MLN Matters Number: MM6254
Related Change Request (CR) #: 6254
Related CR Release Date: October 31, 2008
Effective Date: January 1, 2009
Related CR Transmittal #: R1625CP
Implementation Date: January 5, 2009
Provider Types Affected
Physicians, therapists, and providers of therapy services billing Medicare Carriers, Fiscal Intermediaries (FIs), including Regional Home Health Intermediaries (RHHIs) or Part A/B Medicare Administrative Contractors (A/B MACs) for outpatient rehabilitation therapy services.
What Providers Need to Know
This article is based on Change Request (CR) 6254 and alerts providers to updates to Medicare’s therapy code list with two “sometimes” therapy codes for CY 2009. Note that these codes always represent therapy services and require the use of a therapy modifier when performed by therapists. The two codes added are:
- CPT code 95992 – Standard Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day.
- CPT code 0183T – Low frequency, non-contact, non-thermal ultrasound, including topical applications(s), when performed, wound assessment, and instruction(s) for ongoing care, per day.
Note: If billed by a hospital subject to Outpatient Prospective Payment System (OPPS) for an outpatient service, CPT code 0183T will be paid under the OPPS when the service is not performed by a qualified therapist and it is inappropriate to bill the service under a therapy plan of care. In addition, no Medicare Physician Fee Schedule (MPFS) amount exists for this code. Since the local carrier (or A/B MAC) determines the coverage and pricing for this code, the FI or A/B MAC contacts the local contractor to obtain the appropriate fee schedule amount.
Background
This instruction updates the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the CY 2008 and 2009 HCPCS/CPT-4.
Therapy services, including “always therapy” services, must follow all the policies for therapy services detailed in the Medicare Claims Processing Manual, Chapter 5 which is available at http://www.cms.hhs.gov/manuals/downloads/clm104c05.pdf on the Centers for Medicare & Medicaid Services Web site and the Medicare Benefit Policy Manual, Chapter 12, which is available at http://www.cms.hhs.gov/manuals/Downloads/bp102c12.pdf.
Additional Information
The official instruction (CR 6254) issued to Palmetto GBA, which is at
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Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2008 American Medical Association.