide tools and resources to support the safe and effective provision of physical therapy services in all settings.

COVID-19

OSHA (Occupational Safety and Health Administration) has a series of publications and downloadable posters with industry specific and general guidance for keeping workplaces safe from the spread of COVID-19. Check out these resources here: OSHA COVID-19 Guidance.

OSHA confirms masks do not cause unsafe oxygen or carbon dioxide levels to wearers. OSHA recently issued FAQ guidance in response to increasing claims that mask wearing is unsafe. Read more here: Safety of mask wearing

Public Health Emergency Extended

On 1/8/21 then HHS Secretary Alex Azar extended the PHE, effective for 90 days beginning January 21, 2021 through April 20, 2021. HHS Renews the COVID-19 Public Health Emergency Through April 20, 2021

APTA staff have developed resources for members to guide care and access financial assistance during the Public Health Emergency (PHE).

APTA’s Learning Center has several “learning on demand” resources available for both members and non-members at no cost. In addition, several no cost live webinars are being offered.

CDC guidelines for outpatient and ambulatory care settings

HandLab has published some great resources for protecting therapists and patients. They have published instructions for fabricating a plexiglass shield for clinic use. See the detalils here.

Having trouble explaining the SARS-CoV-2 virus to patients? This YouTube video is one of the best I have seen for explaining how the virus invades and commandeers cells and how possible therapies may work.

Avoiding and Relieving Neck Pain as We Adapt to Use of Face Shields

Additional Helpful Tips for Providing Face to Face Care

  1. Inform patients they should mask prior to entering the office.
  2. Limit the number of people in the office by having patients text when they are in the parking lot and having your office text when they can come in.
  3. Screen all patients: remote temperature check, symptom check list (see CDC link above). Have pts use hand sanitizer, wipes or wash hands prior to treatment.

  4. Consider plexiglass screens. Premade screens can be found on Amazon. They range in price from $35.00-$200.00 and most ship free. If you are handy, you can build your own using PVC pipe or wood.

    Here is another example using PVC pipe courtesy of Dewane Jubara, PTA from Ohio.

    Plexiglass screen

  5. There is not documented proof of the temperature required to kill the virus so the use of heat for tissue preconditioning should include non-communal methods. CDC FAQs
  6. Orfit provides information for cleaning orthoses made from their products. In addition, orthoses should be cleaned with soap and water and/or disinfectant wipes prior to reheating in the splint pan when orthosis modifications are indicated.
  7. Disposable clinic options include: Semmes-Weinstein monofilaments, US gel pads, stethoscopes, electrodes, etc. These are available from most clinic supply sources.

  8. Should masks be worn with face shields? This study may be helpful for convincing you or your employer of the importance of using both. Face shields for infection control: A review

    This study emphasizes the importance of adequate masks

  9. How to adjust a shield and prevent neck pain when using one guidance, developed by University of Iowa physical therapists: Cari Everhart, Amy Little and Deb Parrott.

  10. Guidance for laundering exposed clothing It is highly recommended that outpatient providers wear short sleeves to avoid carrying the virus on clothing and change clothes prior to leaving the clinic in order to avoid contaminating others. Dangling necklaces, scarves, bracelets, watches and rings should be avoided and long hair should be held up and back with barrettes, etc.

Telehealth

The final 2021 PFS did not add PT’s or PTA’s as eligible telehealth providers under the Medicare program. CMS did add the following therapy codes as eligible telehealth services through the end of the calendar year in which the PHE ends. (Presently eligible through 12/31/21.)
97161 - 97164, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761

Once the PHE ends, PT’s will not be able to provide these services via telehealth unless they are provided incident to an eligible telehealth provider. PTA’s cannot provide services incident to a non-PT provider.

Computer Based Technology Services: Permanent additions

Code Description
G2250 Remote assessment of recorded video or image
G2251 Virtual check in
98970-72 E-visit

Details regarding providing these services can be found at APTA guide to CBTS

PT’s and PTA’s remain eligible to deliver and bill for telehealth services and Telephone Assessments for Medicare beneficiaries through April 20, 2021.

Physical Therapist Assistants

PTA Differential
Beginning in 2022, services provided “in whole or part” by PTA’s will be reimbursed at 85% of the PFS.

IN part is defined as >10% of the 15” code performed solely by PTA (not PT and PTA together). If the PT and the PTA each perform billable time for the same CPT code, the services can be reported on separate claim lines with the appropriate modifier (CQ for PTA and GP for PT).

PTA Supervision
CMS revised the definition of direct supervision to include virtual presence of the supervising practitioner using interactive audio/video real-time communications technology in private practice. This remains in effect through the end of the year in which the PHE ends.

CMS made permanent changes proposed during the PHE permitting PT’s to delegate maintenance therapy in part B settings to their supervised PTA.