CPT 97610 Makes the “Sometimes Therapy” List
Replacing Category III code 0183T, new CPT® medicine code 97610 Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day has been added to Medicare’s list of designated “sometimes therapy” services, effective Jan. 1, 2014.
“This is low frequency, non-contact, non-thermal ultrasound modality used to promote the healing of wounds (such as pressure ulcers) using acoustic or sound energy to atomize saline and deliver ultrasound energy by way of continuous mist to the wound bed and surrounding tissue,” according to CPT® Changes 2014: An Insiders View.
For example, the guide continues:
“A 68-year-old presents with a history of a persistent lower extremity ulcer. The area is painful and has an indurated margin, and the wound bed is pale pink in color with minimal yellow/white slough. Low frequency ultrasound is delivered to the patient by a qualified healthcare professional.”
Under the Outpatient Prospective Payment System (OPPS), separate payment is provided for “sometimes therapy” services when furnished to a hospital outpatient as non-therapy service (i.e., without a certified therapy plan of care). Medicare allows payment at 80 percent of the lesser of the actual charge or the applicable fee schedule amount for all outpatient therapy services (physical therapy, speech-language pathology, occupational therapy).
To be paid appropriately for an outpatient non-therapy service under the OPPS, hospitals should not append modifier GP Physical therapy, GO Occupational therapy, or GN Speech-language pathology or a revenue code (042x 043x, 044x) to the claim. Doing so would result in an overpayment (100 percent the actual charge, instead of 80 percent).
To receive payment under the Medicare Physician Fee Schedule (MPFS) for “sometimes therapy” services, however, providers should append the appropriate therapy modifier and revenue code.
See the Medicare Claims Processing Manual, chapter 4 – Part B Hospital (Including Inpatient Hospital Part B and OPPS), section 200.9, for specific guidance and the list of services designated as “sometimes therapy” that may be paid as non-therapy services for hospital outpatients.