Medicaid Billing CPT Codes: Physical Therapy



Medicaid Billing CPT Codes: Physical Therapy

|CPT CODE |DESCRIPTION |SPECIAL RULES |SESSION TIME/UNITS |

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|97001 |PHYSICAL THERAPY EVALUATION | |1per session |

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|97002 |PHYSICAL THERAPY RE-EVALUATION | |1per session |

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|97036 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HOT OR |See Footnote |1per session |

| |COLD PACKS | | |

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|97036 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION,|See Footnote |1per session |

| |MECHANICAL | | |

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|97014 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; |See Footnote |1per session |

| |ELECTRICAL STIMULATION (UNATTENDED) | | |

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|97016 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; |See Footnote |1per session |

| |VASOPNEUMATIC DEVICES | | |

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|97018 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN|See Footnote |1per session |

| |BATH | | |

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|97022 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; |See Footnote |1per session |

| |WHIRLPOOL BATH | | |

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|97024 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; |See Footnote |1per session |

| |DIATHERMY (EG, MICROWAVE) | | |

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|97026 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED|See Footnote |1per session |

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|97028 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; |See Footnote |1per session |

| |ULTRAVIOLET | | |

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|97032 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; | |15 minutes |

| |ELECTRICAL STIMULATION (MANUAL) EACH 15 MINUTES | | |

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|97033 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; | |15 minutes |

| |IONTOPHORESIS, EACH 15 MINUTES | | |

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|97034 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST| |15 minutes |

| |BATHS, EACH 15 MINUTES | | |

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|With one | | | |

|exception, | | | |

|providers should| | | |

|not report more | | | |

|than one | | | |

|physical | | | |

|medicine and | | | |

|rehabilitation | | | |

|therapy service | | | |

|for the same 15 | | | |

|minute period | | | |

| | | | |

|97035 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; | |15 minutes |

| |ULTRASOUND THERAPY, EACH I5 MINUTES | | |

|Footnote: With one exception providers should not report more than one physical medicine and rehabilitation therapy service for the same fifteen minute time |

|period. (The only exception involves a ”supervised modality” defined by CPT codes 97010-97028 which may be reported for the same fifteen minute time period |

|as other therapy services.) |

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Medicaid Billing CPT Codes: Physical Therapy (continued)

|CPT CODE |DESCRIPTION |SPECIAL RULES |SESSION TIME/UNITS |

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| | | | |

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|97036 |APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD | |15 minutes |

| |TANK, EACH 15 MINUTES | | |

| | | | |

|97110 |THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;| |15 minutes |

| |THERAPEUTIC EXERCISES TO DEVELOP STRENGTH AND ENDURANCE, | | |

| |RANGE OF MOTION AND FLEXIBILITY | | |

| | | | |

| | | | |

| | |Intended to Identify therapeutic exercise | |

|97112 |THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;|designed to re-train a body part to perform |15 minutes |

| |NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALANCE, |some task that the body part was previously | |

| |COORDINATION, KINESTHETIC SENSE, POSTURE, AND/OR |able to do. This will usually be in the form of| |

| |PROPRIOCEPTION FOR SITTING AND/OR STANDING ACTIVITIES |some commonly performed task for that body | |

| | |part. Some common examples include | |

| | |Proprioceptive Neuromuscular | |

| | |Facilitation(PNF). Feldenkreis, Bobath, BAP's | |

| | |Boards, and desensitization techniques | |

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|97113 |THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH I5 MINUTES;| |15 minutes |

| |AQUATIC THERAPY WITH THERAPEUTIC EXERCISES | | |

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|97116 |THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH I5 MINUTES;| |15 minutes |

| |GAIT TRAINING (INCLUDES STAIR CLIMBING) | | |

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|97124 |THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH I5 MINUTES;| |15 minutes | |

| |MASSAGE, INCLUDING | | | |

| |EFFLEURAGE, PETRISSAGE AND/OR TAPOTEMENT (STROKING, | | | |

| |COMPRESSION, PERCUSSION) | | | |

| | | | | |

| | | | | |

| | |Therapist performing massage as a manual | |

| |MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION,|therapy technique in order to increase active |15 minutes |

|97140 |MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTION), |pain-free range of motion, increase | |

| |1 OR MORE REGIONS, EACH 15 MINUTES |extensibility of myofascial tissue and | |

| | |facilitate the return to functional activities.| |

| | |Each 15 minutes should be reported. | |

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|97150 |THERAPEUTIC PROCEDURE(S). GROUP (2 OR MORE INDIVIDUALS) | |1per session |

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