2011 Update to Therapy Code List

The Centers for Medicare & Medicaid Services (CMS) instructs contractors in Change Request (CR) 7364 to update the therapy code list with an additional “sometimes therapy” code.

Providers should be aware that, effective Jan. 1, 2011, CPT® code 95992 Standard Canalith repositioning procedure(s) (eg, Eply maneuver, Semont maneuver), per day has been added to the therapy code list.

This code represents a therapy service and requires a therapy modifier unless it is inappropriate to bill the service under a therapy plan of care, and it is billed by a practitioner or provider who is not a therapist (i.e., physician, clinical nurse specialist, nurse practitioner (NP), or psychologist), or it is billed to a fiscal intermediary (FI) by a hospital as an outpatient service.

When 95992 is rendered by a physician or NP with the goal of rehabilitation, a modifier is required.

Contractors will not search for and adjust claims processed before the implementation date (July 5), but will adjust claims brought to their attention.

Source: CMS Transmittal 2175, issued March 18


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