Rehabilitative Service Codes for Occupational Therapy, Physical Therapy and Speech-Language Pathology
There are no requirements for medical authorization for outpatient rehabilitative and therapeutic services — physical therapy, occupational therapy and speech-language pathology professional services.
Occupational Therapy, Physical Therapy and Speech-Language
Code | Required Modifier | Description |
90901 | GO, GP | Biofeedback training by any modality. For billing electromyography biofeedback only. Not to be used to bill nerve impulse, blood pressure, blood flow, brain waves or oculogram biofeedback. Description of service must be included on claim |
90912 | GO, GP | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry, when performed; initial 15 minutes of one-on-one contact with the patient |
90913 | GO, GP | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one contact with the patient. (List separately in addition to code for primary procedure) |
92507 | GN | Treatment of speech, language, voice, communication or auditory processing disorder; individual |
92508 | Group, 2 or more individuals | |
92521 | GN | Evaluation of speech fluency (for example, stuttering, cluttering) |
92522 | GN | Evaluation of speech sound production (for example, articulation, phonological process, apraxia, dysarthria) |
92523 | GN | Evaluation of speech sound production (for example, articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (for example, receptive and expressive language) |
92524 | GN | Behavioral and qualitative analysis of voice and resonance |
92526 | GN, GO | Treatment of swallowing dysfunction or oral function for feeding |
92626 | GN | Evaluation of auditory rehabilitation status; first hour |
92627 | Each additional 15 minutes (list separately in addition to code for primary procedure) | |
92630 | Auditory rehabilitation; prelingual hearing loss | |
92633 | Postlingual hearing loss | |
97533 | GN, GO, GP | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct patient contact by provider – 15 minutes |
92597 | GN | Evaluation for use or fitting of voice prosthetic device to supplement oral speech |
92605 | Evaluation for prescription of non-speech generating augmentative and alternative communication devices, face-to-face with patient; first hour | |
92618 | Each additional 30 minutes (list separately in addition to code for primary procedure) | |
92607 | Evaluation for prescription speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour | |
92608 | Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure) | |
92610 | GN, GO | Evaluation of oral and pharyngeal swallowing function |
92611 | Motion fluoroscopic evaluation of swallowing function by cine or video recording | |
92612 | GN | Flexible fiber optic endoscopic evaluation of swallowing by cine or video recording |
92614 | Flexible fiber optic endoscopic evaluation, laryngeal sensory testing by cine or video recording | |
92616 | Flexible endoscopic evaluation of swallowing | |
95851 | GO, GP | Range of motion measurements and report; each extremity (excluding hand) or each trunk section |
95852 | Range of motion measurement – hand, with or without comparison to normal side | |
96105 | GN | Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, for example, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour |
96110 | GN, GO, GP | Developmental screening (for example, developmental milestone survey, speech and language delay screen) with scoring and documentation, per standardized instrument |
96112 | Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes | |
96113 | Developmental test administration by qualified health care professional with interpretation and report, additional 30 minutes | |
97161 | GP | Physical therapy evaluation, low complexity |
97162 | Physical therapy evaluation, moderate complexity | |
97163 | Physical therapy evaluation, high complexity | |
97164 | Re-evaluation of physical therapy established plan of care | |
97165 | GO | Occupational therapy evaluation, low complexity |
97166 | Occupational therapy evaluation, moderate complexity | |
97167 | Occupational therapy evaluation, high complexity | |
97168 | Re-evaluation of occupational therapy established plan of care | |
97550 | GN, GO, GP | Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community, initial 30 minutes |
97551 | Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community, each additional 15 minutes | |
97552 | Group caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community |
Occupational Therapy and Physical Therapy
Code | Required Modifier | Description | |
Unattended modalities | |||
97010 | GO, GP | Hot or cold packs | |
97012 | Traction, mechanical | ||
97014 | Electrical stimulation, unattended | ||
97016 | Vasopneumatic devices | ||
97018 | Paraffin bath | ||
97022 | Whirlpool | ||
97024 | Diathermy (for example, microwave) | ||
97026 | Infrared | ||
97028 | Ultraviolet | ||
G0283 | Electrical stimulation to one or more areas for indication(s) other than wound care, as part of a therapy plan of care–do not bill with 97014 | ||
Attended modalities: require constant attendance of therapist | |||
95992 | GO, GP | Canalith repositioning procedure(s) (for example, Epley maneuver, Semont maneuver), per day | |
97032 | Application of a modality to one or more areas; electrical stimulation, manual – 15 minutes | ||
97033 | Iontophoresis – 15 minutes | ||
97034 | Contrast bath – 15 minutes | ||
97035 | Ultrasound – 15 minutes | ||
97036 | Hubbard tank – 15 minutes | ||
Therapeutic techniques with direct patient contact | |||
97110 | GO, GP | Therapeutic procedure, exercises – 15 minutes | |
97112 | Neuromuscular – 15 minutes | ||
97113 | Aquatic therapy – 15 minutes | ||
97116 | Gait training – 15 minutes | ||
97124 | Massage – 15 minutes | ||
97140 | Manual therapy techniques (for example, mobilization or manipulation, manual lymphatic drainage, manual traction), one or more regions – 15 minutes | ||
97530 | Therapeutic activities, direct (one-on-one) – 15 minutes | ||
97535 | Self-care home management training (for example, activities of daily living (ADLs) and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment), direct one-on-one contact – 15 minutes | ||
97537 | Community work reintegration training (for example, shopping, transportation, money management, vocational activities), direct one-on-one contact – 15 minutes | ||
97542 | Wheelchair management (assessment, fitting, training) – 15 minutes | ||
Wound care | |||
97597 | GO, GP | Debridement (for example, high pressure waterjet with or without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (for example, fibrin, devitalized epidermis or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when to perform and instruction(s) for ongoing care, per session, total wound (s) surface area; first 20 square centimeters or less | |
97598 | Debridement, each additional 20 square centimeters (list separately in addition to 97597) | ||
97602 | Removal of devitalized tissues from wound(s), non-selective debridement, without anesthesia (for example, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care | ||
97605 | Negative pressure wound therapy (for example, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment and instruction(s) for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters | ||
97606 | Negative pressure wound therapy, total wound(s) surface area greater than 50 square centimeters | ||
97607 | Negative pressure wound therapy (for example, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment, including provision of exudate management collection system, topical application(s), wound assessment and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters | ||
97608 | Negative pressure wound therapy (for example, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters | ||
Orthotic or prosthetic: assessment and training | |||
97760 | GO, GP | Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) or trunk, initial orthotic(s) encounter, each 15 minutes | |
97761 | Prosthetic(s) training, upper or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes | ||
97763 | Orthotic(s) or prosthetic(s) management or training, upper extremity(ies), lower extremity(ies) or trunk, subsequent orthotic(s) or prosthetic(s) encounter, each 15 minutes | ||
Evaluative, Therapeutic and Rehabilitative
Code | Required Modifier | Description |
92606 | GN | Therapeutic service(s) for the use of non-speech-generating device, including programming and modification |
92609 | Therapeutic services for the use of speech-generating device, including programming and modification | |
92700 | Unlisted otorhinolaryngological service or procedure | |
96125 | GN, GO | Standardized cognitive performance testing (for example, Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report |
97129 | GN, GO, GP | Therapeutic interventions that focus on cognitive function (for example, attention, memory, reasoning, executive function, problem solving or pragmatic functioning) and compensatory strategies to manage the performance of an activity (such as, managing time or schedules, initiating, organizing and sequencing tasks), direct one-on-one patient contact, initial 15 minutes |
97130 | Each additional 15 minutes (list separately from primary procedure) | |
97039 | GO, GP | Unlisted modality – Requires a description or claim attachment; specify type and time if constant attendance |
97139 | Unlisted therapeutic procedure – 15 minutes | |
97150 | Therapeutic procedures group, two or more persons | |
97545 | Work hardening or conditioning, initial 2 hours | |
97546 | Work hardening, each additional hour | |
97750 | Physical performance test or measurement (functional capacity) – 15 minutes | |
97755 | Assistive technology assessment (for example, to restore, augment or compensate for existing function, optimize functional task or maximize environmental accessibility), direct one-to-one contact by provider, with written report, each 15 minutes | |
97799 | Unlisted physical, medical or rehabilitative service or procedure– Requires a description or claim attachment | |
98975 | GN, GO, GP | Remote therapeutic monitoring (for example, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment |
98976 | Supplying one or more devices for remote therapeutic monitoring for respiratory system status: includes scheduled recording and programmed alert transmission, each 30 days | |
98977 | Supplying one or more devices for remote therapeutic monitoring for musculoskeletal system status; includes scheduled recording and programmed alert transmission, each 30 days | |
98980 | Treatment management services for remote therapeutic monitoring, such as for respiratory or musculoskeletal system status; first 20 minutes time in a calendar month, includes at least one interactive communication with the patient or caregiver | |
98981 | Treatment management services for remote therapeutic monitoring, such as for respiratory or musculoskeletal system status; additional 20 minutes in a calendar month, includes at least one interactive communication with the patient or caregiver (List separately in addition to code for primary procedure) |
Speech-Language Screening
Code | Required modifier | Description |
V5362 | GN | Speech screening (articulation) |
V5363 | Language screening (receptive or expressive) | |
V5364 | Dysphagia screening |
©2020 CPT Professional, American Medical Association
Report this page