Healthcare and Family Services Therapy Provider Fee Schedule Key

Similar documents
Provider Type 34 Billing Guide

Preschool/School Supportive Health Services Program (SSHSP)

Review of Texas Medicaid Acute Care Therapy Programs. Prepared by: Strategic Decision Support Health and Human Services Commission

Physical Medicine & Rehabilitation: Maximum Combined Frequency per Day Policy

PAC - THE PRICING ACTION CODE IDENTIFIES NON-COVERED SERVICES OR THE SOURCE AND METHOD OF PRICING THE PROCEDURE (REFER TO TABLE II).

Early Intervention Service Procedure Codes, Limits and Rates

Physical Therapy/Occupational Therapy Utilization Management Program FAQs November 2015

Timed Therapeutic Procedures

Occupational Therapy

CHAPTER 515 COVERED SERVICES, LIMITATIONS, AND EXCLUSIONS FOR OCCUPATIONAL/PHYSICAL THERAPY SERVICES CHANGE LOG

Physical Therapy. Physical Therapy Payment Policy Policy number M.RTH effective 10/01/2015. Page 1

Occupational Therapy

OUTPATIENT PHYSICAL, OCCUPATIONAL, & SPEECH THERAPY

Physical Therapy MM /15/2003

Chiropractic Billing Guide

How To Bill For Physical Therapy

Chiropractic Billing Guide

CHAPTER 700 SCHOOL-BASED CLAIMING PROGRAM/DIRECT SERVICE CLAIMING 700 CHAPTER OVERVIEW MEDICAL AND FINANCIAL RECORDS...

Occupational Therapy Program

Physical and Occupational Therapy Services Program Rulebook

Coding and Billing for Physical Therapy and Occupational Therapy Services

OCCUPATIONAL THERAPY

ADDITIONAL FUNDING SOURCES

Physical and Occupational Therapy Services Program Rulebook

Pediatric Case Study OCCUPATIONAL THERAPY EVALUATION REPORT AND INTERVENTION PLAN. Setting: community out-patient in-patient home based

Physical Therapy Program

THE MARYLAND MEDICAL ASSISTANCE PROGRAM

Section 2. Physical Therapy and Occupational Therapy Services

Physical Therapy 12/4/2014. Agenda. Time Based Billing. Presented by Regan Tyler, CPC, CPC-H, CPC-I, CPMA, CEMC Senior Consultant & NAMAS Instructor

Revised: 5/2001 3/2003 5/2003 4/2005 8/2008. CPT Code Definitions

REHABILITATION SERVICES (OUTPATIENT)

SUBCHAPTER 48C - SCOPE OF PHYSICAL THERAPY PRACTICE SECTION PHYSICAL THERAPISTS

School Based Health Services Medicaid Policy Manual MODULE 6 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES

Chapter 17. Medicaid Provider Manual

Issue # All SSHSP Medicaid Providers. NYS OHIP SSHSP & NYSED Medicaid in Education Units. DATE: July 30, Update to SSHSP Billing Codes

MEDICAL COVERAGE POLICY. SERVICE: Occupational Therapy SERVICE: PRIOR AUTHORIZATION: Not required.

OCCUPATIONAL THERAPY Corporate Medical Policy. Medical Policy

Coding and Billing for Outpatient Rehab Made Easy

Procedure code billed is not approved for the therapy/pathology assistant.

SECTION 2 PHYSICAL THERAPY SERVICES. BY INDEPENDENT PHYSICAL THERAPISTS (including Group Practices) Not in Rehabilitation Centers

CPT Development. CPT Coding for Outpatient PT. Who Can Use CPT Codes? Current Procedural Terminology (CPT) 4/17/2014

Coverage and Recreation Therapy Services

Rehabilitation Therapies

Questions: Procedure Coding Basics. Procedure Coding Basics. HCPCS II Codes. Coding for Slide Rehabilitation Title Services

PPTA Payer Summit Medical Review Challenges and Red Flags in Documentation. CPT Coding for Physical Therapy Services Series and Beyond

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES

Speech-Language Pathology, Audiology and Hearing Aid Services Rulebook

Chiropractic. Manual for Physicians and Providers Chiropractic

PHYSICAL THERAPY Corporate Medical Policy. Medical Policy

MODEL SUPERBILL for AUDIOLOGY

School Age Services INTERVENTION SERVICES FOR CHILDREN WITH DEVELOPMENTAL DELAYS

Physical Therapy (PT) Modalities and Evaluation

Local Coverage Determination (LCD) for Physical Medicine and Rehabilitation Policy (L28290)

SCHOOL-BASED REHABILITATIVE AND RBHS SERVICE RATES (With Interim PRS Rates) Revised 4/16/15 Description Code Modifiers Reimbursement Rates AUDIOLOGY

PROVIDER POLICIES & PROCEDURES

PT and Physician Perspectives

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES PROCEDURE CODES & FEE SCHEDULE

Chapter 24: Physical Medicine Services

Doctor of Physical Therapy Degree Curriculum:

Speech-Language Pathology (SLP)

Who May Bill For Physical Medicine Services Board Certified Physical Medicine and Rehabilitation (Physiatry) Physicians

Untimed Billing Procedure CPT Codes Effective February 1, 2010

Medicaid School Based Services

Medicare Outpatient Therapy Billing

Florida Medicaid THERAPY SERVICES COVERAGE AND LIMITATIONS HANDBOOK

EPSDT HEALTH AND IDEA RELATED SERVICES

Chapter. CPT only copyright 2009 American Medical Association. All rights reserved. 29Physical Medicine and Rehabilitation

How To Enroll In The Cson Services Program

Basic Training: Home Health Edition. Defining and Documenting, Medical Necessity. March 28, 2013

SCHOOL HEALTH SERVICES PROGRAM PROGRAM MANUAL

Chapter. CPT only copyright 2010 American Medical Association. All rights reserved. 29Physical Medicine and Rehabilitation

Outpatient Physical and Occupational Therapy Fee-For-Service Billing Manual

Department of Occupational Therapy Doctorate of Occupational Therapy Program

SHARS Billing Guidelines (Effective 9/1/06)

The Pediatric Program at Marianjoy

Department of Physiotherapy and Rehabilitation:

IDAPA 2/18/2015. School Based Medicaid Related Services School Based Medicaid SLP OT PT

Local Coverage Determination (LCD): Outpatient Occupational Therapy (L31591)

Rehabilitation Services. Hospital Pavilion North, 5 th Floor Monday-Friday Saturday/Sunday

Resident will learn independently in addition to scheduled didactics. Learning is centered on the 7 core competencies as follows:

Upon successful completion of the program, graduates may obtain employment as Physical Therapist Assistants (CIP # ; O-NET #

Comments and Responses Regarding Draft Local Coverage Determination: Outpatient Physical and Occupational Therapy Services

2016 Medicare Fee Schedule for Audiologists. American Speech-Language-Hearing Association

Medicare Coverage of Skilled Nursing Facility Care

Therapy Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2016 Hewlett Packard Enterprise Development LP

The following references are used throughout the billing scenarios that follow:

Transcription:

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.

Healthcare and Family Services Therapy Fee Schedule Effective 01/01/2014 Updated 11.14.14 Procedure Code Definition Note Prog Cov Eff Date Modifiers Unit Unit GN GO GP Child (0-20 years) Adult (21-99) 31579 Laryngoscopy flex or rigid fiberoptic w/ stroboscopy 04 07/14/02 Y 187.74 1 187.74 187.74 1 187.74 92507 Treatment of speech, language, voice, communication A 04 04/01/04 Y 12.99 4 51.96 9.00 4 36.00 and/or auditory processing, individual 92520 Laryngeal function studies 92521 Evaluation of speech fluency 92522 Evaluation of speech sound production 92523 Evaluation of speech sound production with evaluation of language comprehension and expression 92524 Behavioral and qualitative analysis of voice and resonance 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech 92605 Evaluation for prescription of non-speech-generating 04 01/01/14 Y 12.99 4 51.96 9.00 4 36.00 augmentative & alternative communication device, first hr 92618* each additional 30 min of 92605 04 01/01/14 Y 12.99 4 51.96 * * * 92607 Evaluation for prescription for speech-generating 04 01/01/14 Y 12.99 4 51.96 9.00 4 36.00 augmentative & alternative communication device, first hr 92608* each additional 30 min of 92607 04 01/01/14 Y 12.99 4 51.96 * * * 92610 Evaluation of oral & pharyngeal swallowing function 92611 Motion fluoroscopic evaluation of swallowing function by cine or video recording 92626 Evaluation of auditory rehabilitation status, 1 st hour 04 01/01/14 Y 12.99 4 51.96 9.00 4 36.00 92627* Each additional 15 min of 92626 04 01/01/14 Y 12.99 4 51.96 * * * 96105 Assessment of aphasia (incl assessment of expressive & receptive speech & language function, speech production ability, reading,., per hour 96110 Developmental screening, w/interpretation & report, per standarized instrument form 96111 Developmental testing, incl assessment of motor, language, social, adaptive &/or cognitive functioning..

Procedure Code Definition Note Prog Cov Eff Date Modifiers Unit Unit GN GO GP Child (0-20 years) Adult (21-99) 96125 Standardized cognitive performance testing per hour of a qualified health care professional s time 97001** PT Evaluation 04 04/01/04 Y 12.99 8 103.92 9.00 4 36.00 97003 OT Evaluation 04 04/01/04 Y 12.99 8 103.92 9.00 4 36.00 97110** Therapeutic procedure, 1 or more areas, each 15 min, to develop strength & endurance, flex & ROM A 04 04/01/04 Y Y 12.99 4 51.96 9.00 4 36.00

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 92507 92526 Treatment of swallowing dysfuntion and/or oral function for feeding 92507 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, w/ recording 97001 92542 Positional nystagmus test, minimum of 4 positions, w/ recording 97001 92545 Oscillating tracking test, w/ recording 97001 92548 Computerized dynamic posturography 97001 92585 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive 97001 92606 Therapeutic service(s) for the use of a non-speech-generating device, incl programming & modification 92507 92609 Therapeutic services for the use of speech-generating device, incl programming & modification 92507 92630 Auditory rehabilitation; pre-lingual hearing loss 92507 92633 Auditory rehabilitation; post-lingual hearing loss 92507 95831 Muscle testing, manual with report; extremity (excluding hand) or trunk 97001 97003 95832 95831; hand, with or without comparison with normal side 97001 97003 95833 95831; total evaluation of body; excluding hands 97001 97003 95834 95831; total evaluation of body; including hands 97001 97003 95851 Range of motion measurements & report; each extremity (excl hand or each trunk section, spine) 97001 97003 95852 95851; hand, with or without comparison with normal side 97001 97003 95992 Canalith Repositioning procedure 97110 97002 PT Re-evaluation 97110 97004 OT Re-evaluation 97110 97010 Application of modality to 1 or more areas; hot or cold packs (97010-97028 are supervised modalities ) 97110 97110 97012 97010; traction, mechanical 97110 97110 97014 P T Electrical Stimulation 97110 97018 97010; paraffin bath 97110 97110

Procedure Code Definition PT OT ST 97022 97010; whirlpool 97110 97110 97032 Application of modality to 1 or more areas; electrical stim each 15 min (97032-97039 "constant attendandance") 97110 97110 97033 97032; iontophoresis, each 15 min 97110 97110 97034 97032; contrast baths, each 15 min 97110 97110 97035 97032; ultrasound, each 15 min 97110 97110 97110 Therapeutic procedure, 1 or more areas, each 15 min, to develop strength & endurance, flex & ROM 97110 97110 97112 97110; neuromuscular re-education of movement, balance, coordination, posture, sitting/standing activities. 97110 97110 97113 97110; aquatic therapy with therapeutic exercises 97110 97110 97116 97110; gait training 97110 97110 97124 97110; massage, including efflueruage, petrissage and/or tapotement 97110 97110 97140 Manual therapy techniques, 1 or more regions, each 15 min incl mobilization, manipulation, traction. 97110 97110 97530 Therapuetic activities, direct 1 on1 pt contact, each 15 min to improve functional performance 97110 97110 97532 Development of cognitive skills to improve attention, memory, problem solving, direct 1 on 1, each 15 min 97110 97110 92507 97533 Sensory integrative techniquest to enhance sensory procesisng & promote adaptive responses.each 15 min. 97110 97110 97535 Self care/home mngt training, 1 on 1, each 15 min incl meal prep, safety procedures, instruction on adaptive equip. 97110 97110 97537 Community/work reintegration training, 1 on 1 each 15 min incl shopping, $ management, instruction on adaptive equip. 97110 97110 97542*** Wheelchair management, each 15 min 97001 97003 97545 Work hard/condition 1st 2 hrs 97110 97110 97597 Debridement, open wound, incl topical appl, use of whirlpool, suction, sharp selective debride, 1st 20 sq cm. 97110 97110 97598 97597; each additional 20 sq cm 97110 97110 97750**** Physical performance test or measurement, each 15 min 97001 97760 Orthotic mngt & training incl assessment & fitting, upper/lower extremity, trunk, each 15 min 97110 97110 97761 Prosthetic training, upper and/or lower extremity(s), each 15 minutes 97110 97110 97762 Checkout for orthotic/prosthetic use, establish pt, each 15 min 97110 97110

2026 © DocPlayer.net Privacy Policy | Terms of Service | Feedback  | Do Not Sell My Personal Information