Onset Date for Physical Therapy

I. Description

The onset date (entered in block 14 of the CMS 1500 claim form or the onset date field in EMC) is the date that the injury occurred or the illness began. As payment for service is often based on this onset date, it is important that this date is entered correctly.

II. Criteria for Determining the Onset Date

The following tips may be helpful in determining the onset date:

1. If therapy is performed to treat an injury incurred due to an accident, the date the accident occurred should be entered as the onset date
2. For re-injuries occurring within 90 days of a previous injury, the onset date is date the first injury occurred.
3. For medical conditions not associated with an accident, consult with the referring physician regarding how long the patient has had the condition.
4. If therapy follows a surgical procedure, the date of the surgery is the onset date.

III. Limitations

1. The date of service should not be entered as the onset date for physical therapy services.

IV. Claims Filing Instructions

For more information on how to enter the onset date on the CMS 1500 claim form, see CMS 1500 Interactive Health Insurance Claim Form [PDF] and review the instructions for entering information in Block 14.

Revision History