| 2008 L'Therapy Group LLC - All Rights Reserved 98 Oakridge Drive, Indiana, PA 15701, 724-464-5341, info@ltherapy.com |
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| CPT & ICD Codes |
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Most Used Codes & Fees
95831 - Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk - $13.71 95832 - Muscle testing, manual (separate procedure) with report; hand, with or without comparison with normal side - $14.45 95833 - Muscle testing, manual (separate procedure) with report; total evaluation of body, excluding hands - $22.60 95834 - Muscle testing, manual (separate procedure) with report; total evaluation of body, including hands -$29.26 95851 - Range of motion measurements and report; each extremity (excluding hand) or each trunk section (spine) - $7.78 95852 - Range of motion measurements and report; hand, with or without comparison with normal side - $5.34 97032 - Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes - $15.00 97035 - Application of a modality to one or more areas; ultrasound, each 15 minutes - $10.69 97014 - Application of a modality to one or more areas; electrical stimulation (unattended) - $12.72 97110 - Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility - $26.04 97112 - Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities - $27.08 97113 - Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercises - $31.22 97116 - Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing) - $22.74 97124 - Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) - $20.87 97139 - Unlisted therapeutic procedure (specify) Shiatsu, Trigger Point, Trager & Other Bodywork - $ 97140 - Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes - $24.23 97150 - Therapeutic procedure(s), group (2 or more individuals) - $16.46 97799 - Unlisted physical medicine/rehabilitation service or procedure - $ 99056 - Service(s) typically provided in the office, provided out of the office at request of patient, in addition to basic service - $ 99358 - Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); first hour (List separately in addition to code(s) for other physician service(s) and/or inpatient or outpatient Evaluation and Management service) - $91.43 99359 - Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); each additional 30 minutes (List separately in addition to code for prolonged physician service) - $44.00 A4558 - Conductive gel or paste, for use with electrical device (e.g. TENS, NMES), per oz - $4.63 A4559 - Coupling gel or paste, for use with ultrasound device, per oz - $.10 A9282 - Wig, any type, each - $ S0390 - Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g. diabetes), per visit - $ S9451 - Exercise classes, non-physician provider, per session - $ |
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Billing Guidelines
1. Billing - CPT Codes: Not Permitted In the same 15-minute (or other) time period, a therapist cannot bill any of the following pairs of CPT codes for outpatient therapy services provided to the same, or to different patients. Examples include: Any two CPT codes for "therapeutic procedures" requiring direct one-on-one patient contact (CPT codes 97110-97542); Any two CPT codes for modalities requiring "constant attendance" and direct one-on-one patient contact (CPT codes 97032 - 97039); Any two CPT codes requiring either constant attendance or direct one-on-one patient contact - as described in (a) and (b) above -- (CPT codes 97032- 97542). For example: any CPT code for a therapeutic procedure (eg. 97116-gait training) with any attended modality CPT code (eg. 97035-ultrasound); Any CPT code for therapeutic procedures requiring direct one-on-one patient contact (CPT codes 97110 - 97542) with the group therapy CPT code (97150) requiring constant attendance. For example: group therapy (97150) with neuromuscular reeducation (97112); Any CPT code for modalities requiring constant attendance (CPT codes 97032 - 97039) with the group therapy CPT code (97150). For example: group therapy (97150) with ultrasound (97035); Any untimed evaluation or reevaluation code (CPT codes 97001-97004) with any other timed or untimed CPT codes, including constant attendance modalities (CPT codes 97032 - 97039), therapeutic procedures (CPT codes 97110-97542) and group therapy (CPT code 97150) 2. Billing - CPT Codes: Permitted In the same 15-minute time period, one therapist may bill for more than one therapy service occurring in the same 15-minute time period where "supervised modalities" are defined by CPT as untimed and unattended -- not requiring the presence of the therapist (CPT codes 97010 - 97028). One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact. However, any actual time the therapist uses to attend one-on-one to a patient receiving a supervised modality cannot be counted for any other service provided by the therapist. 3. Group Therapy-vs- Individual Therapy: The following is provided to assist you in determining whether to bill for group therapy (97150) or individual therapy (defined by the timed CPT codes for therapeutic procedures requiring direct one-on-one patient contact), when treating two or more patients during the same time period. When direct one-on-one patient contact is provided, the therapist bills for individual therapy, and counts the total minutes of service to each patient in order to determine how many units of service to bill each patient for the timed codes. These direct one-on-one minutes may occur continuously (15 minutes straight), or in notable episodes (for example, 10 minutes now, 5 minutes later). Each direct one-on-one episode, however, should be of a sufficient length of time to provide the appropriate skilled treatment in accordance with each patient's plan of care. Also, the manner of practice should clearly distinguish it from care provided simultaneously to two or more patients. Group therapy consists of simultaneous treatment to two or more patients who may or may not be doing the same activities. If the therapist is dividing attention among the patients, providing only brief, intermittent personal contact, or giving the same instructions to two or more patients at the same time, it is appropriate to bill each patient one unit of group therapy, 97150 (untimed). One-on-One Example: In a 45-minute period, a therapist works with 3 patients - A, B, and C - providing therapeutic exercises to each patient with direct one-on-one contact in the following sequence: Patient A receives 8 minutes, patient B receives 8 minutes and patient C receives 8 minutes. After this initial 24-minute period, the therapist returns to work with patient A for 10 more minutes (18 minutes total), then patient B for 5 more minutes (13 minutes total), and finally patient C for 6 additional minutes (14 minutes total). During the times the patients are not receiving direct one-on-one contact with the therapist, they are each exercising independently. The therapist appropriately bills each patient one 15 minute unit of therapeutic exercise (97110) corresponding to the time of the skilled intervention with each patient. Group Example: In a 25-minute period, a therapist works with two patients, A and B, and divides his/her time between two patients. The therapist moves back and forth between the two patients, spending a minute or two at a time, and provides occasional assistance and modifications to patient A’s exercise program and offers verbal cues for patient B’s gait training and balance activities in the parallel bars. The therapist does not track continuous or notable, identifiable episodes of direct one-on-one contact with either patient and would bill each patient one unit of group therapy (97150) corresponding to the time of the skilled intervention with each patient. |
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250.00 - Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled 250.01 Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled 250.02 Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled 250.03 Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled 250.70 Diabetes mellitus with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled 250.71 Diabetes mellitus with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled 250.72 Diabetes mellitus with peripheral circulatory disorders, type II or unspecified type, uncontrolled 250.73 Diabetes mellitus with peripheral circulatory disorders, type I [juvenile type], uncontrolled 443.9 - Peripheral vascular disease, unspecified 524.69 - Temporomandibular joint disorders, other specified temporomandibular joint disorders 716.10 Traumatic arthropathy, site unspecified 716.11 Traumatic arthropathy involving shoulder region 716.12 Traumatic arthropathy involving upper arm 716.13 Traumatic arthropathy involving forearm 716.14 Traumatic arthropathy involving hand 716.15 Traumatic arthropathy involving pelvic region and thigh 716.16 Traumatic arthropathy involving lower leg 716.17 Traumatic arthropathy involving ankle and foot 716.18 Traumatic arthropathy involving other specified sites 716.19 Traumatic arthropathy involving multiple sites 724.6 - Disorders of sacrum 724.9 - Other unspecified back disorders 729.1 - Myalgia and myositis, unspecified 729.9 - Other and unspecified disorders of soft tissue 782.3 - Edema 840.0 Acromioclavicular (joint) (ligament) sprain 840.1 Coracoclavicular (ligament) sprain 840.2 Coracohumeral (ligament) sprain 840.3 Infraspinatus (muscle) (tendon) sprain 840.4 Rotator cuff (capsule) sprain 840.5 Subscapularis (muscle) sprain 840.6 Supraspinatus (muscle) (tendon) sprain 840.7 Superior glenoid labrum lesion 840.8 Sprain of other specified sites of shoulder and upper arm 840.9 Sprain of unspecified site of shoulder and upper arm 841.0 Radial collateral ligament sprain 841.1 Ulnar collateral ligament sprain 841.2 Radiohumeral (joint) sprain 841.3 Ulnohumeral (joint) sprain 841.8 Sprain of other specified sites of elbow and forearm 841.9 Sprain of unspecified site of elbow and forearm 842.00 Sprain of unspecified site of wrist 842.01 Sprain of carpal (joint) of wrist 842.02 Sprain of radiocarpal (joint) (ligament) of wrist 842.09 Other wrist sprain 842.10 Sprain of unspecified site of hand 842.11 Sprain of carpometacarpal (joint) of hand 842.12 Sprain of metacarpophalangeal (joint) of hand 842.13 Sprain of interphalangeal (joint) of hand 842.19 Other hand sprain 843.0 Iliofemoral (ligament) sprain 843.1 Ischiocapsular (ligament) sprain 843.8 Sprain of other specified sites of hip and thigh 843.9 Sprain of unspecified site of hip and thigh 844.0 Sprain of lateral collateral ligament of knee 844.1 Sprain of medial collateral ligament of knee 844.2 Sprain of cruciate ligament of knee 844.3 Sprain of tibiofibular (joint) (ligament) superior, of knee 844.8 Sprain of other specified sites of knee and leg 844.9 Sprain of unspecified site of knee and leg 845.00 Unspecified site of ankle sprain 845.01 Deltoid (ligament), ankle sprain 845.02 Calcaneofibular (ligament) ankle sprain 845.03 Tibiofibular (ligament) sprain, distal 845.09 Other ankle sprain 845.10 Unspecified site of foot sprain 845.11 Tarsometatarsal (joint) (ligament) sprain 845.12 Metatarsaophalangeal (joint) sprain 845.13 Interphalangeal (joint), toe sprain 845.19 Other foot sprain 846.0 Lumbosacral (joint) (ligament) sprain 846.1 Sacroiliac (ligament) sprain 846.2 Sacrospinatus (ligament) sprain 846.3 Sacrotuberous (ligament) sprain 846.8 Other specified sites of sacroiliac region sprain 846.9 Unspecified site of sacroiliac region sprain 847.0 Neck sprain 847.1 Thoracic sprain 847.2 Lumbar sprain 847.3 Sprain of sacrum 847.4 Sprain of coccyx 847.9 Sprain of unspecified site of back 848.0 Sprain of septal cartilage of nose 848.1 Jaw sprain 848.2 Thyroid region sprain 848.3 Sprain of ribs 848.40 Sternum sprain, unspecified part 848.41 Sternoclavicular (joint) (ligament) sprain 848.42 Chondrosternal (joint) sprain 848.49 Other sprain of sternum 848.5 Pelvic sprain 848.8 Other specified sites of sprains and strains 848.9 Unspecified site of sprain and strain 905.7 - Late effect of sprain and strain without mention of tendon injury 905.8 - Late effect of tendon injury V62.89 - Other psychological or physical stress, not elsewhere classified |
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