Saturday, June 25, 2016

Therapy and Acupuncture CPT code list

Therapeutic Procedures

Physician or therapist required to have direct (one-on-one) patient contact. The therapeutic procedures, for one or more areas, each 15 minutes interval is as follows:

• 97110 Therapeutic exercises to develop strength and endurance, range of motion and flexibility

• 97112 Neuromuscular reeducation of movement, balance, coordination, kinesthetic senses, posture, and/or proprioception for sitting and/or standing activities

• 97113 Aquatic therapy with therapeutic exercises

• 97116 Gait training (includes stair climbing)

• 97124 Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)

• 97140 Manual therapy techniques, one or more regions, each 15 minutes

• 97150 Therapeutic procedure(s), group (2 or more individuals)

• 97530 Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes

• 97535 Self-care/home management training (e.g., ADL), each 15 minutes

Tests and Measurements (Requires direct on-on-one patient contact)

• 97750 Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes

• Orthotic Management and Prosthetic Management

• 97760 Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes

• 97762 Checkout for orthotic/prosthetic use, established patient, each 15 minutes


• 97810 Without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

• 97811 Without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s)

• 97813 With electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

• 97814 With electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s)

Florida Blue reserves the right to change the contents of the listing in accordance with revisions to industry standards, AMA/CPT guidelines, and with normal annual fee schedule coding updates.

Thursday, June 23, 2016

Chiropractic Modalities

• Physical Medicine and Rehabilitation

• CPT Code Description

The application of a modality that does not require direct (one-on-one) patient contact by the provider is as follows:

• 64550 Application of surface (transcutaneous) neuro stimulator

• 97012 Traction, mechanical

• 97014 Electrical stimulation (unattended)

• 97016 Vasopneumatic devices

• 97018 Paraffin bath

• 97022 Whirlpool

• 97024 Diathermy (e.g., microwave)

• 97028 Ultraviolet

Constant Attendance Modalities

The application of a modality that requires direct (one-on-one) patient contact by the provider is as follows:

97032 Electrical stimulation (manual)

97033 Iontophoresis

97034 Contrast baths

97035 Ultrasound

97036 Hubbard tank

Monday, June 20, 2016

Acupuncture CPT CODES 97810, 97813, 97814

Acupuncture: A chiropractic provider may not provide acupuncture services until certified by the Florida Board of Chiropractic Medicine. Acupuncture is reported based on 15 minute increments of personal (face-to-face) contact with the patient, not the duration of acupuncture needle(s) placement. If no electrical stimulation is used during a 15 minute increment, use 97810 or 97811. If electrical stimulation of any needle is used during a 15 minute increment, use 97813 or 97814. Only one code may be reported for each 15 minute increment. Use either 97810 or 97813 for the initial 15 minute increment. Only one initial code is reported per day.
The FEP does not include benefits for acupuncture when performed by a chiropractor.

Covered Services for Medicare Advantage Members:

According to the Centers for Medicare & Medicaid Services (CMS) Internet-only manual, Publication 100-02 Medicare Benefit Policy Manual, chapter 15, section 30.5, chiropractors’ services extend only to treatment by means of manual manipulation of the spine to correct a subluxation. All other services furnished or ordered by chiropractors are not covered. Chiropractors are not limited to any specific procedures and may render services as they feel necessary, but according to CMS guidelines; the benefit will only cover manual spinal manipulation, which includes procedure codes: 98940, 98941, and 98942.

The following procedure code ranges will deny for chiropractors as non-covered services:

• 00100 through 98929

• 98943 through 99607

• A0021 through V5364

Saturday, June 18, 2016

Billing tips for 98943, 97140, E0720 AND E0730

The chiropractic manipulative treatment codes include a pre-manipulation patient assessment. Additional E/M services may be reported separately using modifier 25, if the member’s condition requires a significant separately identifiable E/M service, above and beyond the usual pre-service and post-service work associated with the procedure.

Chiropractic Manipulative Treatment: CMT is a form of manual treatment to influence joint and neurophysiological function.

When similar or identical procedures are performed, but are qualified by an increased level of complexity:

Only the definitive or most comprehensive service performed should be reported

Only one CMT service of the spinal region (procedures 98940-98942) is eligible for payment on a single date of service.

Payment is limited to one clinically indicated and medically necessary physical medicine modality or procedure code per patient, per date of service.

Payment is allowed for one clinically indicated and medically necessary extra spinal manipulation code (i.e., 98943-51) in combination with a spinal manipulation code (i.e., 98940, 98941, or 98942) per date of service.

When multiple procedures are performed at the same session by the same provider, the modifier 51 may be appended to the additional CPT codes (excluding E/M codes).

Physical Medicine and Rehabilitation: The selection of appropriate physical medicine modalities and procedures should be based on the desired physiological response in correlation to the stages of healing. In most conditions or injuries, utilization of one carefully selected modality or procedure in combination with CMT is adequate to achieve a successful clinical outcome.

97140, manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes, will not be separately reimbursed when billed with 98940-98943 (CMT) for the same region. Modifier 59 should be used with 97140 when billed with a CMT code, but performed on a different anatomical region.

It is not appropriate to bill 97124, massage, for myofascial release. For myofascial release, 97140 should be reported and is reimbursable if it is not billed with a CMT code pertaining to the same anatomical region. When reporting or billing for 97112 (neuromuscular reeducation) and 97124 (massage) as well as all other physical medicine modalities and therapeutic procedures, the details of the procedure shall be recorded in the medical record, including clinical rationale, anatomical site, description of service, and time (as required by the selected procedure code).

TENS: When found to be medically necessary, the following codes are reimbursed for TENS when billed under the following codes:

• E0720

• E0730

Friday, June 17, 2016

Billing Guide for Allergy Shots and Visit Services on the Same Day - CPT 95115

At the outset of the physician fee schedule, the question was posed as to whether visits should be billed on the same day as an allergy injection (CPT codes 95115-95117), since these codes have status indicators of A rather than T. Visits should not be billed with allergy injection services 95115 or 95117 unless the visit represents another separately identifiable service. This language parallels CPT editorial language that accompanies the allergen immunotherapy codes, which include codes 9515 and 95117. Prior to January 1, 1995, you appeared to be enforcing this policy through three (3) different means:

• Advising physician to use modifier 25 with the visit service;

• Denying payment for the visit unless documentation has been provided; and

• Paying for both the visit and the allergy shot if both are billed for.

For services rendered on or after January 1, 1995, you are to enforce the requirement that visits not be billed and paid for on the same day as an allergy injection through the following means. Effective for services rendered on or after that date, the global surgery policies will apply to all codes in the allergen immunotherapy series, including the allergy shot codes 95115 and 95117. To accomplish this, CMS changed the global surgery indicator for allergen immunotherapy codes from XXX, which meant that the global surgery concept did not apply to those codes, to 000, which means that the global surgery concept applies, but that there are no days in the postoperative global period.

Now that the global surgery policies apply to these services, you are to rely on the use of modifier 25 as the only means through which you can make payment for visit services provided on the same day as allergen immunotherapy services. In order for a physician to receive payment for a visit service provided on the same day that the physician also provides a service in the allergen immunotherapy series (i.e., any service in the series from 95115 through 95199), the physician is to bill a modifier 25 with the visit code, indicating that the patient’s condition required a significant, separately identifiable visit service above and beyond the allergen immunotherapy service provided.

D. Reasonable Supply of Antigens

See CMS Manual System, Internet Only Manual, Medicare Benefits Policy Manual, CMS Pub. 100-02 Chapter 15, section 50.4.4, regarding the coverage of antigens, including what constitutes a reasonable supply of antigens.