MDS Alert
What Do You Think?
Published on Thu Feb 23, 2012 
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Question:
Answer:
CPT® code 95992 became payable by the Medicare program on January 1, 2011. This code is a per day so regardless of how many times the patient receives canalith re-positioning interventions or how long the treatment lasts, providers may only bill 1 unit of 95992 per day.The Medicare program did not recognize 95992 in 2009 and 2010 and had instructed providers to bill for canalith re-positioning under CPT® code 97112, neuromuscular re-education during those years.
Question:
Can you be reimbursed for other one-on-one codes on the same day you bill 95992 to the Medicare program?Answer:
Effective April 1, 2011, the Medicare program did create new CCI edits when billing 95992 on the same day as any combination of 97110 (therapeutic exercise), 97112 (neuromuscular re-education), 97140 (manual therapy) and 97530 (therapeutic activities). If a provider bills any one or combination of 97110, 97112, 97140 and 97530 on the same day, they are also billing 95992 [and] providers must append modifier-59 [distinct procedural service] to the one-on-one codes on the claim form in order to be reimbursed for all services provided.Documentation must support the need for each service billed and that the services were provided at separate and distinct times of each other.
Editor's note: The preceding Q&As were provided courtesy of
Rick Gawenda, PT, and were previously published in Eli's Rehab Report. Gawenda is principal of Gawenda Consulting and Education (www.gawendaseminars.com). To subscribe to Rehab Report, call 1-877-912-1691.Other Articles in this issue of
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