May 1, 2005
MDCH Outpatient Therapy Services Database (See Database Instructions for futher explanation.)
Outpatient Physical Therapy and Occupational Therapy Services The following codes are to be billed with revenue codes 042x or 043x as appropriate HCPCS REQUIRED CODE MODIFIER 92526 95851 95852 97001 97002 97003 97004 97012 97014 97016 97018 97020 97022 97024 97026 97028 97032 97033 97034 97035 97036 97039 97110 97112 97116 97124 97139 97140 97504 97520 97530 97535 97542 97799 CODE DESCRIPTION ORAL FUNCTION THERAPY RANGE OF MOTION MEASUREMENTS RANGE OF MOTION MEASUREMENTS PT EVALUATION PT RE-EVALUATION OT EVALUATION OT RE-EVALUATION MECHANICAL TRACTION THERAPY ELECTRIC STIMULATION THERAPY VASOPNEUMATIC DEVICE THERAPY PARAFFIN BATH THERAPY MICROWAVE THERAPY WHIRLPOOL THERAPY DIATHERMY TREATMENT INFRARED THERAPY ULTRAVIOLET THERAPY ELECTRICAL STIMULATION ELECTRIC CURRENT THERAPY CONTRAST BATH THERAPY ULTRASOUND THERAPY HYDROTHERAPY PHYSICAL THERAPY TREATMENT THERAPEUTIC EXERCISES NEUROMUSCULAR REEDUCATION GAIT TRAINING THERAPY MASSAGE THERAPY PHYSICAL MEDICINE PROCEDURE MANUAL THERAPY ORTHOTIC TRAINING PROSTHETIC TRAINING THERAPEUTIC ACTIVITIES SELF CARE MNGMENT TRAINING WHEELCHAIR MNGMENT TRAINING PHYSICAL MEDICINE PROCEDURE STATUS MAXIMUM CODE FEE A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A M $47.58 $11.41 $8.18 $43.06 $22.82 $46.07 $27.77 $8.40 $8.18 $7.97 $3.66 $2.80 $8.40 $3.01 $2.80 $3.44 $9.04 $11.63 $7.97 $6.89 $13.13 $6.67 $15.93 $16.79 $13.99 $12.70 $9.04 $15.07 $17.44 $15.93 $16.79 $17.01 $15.93 $0.01 LIMITS 36 PER 3 MONTHS PA N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N Y AGE LIMITS 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-099
GO GP GO GP
GO GP
GO GP
GO GP GO GP GO GP GO GP GO GP GO GP GO GP GO GP GO GP GO GP
2 PER YEAR 2 PER YEAR 2 PER YEAR 2 PER YEAR 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS 36 SESSIONS PER 3 MONTHS
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May 1, 2005
MDCH Outpatient Therapy Services Database (See Database Instructions for futher explanation.)
Outpatient Speech Therapy Services The following codes are to be billed with revenue codes 044x as appropriate. HCPCS REQUIRED CODE MODIFIER 31579 92506 92507 92508 92520 92526 92597 92601 92602 92603 92604 92607 92608 92609 92610 92700 94010 96115 97532 97533 97799 CODE DESCRIPTION DIAGNOSTIC LARYNGOSCOPY SPEECH/HEARING EVALUATION SPEECH/HEARING THERAPY SPEECH/HEARING THERAPY LARYNGEAL FUNCTION STUDIES ORAL FUNCTION THERAPY ORAL SPEECH DEVICE EVAL COCHLEAR IMPLT F/UP EXAM <7 REPROGRAM COCHLEAR IMPLT <7 COCHLEAR IMPLT F/UP EXAM 7> REPROGRAM COCHLEAR IMPLT 7> EX FOR SPEECH DEVICE RX, 1 HR EX FOR SPEECH DEVICE RX ADDL USE OF SPEECH DEVICE SERVICE EVALUATE SWALLOWING FUNCTION ENT PROCEDURE/SERVICE BREATHING CAPACITY TEST NEUROBEH STATUS EXAM PER HR COGNITIVE SKILLS DEV 15 MIN SENSORY ITEGRATION 15 MIN PHYSICAL MEDICINE PROCEDURE STATUS CODE A A A A A A A A A A A A A A A M A A A A M $134.13 $74.92 $35.52 $16.79 $27.99 $47.58 $55.55 $76.86 $52.75 $47.58 $30.57 $67.39 $12.92 $35.09 $75.57 $0.01 $18.73 $41.77 $13.99 $14.86 $0.01 LIMITS 2 PER YEAR 36 PER 3 MONTHS 36 PER 3 MONTHS 36 PER 3 MONTHS 1 PER 3 YEARS 1 PER YEAR 2 PER YEAR 1 PER YEAR 2 PER YEAR 1 PER 3 YEARS 10 PER 3 YEARS 2 PER YEAR 4 PER YEAR PA N N N N N N N N N N N N N N N Y N N N N Y AGE LIMITS 000-099 000-099 000-099 000-099 000-099 000-099 000-099 000-006 000-006 007-099 007-099 000-099 000-099 000-099 000-099 000-999 000-099 000-099 000-099 000-099 000-099
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