W series CPT codes Introduction
Current Procedural Terminology (CPT) codes are used for reporting medical services and procedures performed by physicians. Their purpose is to provide a uniform language that will accurately describe medical, surgical, and diagnostic services, thereby providing an effective means for reliable nationwide communication among physicians, patients, and third parties. This system of terminology is the most widely accepted nomenclature for the reporting of physician procedures and services under government and private health insurance programs.
CPT V. 6.0 provides the software to update the CPT files. The software includes all CPT codes to code outpatient services for reimbursement and workload purposes (as determined by the American Medical Association) and the Common Procedure Coding System from the Health Care Financing Administration (HCPCS). These codes may also be utilized to report inpatient services in certain instances.
In addition to the National CPT and HCPCS codes, the VA also uses the following VA specific HCPCS format codes. These codes are not included in the HCPCS or CPT manuals.
W-CODES (VA NATIONAL CODES)
CPT Code Service Description Billing Unit Rate as of July 1, 2016 Max Daily Unit/ Service Limit Place of ServiceW5014 Art Therapy Individual – certified 45-50 min $63.43 1 11,99
W5026 Art Therapy Individual – certified 75-80 min $82.47 1 11,99
W5027 Art Therapy Individual – licensed 45-50 min $69.78 1 11,99
W5028 Art Therapy Individual – licensed 75-80 min $91.41 1 11,99
W5015 Art Therapy Group – certified 45-60 min $24.64 1 11,99
W5029 Art Therapy Group – certified 75-80 min $32.04 1 11,99
W5030 Art Therapy Group – licensed 45-60 min $27.74 1 11,99
W5031 Art Therapy Group – licensed 75-80 min $36.07 1 11,99
W5012 Dance Therapy Individual – certified 45-50 min $63.43 1 11,99
W5032 Dance Therapy Individual – certified 75-80 min $82.47 1 11,99
W5033 Dance Therapy Individual – licensed 45-60 min $69.78 1 11,99
W5034 Dance Therapy Individual – licensed 75-80 min $91.41 1 11,99
W5013 Dance Therapy Group – certified 45-60 min $24.64 1 11,99
W5035 Dance Therapy Group – certified 75-80 min $32.04 1 11,99
W5036 Dance Therapy Group – licensed 45-60 min $27.74 1 11,99
W5037 Dance Therapy Group – licensed 75-80 min $36.07 1 11,99
W5010 Equine Assisted Therapy Individual -certified 45-50 min $63.43 1 99
W5044 Equine Assisted Therapy Individual -certified 75-80 min $82.47 1 99
W5045 Equine Assisted Therapy Individual – licensed 45-50 min $69.78 1 99
W5046 Equine Assisted Therapy Individual – licensed 75-80 min $91.41 1 99
W5011 Equine Assisted Therapy Group – certified 45-60 min $24.64 1 99
W5047 Equine Assisted Therapy Group – certified 75-80 min $32.04 1 99
W5048 Equine Assisted Therapy Group – licensed 45-60 min $27.74 1 99
W5049 Equine Assisted Therapy Group – licensed 75-80 min $36.07 1 99
W5020 Horticultural Therapy Individual – certified 45-50 min $63.43 1 99
W5050 Horticultural Therapy Individual – certified 75-80 min $82.47 1 99
W5051 Horticultural Therapy Individual – licensed 45-50 min $69.78 1 99
W5052 Horticultural Therapy Individual – licensed 75-80 min $91.41 1 99
W5021 Horticultural Therapy Group – certified 45-60 min $24.64 1 99
W5053 Horticultural Therapy Group – certified 75-80 min $32.04 1 99
W5054 Horticultural Therapy Group – licensed 45-60 min $27.74 1 99
W5055 Horticultural Therapy Group – licensed 75-80 min $36.07 1 99
W5022 Face to face caregiver peer to peer support 15 min $16.29 8/11 hrs per month 11,12,99
W5023 Collateral (telephonic) caregiver peer to
peer support
15 min $8.14 8/16 hrs per month 11,12,99
W5024 Mobile Crisis and Stabilization 15 min $26.13 12 hrs 12,99
W5025 Crisis Assessment 1 $313.54 1 12,99
W5016 Music Therapy Individual – certified 45-50 min $63.43 1 11,99
W5038 Music Therapy Individual – certified 75-80 min $82.47 1 11,99
W5039 Music Therapy Individual – licensed 45-50 min $69.78 1 11,99
W5040 Music Therapy Individual – licensed 75-80 min $91.41 1 11,99
W5017 Music Therapy Group – certified 45-60 min $24.64 1 11,99
W5041 Music Therapy Group – certified 75-80 min $32.04 1 11,99
W5042 Music Therapy Group – licensed 45-60 min $27.74 1 11,99
W5043 Music Therapy Group – licensed 75-80 min $36.07 1 11,99
W5018 Drama Therapy Individual – certified 45-50 min $63.43 1 11,99
W5056 Drama Therapy Individual – certified 75-80 min $82.47 1 11,99
W5057 Drama Therapy Individual – licensed 45-50 min $69.78 1 11,99
W5058 Drama Therapy Individual – licensed 75-80 min $91.41 1 11,99
W5019 Drama Therapy Group – certified 45-60 min $24.64 1 11,99
W5059 Drama Therapy Group – certified 75-80 min $32.04 1 11,99
W5060 Drama Therapy Group – licensed 45-60 min $27.74 1 11,99
W5061 Drama Therapy Group – licensed 75-80 min $36.07 1 11,99
W5000 Respite Care In Home/Commuinty Based 1 Hour $25.66 6/6 hrs per day 12,99
W5001 Respite Care Residential/Out of Home 1 overnight stayminimum of 12 hours $203.43 1/24 units per waiver year 12,99
W5062 Intensive In Home Services (EBP) Weekly $253.88 1 12
W5063 Intensive In Home Services weekly $201.42 1 12
W5066 Customized Goods and Services Billed Charges $2000.00 max 99
CPT CODE DESCRIPTION
W0100 GENERAL MEDICAL EXAM, VA FACILITY
W0105 PSYCHIATRY EXAM, PER HOUR, VA FACILITY
W0110 NEUROLOGICAL EXAM, VA FACILITY
W0115 ENT EXAM, VA FACILITY
W0120 OPTHOMOLOGY EXAM, VA FACILITY
W0125 AUDIOLOGY EXAM, VA FACILITY
W0130 ORTHOPEDIC EXAM, VA FACILITY
W0135 CARDIOLOGY EXAM, VA FACILITY
W0140 DERMATOLOGY EXAM, VA FACILITY
W0145 NEUROSURGICAL EXAM, VA FACILITY
W0150 GU EXAM, VA FACILITY
W0155 GI EXAM, VA FACILITY
W0160 PULMONARY EXAM, VA FACILITY
W0200 POW EXAM, VA FACILITY, PER HOUR
W0210 AGENT ORANGE EXAM, VA FACILITY
W0220 SOCIAL/INDUSTRIAL SURVEY, PER HOUR
W0230 PTSD EXAM, VA FACILITY, PER HOUR
W5000 GENERAL MEDICAL EXAM, NON-VA FACILITY
W5010 PSYCHIATRIC EXAM, NON-VA FACILITY
W5015 NEUROLOGICAL EXAM, NON-VA FACILITY
W5020 ENT EXAM, NON-VA FACILITY
W5025 OPTHOMOLOGY EXAM, NON-VA FACILITY
W5030 AUDIOLOGY EXAM, NON-VA FACILITY
W5035 ORTHOPEDIC EXAM, NON-VA FACILITY
W5040 CARDIOLOGY EXAM, NON-VA FACILITY
W5045 DERMATOLOGY EXAM, NON-VA FACILITY
W5050 NEUROSURGICAL EXAM, NON-VA FACILITY
W5055 GU EXAM, NON-VA FACILITY
W5060 GI EXAM, NON-VA FACILITY
W5065 PULMONARY EXAM, NON-VA FACILITY
W5220 SOCIAL/INDUSTRIAL SURVEY, PER HOUR, NON-VA FACILITY
W5230 PTSD EXAM, NON-VA FACILITY
