Canalith Repositioning/Epley Maneuver Update

Question: Our therapist recently saw a patient for whom she performed an Epley maneuver for the treatment of benign paroxysmal positional vertigo (BPPV). In researching how to code for this, I came across a 2010 article in AAPC’s Coding Edge stating that Medicare will not pay for the procedure. Is this true?
Answer: In 2009, CPT® added 95992 Canalith repositioning procedure(s) (e.g. Epley maneuver, Semont maneuver), per day for canalith repositioning, which involves therapeutic maneuvering of the patient’s body and head to redeposit calcium crystal debris in the semicircular canal system, for treatment of BPPV.
The Centers for Medicare & Medicaid Services (CMS) initially assigned a “B” (bundled) status indicator to 95992, such that no separate Medicare payment was available for the service (payment was bundled to any E/M service provided on the same date). This was especially problematic for therapists, who are not allowed to bill E/M codes. CMS later issued guidance allowing therapists to report 97112 Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities for the service (maximum one unit per day, per patient).
Since that time, CMS has revised its guidance once again. Beginning with the 2011 National Physician Fee Scheduled Relative Value File, CMS has assigned an “A” (active) status to 95992, which means Medicare now recognizes the code for payment. Physical therapists may now submit 95992 for payment for canalith repositioning.

John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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