2001 physical therapy and occupational therapy CPT and HCPCS code changes
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1 May 2001 No PHC 1795 To: Nursing Homes Occupational s Physical s Rehabilitation Agencies Therapy Groups HMOs and Other Managed Care Programs 2001 physical therapy and occupational therapy and HCPCS code changes The following changes to HCFA Common Coding System (HCPCS) codes for physical therapy (PT) and occupational therapy (OT) services are effective for dates of service on and after June 1, Wisconsin Medicaid will no longer accept the discontinued OT code for dates of service on and after November 1, scalpel and tweezers), including topical application(s), wound assessment, and instructions(s) for ongoing care, per session. Refer to Attachment 1 of this Update for a complete list of Medicaid procedure codes for PT services. code changes due to 2001 and HCPCS code changes Due to changes in Current Procedural Terminology () and HCFA Common Coding System (HCPCS) codes, effective for dates of service on and after June 1, 2001, Wisconsin Medicaid will make the following changes. Physical therapy code changes Two codes are added to physical therapy (PT) services: Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes Removal of devitalized tissue from wound; selective debridement, without anesthesia (eg, high pressure waterjet, sharp selective debridement with scissors, Occupational therapy code changes Three codes are added for occupational therapy (OT) services: Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes Removal of devitalized tissue from wound; selective debridement, without anesthesia (eg, high pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers), including topical application(s), wound assessment, and instructions(s) for ongoing care, per session. Department of Health and Family Services
2 One code is discontinued for OT: Development of cognitive skills to improve attention, memory, problem solving, including compensatory training and/or sensory integrative activities, direct (one-on-one) patient contact by the provider, each 15 minutes. Refer to Attachment 2 for a complete list of Medicaid procedure codes for OT services. Prior authorization New procedure codes Wisconsin Medicaid will begin accepting the new procedure codes on prior authorization (PA) requests or on PA amendments beginning May 1, 2001, for dates of service on and after June 1, Refer to the Physical Therapy or the Occupational Therapy handbook for instructions on how to amend a PA. to submit Medicaid claims for PT and OT services: Modifier PT for physical therapy. Modifier OT for occupational therapy. Refer to the Physical Therapy and Occupational Therapy handbooks for more information on therapy modifiers. Reminder about services provided by therapist assistants Wisconsin Medicaid covers only certain services provided by physical therapist assistants (PTAs) and certified occupational therapist assistants (COTAs). Some procedure codes and some procedures within a procedure code are not within the scope of practice of a PTA or COTA, and therefore are not covered by Wisconsin Medicaid. Refer to Attachments 1 and 2 for a list of procedure codes covered for PTAs and COTAs. W isconsin Medicaid will continue to reimburse providers for code as long as the date of service billed is prior to November 1, Coverage of code in an approved prior authorization Some providers have requested and received PA for the to-be-discontinued OT code Wisconsin Medicaid will continue to reimburse providers for code as long as the date of service billed is prior to November 1, However, claims submitted for procedure code for dates of service on and after November 1, 2001, will be denied. Therefore, providers with an approved PA that has an expiration date on and after November 1, 2001, are required to do one of the following: Amend the PA to conform to the code change. Submit a new PA request. Continue using Medicaid modifiers Providers are required to continue using the Medicaid therapy modifiers to request PA and This Update applies to fee-for-service Medicaid providers only. If you are a Medicaid HMO network provider, contact your managed care organization for more information about its PA and billing procedures. Wisconsin Medicaid HMOs are required to provide at least the same benefits for enrollees as those provided under fee-for-service arrangements. The Wisconsin Medicaid and BadgerCare Update is the first source of program policy and billing information for providers. Although the Update refers to Medicaid recipients, all information applies to BadgerCare recipients also. Wisconsin Medicaid and BadgerCare are administered by the Division of Health Care Financing, Wisconsin Department of Health and Family Services, P.O. Box 309, Madison, WI For questions, call Provider Services at (800) or (608) or visit our Web site at 2 Wisconsin Medicaid and BadgerCare Service-Specific Information May 2001 No
3 ATTACHMENT 1 Medicaid procedure codes for physical therapy services Effective June 1, 2001 Wisconsin Medicaid and BadgerCare Service-Specific Information May 2001 No Action No Change No Change No Change No Change No Change Allowable Types and Places of Service for Specific Service Providers Rehabilitation Agencies (Type of Service = 9) Allowable Places of Service = 0, 3, 4, 7, 8 OTHER PROCEDURES Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session) [15 minutes] Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session) [15 minutes] Intermittent positive pressure breathing (IPPB) treatment, air or oxygen, with or without nebulized medication; initial demonstration and/or evaluation [15 minutes] Intermittent positive pressure breathing (IPPB) treatment, air or oxygen, with or without nebulized medication; subsequent [15 minutes] Intermittent positive pressure breathing (IPPB) treatment, air or oxygen, with or without nebulized medication; newborn infants [15 minutes] Independent s, Therapy Groups, and Therapy Clinics (Type of Service = 1) Allowable Places of Service = 0, 3, 4, 7, 8 for /HCPCS Limit Allowable for Therapy $1 1 per day Not Allowed $2 1 per day Not Allowed $1 1 per day Not Allowed $1 1 per day Not Allowed $1 1 per day Not Allowed
![Service = 9) Allowable Places of Service = 0, 3, 4, 7, 8 OTHER PROCEDURES Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session) [15 minutes]](/docs-images/54/10448301/images/page_3.jpg "Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session) [15 minutes] Intermittent positive pressure breathing (IPPB) treatment, air or oxygen, with or")
4 4 Wisconsin Medicaid and BadgerCare Service-Specific Information May 2001 No Action No Change No Change Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation [15 minutes] Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent [15 minutes] MODALITIES for /HCPCS Limit Allowable for $1 2 per day Allowed $0.50 Not Applicable Allowed No Change Biofeedback training by any modality [15 minutes] $2 Not Applicable Allowed No Change No Change No Change No Change No Change No Change No Change No Change hot or cold packs [15 minutes] traction, mechanical [15 minutes] electrical stimulation (unattended) [15 minutes] vasopneumatic devices [15 minutes] paraffin bath [15 minutes] microwave [15 minutes] whirlpool [15 minutes] diathermy [15 minutes] No Change No Change infrared [15 minutes] ultraviolet [15 minutes]
![Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent [15 minutes] MODALITIES for /HCPCS Limit Allowable for $1 2 per day Allowed $0.](/docs-images/54/10448301/images/page_4.jpg "50 Not Applicable Allowed No Change 90901 Biofeedback training by any modality [15 minutes] $2 Not Applicable Allowed No Change 97010 No Change 97012 No Change 97014 No Change 97016 No Change 97018")
5 Action for /HCPCS Limit Allowable for Wisconsin Medicaid and BadgerCare Service-Specific Information May 2001 No No Change No Change No Change No Change No Change No Change No Change No Change No Change No Change No Change electrical stimulation (manual), each 15 minutes iontophoresis, each 15 minutes contrast baths, each 15 minutes ultrasound, each 15 minutes Hubbard tank, each 15 minutes Unlisted modality (specify type and time if constant attendance) [15 minutes] THERAPEUTIC PROCEDURES 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception 15 minutes; aquatic therapy with therapeutic exercises 15 minutes; gait training (includes stair climbing) 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)
6 6 Wisconsin Medicaid and BadgerCare Service-Specific Information May 2001 No Action for /HCPCS Limit Allowable for No Change Unlisted therapeutic procedure (specify) No Change No Change No Change Add No Change No Change Add Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes Prosthetic training, upper and/or lower extremities, each 15 minutes Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes Self care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment) direct one-on-one contact by provider, each 15 minutes Wheelchair management/propulsion training, each 15 minutes Removal of devitalized tissue from wound; selective debridement, without anesthesia (eg, high pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session. $1 Not Applicable Allowed when Appropriate* $2 1 per day Not Allowed * assistants are never allowed to perform a myofascial release/soft tissue mobilization, one or more regions. They are also never allowed to perform a joint mobilization, one or more areas (peripheral or spinal).
7 Action for /HCPCS Limit Allowable for Wisconsin Medicaid and BadgerCare Service-Specific Information May 2001 No EVALUATION No Change Physical therapy evaluation [15 minutes] $1 Not Applicable Not Allowed No Change Physical therapy re-evaluation [15 minutes] $ per day Not Allowed
![2001-12 7 EVALUATION No Change 97001 Physical therapy evaluation [15 minutes]](/docs-images/54/10448301/images/page_7.jpg "$1 Not Applicable Not Allowed No Change 97002 Physical therapy re-evaluation")
8 8 Wisconsin Medicaid and BadgerCare Service-Specific Information May 2001 No Action ATTACHMENT 2 Medicaid procedure codes for occupational therapy services Effective June 1, 2001 Allowable Types and Places of Service for Specific Service Providers Rehabilitation Agencies (Type of Service = 9) Allowable Places of Service = 0, 3, 4, 7, 8 MODALITIES Independent s, Therapy Groups, and Therapy Clinics (Type of Service = 1) Allowable Places of Service = 0, 3, 4, 7, 8 for /HCPCS Limit Allowable for No Change Biofeedback training by any modality [15 minutes] $2 Not A pplicable A llowed No Change No Change No Change hot or cold packs [15 minutes] paraffin bath [15 minutes] contrast baths, each 15 minutes THERAPEUTIC PROCEDURES No Change No Change minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception
9 Action for / HCPCS Limit Allowable for Wisconsin Medicaid and BadgerCare Service-Specific Information May 2001 No No Change minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) No Change Unlisted therapeutic procedure (specify) No Change No Change No Change No Change Add Add No Change Manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes Therapeutic procedure(s); group (2 or more individuals) [each 15 minutes] Prosthetic training, upper and/or lower extremities, each 15 minutes Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes Self care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment) direct one-on-one contact by provider, each 15 minutes $1 Not Applicable * assistants are never allowed to perform a myofascial release/soft tissue mobilization, one or more regions. They are also never allowed to perform a joint mobilization, one or more areas (peripheral or spinal). Allowed when Appropriate* $0.50 Not Applicable Allowed
10 10 Wisconsin Medicaid and BadgerCare Service-Specific Information May 2001 No Action No Change Add Delete Wheelchair management/propulsion training, each 15 minutes Removal of devitalized tissue from wound; selective debridement, without anesthesia (eg, high pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session OTHER PROCEDURES Development of cognitive skills to improve attention, memory, problem solving, includes compensatory training and/or sensory integrative activities, direct (one-on-one) patient contact by the provider, each 15 minutes EVALUATION for / HCPCS Limit Allowable for $2 1 per day Not Allowed $1 Not Applicable Allowed No Change Occupational therapy evaluation [15 minutes] $1 Not A pplicable Not A llowed No Change Occupational therapy re-evaluation [15 minutes] $ per day Not Allowed
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