Healthcare and Family Services Therapy Provider Fee Schedule Key
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1 Healthcare and Family Services Therapy Provider Fee Schedule Key The therapy fee schedule and instructions apply to the following providers: Physical, Occupational, and Speech therapists billing with their individual NPIs. Effective 1/1/2014 Hospitals billing for salaried/hourly Physical, Occupational, and Speech therapists services with the Hospital fee for service NPI. Rehabilitation hospitals billing for salaried/hourly Physical, Occupational, and Speech Therapists services with the Hospital fee for service NPI. Health Department billing for salaried/hourly Physical, Occupational, and Speech Therapists services on site with their Health Department NPI. This schedule does not apply to services rendered by a Home Health Agency. See the Home Health Fee Schedule (link) for information. Column Heading Procedure Code Note Prog Cov Eff Date Modifiers Unit Column Description CPT Code Special Information applies to the code. A: Prior approval is required for adults ages 21 and older receiving this service. Program Coverage 04 Medicaid covered services Effective Date the code became billable to HFS. GN Required when billing Speech Therapy services GO - Required when billing Occupational Therapy services GP Required when billing Physical Therapy services The maximum reimbursement rate for 15 minute units billable for the procedure code. The maximum number of 15 minute units billable for the procedure code. The maximum allowable amount payable by the department for the procedure. The amount reflects the 2.7% rate reduction. Pages 2 and 3 contain the procedure codes billable to HFS. Pages 4 and 5 contain a list of allowable services that can be crosswalked to an HFS billable procedure code.
2 Healthcare and Family Services Therapy Fee Schedule Effective 01/01/2014 Updated Procedure Code Definition Note Prog Cov Eff Date Modifiers Unit Unit GN GO GP Child (0-20 years) Adult (21-99) Laryngoscopy flex or rigid fiberoptic w/ stroboscopy 04 07/14/02 Y Treatment of speech, language, voice, communication A 04 04/01/04 Y and/or auditory processing, individual Laryngeal function studies Evaluation of speech fluency Evaluation of speech sound production Evaluation of speech sound production with evaluation of language comprehension and expression Behavioral and qualitative analysis of voice and resonance Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech Evaluation for prescription of non-speech-generating 04 01/01/14 Y augmentative & alternative communication device, first hr 92618* each additional 30 min of /01/14 Y * * * Evaluation for prescription for speech-generating 04 01/01/14 Y augmentative & alternative communication device, first hr 92608* each additional 30 min of /01/14 Y * * * Evaluation of oral & pharyngeal swallowing function Motion fluoroscopic evaluation of swallowing function by cine or video recording Evaluation of auditory rehabilitation status, 1 st hour 04 01/01/14 Y * Each additional 15 min of /01/14 Y * * * Assessment of aphasia (incl assessment of expressive & receptive speech & language function, speech production ability, reading,., per hour Developmental screening, w/interpretation & report, per standarized instrument form Developmental testing, incl assessment of motor, language, social, adaptive &/or cognitive functioning..
3 Procedure Code Definition Note Prog Cov Eff Date Modifiers Unit Unit GN GO GP Child (0-20 years) Adult (21-99) Standardized cognitive performance testing per hour of a qualified health care professional s time 97001** PT Evaluation 04 04/01/04 Y OT Evaluation 04 04/01/04 Y ** Therapeutic procedure, 1 or more areas, each 15 min, to develop strength & endurance, flex & ROM A 04 04/01/04 Y Y
4 Therapy Services Crosswalk This Table provides a list of covered therapy services that are allowable to crosswalk to the HFS therapy billable codes indicated below Procedure Code Definition PT OT ST 92508* Treatment of speech, language, voice, communication and/or auditory processing, group Treatment of swallowing dysfuntion and/or oral function for feeding Spontaneous nystagmus test, including gaze and fixation nystagmus, w/ recording Positional nystagmus test, minimum of 4 positions, w/ recording Oscillating tracking test, w/ recording Computerized dynamic posturography Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive Therapeutic service(s) for the use of a non-speech-generating device, incl programming & modification Therapeutic services for the use of speech-generating device, incl programming & modification Auditory rehabilitation; pre-lingual hearing loss Auditory rehabilitation; post-lingual hearing loss Muscle testing, manual with report; extremity (excluding hand) or trunk ; hand, with or without comparison with normal side ; total evaluation of body; excluding hands ; total evaluation of body; including hands Range of motion measurements & report; each extremity (excl hand or each trunk section, spine) ; hand, with or without comparison with normal side Canalith Repositioning procedure PT Re-evaluation OT Re-evaluation Application of modality to 1 or more areas; hot or cold packs ( are supervised modalities ) ; traction, mechanical P T Electrical Stimulation ; paraffin bath
5 Procedure Code Definition PT OT ST ; whirlpool Application of modality to 1 or more areas; electrical stim each 15 min ( "constant attendandance") ; iontophoresis, each 15 min ; contrast baths, each 15 min ; ultrasound, each 15 min Therapeutic procedure, 1 or more areas, each 15 min, to develop strength & endurance, flex & ROM ; neuromuscular re-education of movement, balance, coordination, posture, sitting/standing activities ; aquatic therapy with therapeutic exercises ; gait training ; massage, including efflueruage, petrissage and/or tapotement Manual therapy techniques, 1 or more regions, each 15 min incl mobilization, manipulation, traction Therapuetic activities, direct 1 on1 pt contact, each 15 min to improve functional performance Development of cognitive skills to improve attention, memory, problem solving, direct 1 on 1, each 15 min Sensory integrative techniquest to enhance sensory procesisng & promote adaptive responses.each 15 min Self care/home mngt training, 1 on 1, each 15 min incl meal prep, safety procedures, instruction on adaptive equip Community/work reintegration training, 1 on 1 each 15 min incl shopping, $ management, instruction on adaptive equip *** Wheelchair management, each 15 min Work hard/condition 1st 2 hrs Debridement, open wound, incl topical appl, use of whirlpool, suction, sharp selective debride, 1st 20 sq cm ; each additional 20 sq cm **** Physical performance test or measurement, each 15 min Orthotic mngt & training incl assessment & fitting, upper/lower extremity, trunk, each 15 min Prosthetic training, upper and/or lower extremity(s), each 15 minutes Checkout for orthotic/prosthetic use, establish pt, each 15 min
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