Therapy Services Coding Requirements Updated

The Centers for Medicare & Medicaid Services (CMS) updated the therapy services chapter of the Medicare Claims Processing manual to reflect the extension of the therapy caps exceptions process to Dec. 31, 2009, mandated by the Medicare Improvements for Patients and Providers Act (MIPAA) of 2008. CMS also added HCPCS Level II coding requirements.

When performed by a therapist, codes 95992 (Standard Canalith repostionary procedure(s) (eg, Epley maneuver, Semont maneuver), per day) and 0183T (Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day) always represent therapy services and require a therapy modifier.

The physician fee schedule abstract file does not contain a price for 0183T, since it is priced by the carrier. If billed by a hospital subject to the Outpatient Prospective Payment System (OPPS) for an outpatient service, 0183T—also referred to as a “sometimes therapy” service—will be paid under the OPPS when the service is not performed by a qualified therapist and it is appropriate to bill the service under a therapy plan of care.

For more information on the therapy caps exceptions process, read CMS Transmittal 1631, Change Request 6222, released Nov. 7.

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6 Responses to “Therapy Services Coding Requirements Updated”

  1. Susan Waremburg says:

    In the online test for this CEU, the correct answer is not accepted. There is only one HCPCS Level II code in the choices, but none of the answers are accepted in this test. Did anyone else experience difficulty with this? This has happened to me on other tests…I mark the right answer and it says to correct it…mark a different answer and am prompted to correct it…mark the correct answer a second time and it passes.

  2. Pam Gordon says:

    I had the same problem. Although, I never did get it to accept the correct answer.

  3. Patsy Oglesby says:

    I had the same problem as the other two commentors. The correct answer was never accepted (I don’t think “all of the above”-which was accepted-is correct.) I have had this same problem with other self tests on the website.
    Thanks

  4. Julie K. Collins, CPC says:

    I agree with Susan, Pam & Patsy, the only accepted answer is d. all of the above which is not correct, since b. 0183T is the only HCPCS code and therefore the correct response. I am emailing AAPC customer service to clarify this.
    Thanks!

  5. D. Huber,CPC says:

    Same here. It has happened to me several times and I know I’ve had the correct answer. Someone in customer service needs to take some of these test to see what we are talking about. Maybe that will help. It often makes me second guess myself. They also do not make it easy to locate the answers. I do not have hours to devote for something I’m only getting .50 CEU for.

  6. A. Witko says:

    The answer D is correct for this question, however, the question wording is incorrect. It should read Level II HCPCS/CPT codes, as per Transmittal 1631. If you read this transmittal from CMS, go down to pages 25 and 26 and look at the chart they have. All three of these codes are listed and all three have a “+” next to them delineating that they sometimes represent therapy services. If, however, they are performed by a therapist, they always represent therapy services and require the use of a therapy modifier.

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