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.