Positioning the Athletic Trainer as Indiana’s Preferred Healthcare Provider

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2017 Changes in coding for Third Party Reimbursement

CPT codes - American Medical Association
2017 Athletic Training Evaluation Codes

Third Party Payor’s recognizing Athletic Training Services have been reimbursing for Athletic Training CPT Codes; Evaluation 97005 and Re-Evaluation 97006 for over 14 years. Athletic Trainer’s billing these codes in the rehabilitation setting have provided excellent care, improved access and patient satisfaction in many institutions.

New for 2017, the American Medical Association has updated their 97000 series CPT codes for all rehabilitation disciplines. Current Third Party payor’s who formally recognize and reimburse for Athletic Training services delivered in the outpatient rehabilitation setting, currently reimburse Athletic Training Evaluation codes 97005/97006.

Effective January 1, 2017 you will see new Athletic Training evaluation codes 97169, 97170 and 97171 as well as re-evaluation 97172 CPT codes submitted for reimbursement. You should check to see if the appropriate modifications within your system, to the new 2017 CPT Athletic Training evaluation/re-evaluation codes have been made. This will allow for a smooth transition as we move into 2017.

Athletic Training new evaluation codes are as follows (please reference page 667 of the AMA CPT Code manual for specifics related to the new codes):

  • 97169 Athletic Training Evaluation (low complexity)
    • A medical history and physical activity profile with no comorbidities that affect physical activity
    • An examination addressing 1-2 elements from: body structures, physical activity, and/or performance deficiencies.
    • Clinical decision making of low complexity using standardized assessment instruments and/or functional outcomes.
  • 97170 Athletic Training Evaluation (moderate complexity)
    • A medical history and physical activity profile with 1-2 comorbidities and affect physical performance.
    • An examination addressing 3 or more elements from: body structures, physical activity, and/or participation deficiencies.
    • Clinical decision making of moderate complexity using standardized assessment instruments and/or functional outcomes.
  • 97171 Athletic Training Evaluation (high complexity)
    • A medical history and physical activity profile with 3 or more comorbidities that affect physical activity.
    • A comprehensive examination addressing 4 or more elements from: body structures, physical activity, and/or performance deficiencies.
    • Clinical presentation with unstable and unpredictable characteristics.
    • Clinical decision making of high complexity using standardized assessment instruments and/or functional outcomes.
  • 97172 Re-Evaluation of Athletic Training established plan of care
    • Assessment of patient’s current functional status when there is a documented change. A revised plan of care with an update in management options.

DCH Named Pilot Site for Athletic Training Reimbursement

August 23, 2016
Daviess Community Hospital
Washington, Indiana
Contact: Angie Steiner, Business Development 812-254-8858
Release: Immediate

August 22, 2016 (WASHINGTON, IN) – In 2011, the Indiana legislature passed Indiana House Bill No. 1467 which allows for Athletic Trainers to receive reimbursement from Third Party payers for services that those payers typically reimburse.

Daviess Community Hospital has recently been designated as one of five pilot sites for the state of Indiana. All sites were chosen for various reasons. DCH stood out as a hospital setting, and billing for Athletic Training services is new to this facility. Others in the program include Community Hospital (Munster, IN), Indiana State University (Terre Haute, IN), Methodist Sports Medicine (Indianapolis, IN), and St. Vincent Sports Performance (Indianapolis, IN).

Those who are not familiar with rehabilitation therapy may not realize that until this bill passed, insurance companies did not reimburse facilities for care given by a certified athletic trainer. Rick Shaw, MS, LAT, ATC, is the Indiana State Business Development Coordinator who has been instrumental in guiding the pilot project. Shaw states, “The goal of this pilot project is to develop and implement strategies for successful reimbursement of services listed in insurers’ benefit plans when services are provided by athletic trainers.”

As a participant, Daviess Community Hospital Athletic Trainers bill for their services under specific “codes”. Each insurance carrier is to recognize these codes and process claims. If claims are denied, it is Shaw’s team who works with the insurers to rectify the situation and pay the claim appropriately. “At this point, we see very little issue with the exception of an occasional paperwork error,” said Shaw.

Per Shaw, the pilot is a collaboration between the National Athletic Trainers’ Association and individual states. The National Athletic Trainers’ Association chose to focus on states that have practice acts which are non-restrictive to reimbursement and strong member support for reimbursement. Indiana, along with Ohio and Wisconsin are the only three states participating at this time. The program is scheduled to run until October 2017.

A few facts about athletic trainers:

- Athletic trainers are health care professionals who collaborate with physicians to optimize patient and client activity and participation in athletics, work and life.

- The practice of athletic training encompasses the prevention, examination and diagnosis, treatment, and rehabilitation of emergent, acute, subacute, and chronic neuro-musculoskeletal conditions and certain medical conditions in order to minimize subsequent impairments, functional limitations, disability, and societal limitations.

 Services are provided primarily in an outpatient therapy clinic

Scott Sell, MS, ATC, Director of Athletic Training Services at Daviess Community Hospital stated, “I am honored that the state of Indiana and Indiana Athletic Trainers Association (IATA) chose DCH to be a pilot site. This is a great opportunity for athletic trainers to be recognized alongside their physical and occupational therapy colleagues. The support of our CEO, David Bixler, and the entire DCH organization continues to be vital to the program. Special thanks to Clark Simpson, Rick Shaw, Joe Greene, and all the other athletic trainers who made this a possibility. This is a great step forward in recognizing the value of athletic trainers, and I look forward to the continued success of our profession.”


Third Party Reimbursement Update

We are very proud of the progress made over the past sixteen months since we began a joint effort with the NATA and the states of Indiana, Ohio and Wisconsin. In Indiana much progress has been made toward reimbursement for physical medicine and rehabilitation by an Indiana athletic trainer. There were 952 Indiana Athletic Trainers with an NPI as of February 15, 2016. Our Indiana Team will be contacting all Indiana education programs in an attempt to educate students on the importance of the NPI number and get them to secure their individual number.

If you have not gotten your NPI number yet, please take ten minutes to complete the process at https://nppes.cms.hhs.gov/NPPES/Welcome.do There is also a “How To” PowerPoint on the IATA website with information to help anyone secure their NPI. More information will be presented at the GLATA Winter Meeting as well as updated data from the Indiana Pilot Sites.

We continue to track the number of Indiana athletic trainers billing for services provided by an athletic trainer has increased from nineteen in 2014 to fifty-four as of February, 2016. Also, Indiana employers billing third party payers for services provided by an athletic trainer has from seven to thirteen employers as of February 15, 2016. If you are billing Third Party as an Athletic Trainer, please contact Rick Shaw to be included as part of the Indiana tracking.

Our Indiana Team continues to work with lobbyist and legislators to insure the Athletic Trainer Practice Act is being followed by payors and we are not being discriminated against in the reimbursement of services provided to our patients. We are seeing progress as Athletic Trainers continue to request reimbursement for physical medicine and modalities. There is still much to be done. If you have questions, contact your Indiana Business Development Coordinator, Rick Shaw at RICKASHAW@aol.com.

Rick Shaw, LAT, ATC
Indiana Business Development Coordinator

The INDIANA Third Party Reimbursement Strategic Plan

Click here to download

Indiana AT Practice Act Quiz

How well do you know your Indiana AT Practice Act? The goal of this quiz is to provide some insight into your knowledge of the Indiana State Athletic Training Practice Act. Moreover, it is a way to connect your knowledge with additional resources the IATA and this committee will continue to provide over the next two years of the Pilot Program.


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