August 16, 2018
Physical, Occupational and Chiropractic therapies are the cornerstone for healing for many injured workers. This function plays an important role in getting workers back on the job and feeling better. Department of Labor & Industry posts Instruction sets for physical rehabilitation (see below for website links). These should be used in conjunction with the Montana Utilization and Treatment Guidelines (U&T) at http://mtguidelines.com/.
Montana Professional Fee Schedule
Services should be within the Utilization and Treatment Guidelines at www.mtguidelines.com.
If a physical therapy/modality is not listed in the Utilization and Treatment Guideline (U&T) or goes over the maximum threshold, services must be pre-authorized by Montana State Fund. Treatment should be directly related to the accepted part of body unless pre-authorized.
Timed Modalities (also applies to Facility services effective 7/1/2014) Services of less than 8 minutes when that is the only service performed during a visit is not billable. Time intervals are incremented in 15 minute units (base is 8 minutes):
8-22 minutes = 1 unit
23-37 minutes = 2 units
38-52 minutes = 3 units
53-67 minutes = 4 units etc
When more than one service of a timed modality is performed in a single day, the total minutes of the service performed should be included in the patient record to substantiate the level of service. A total of 8 units of active and passive therapy may be billed per visit. If active therapy is being applied, only two units of a passive modality may be included in the 8 units.
Passive therapies (listed in U&T Guidelines) will be limited to 4 units per visit, if only passive therapy is being applied. Note: Only 2 units may be billed if active therapy is being applied.
All timed codes must have the time documented (in minutes) in the office notes submitted for each code billed for reimbursement.
Therapy codes billed must have part of body documented or it must be clearly identified in a flow sheet or other attached documentation. If the procedures are clearly documented in the notes, a flow sheet is unnecessary. If the notes do not support the procedures billed but refers to a flow sheet then the flow sheet must be attached.
Passive vs Active
Passive modalities utilize a tool to cause an effect (i.e. electrical stimulation, hot/cold packs, iontophoresis, ultrasound, etc.).
Passive therapeutic procedures are procedures that do not require energy on the part of the patient (i.e. massage, manual therapy, etc.) and are considered with the active therapy for purposes of the rule of Eights.
|97010||Hot or cold packs – one or more regions|
|97012||Traction – mechanical|
|97014||Electrical stimulation (unattended)|
|97024||Diathermy (e.g. microwave)|
|97032||Electrical stimulation (manual) one or more areas, ea 15 minutes|
|97033||Iontophoresis, ea 15 minutes|
|97034||Contrast Baths, ea 15 minutes|
|97035||Ultrasound, ea 15 minutes|
|97036||Hubbard tank, ea 15 minutes|
|97039||Unlisted modality, specify type and time if constant attendance|
Active/Passive Therapeutic Procedures:
|CPT Code||Description||Passive or Active|
|97110||Therapeutic Procedure, 1 or more areas, each 15 minutes. Therapeutic exercises to develop strength, endurance, range of motion and flexibility.||Active|
|97113||Aquatic therapy with therapeutic exercises||Active|
|97116||Gait training (includes stair climbing)||Active|
|97139||Unlisted therapeutic procedure. ** Passive or Active will depend upon the procedure.||Passive or Active**|
|97140||Manual therapy, ea 15 minutes. NOTE: This is passive unless billed with an active procedure – in that case it would be considered active.||Passive|
|97150||Therapeutic procedure(s), group (2 or more individuals)||Active|
|97530||Therapeutic activities, direct (one-on-one) pt contact, ea 15 minutes.||Active|
|97532||Development of cognitive skills to improve attention, memory, problem solving, direct (one-on-one) pt contact, ea 15 minutes.||Active|
|97533||Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) pat contact, ea 15 minutes.||Active|
|97535||Self-care/home management training, direct (one-on-one) pt contact, ea 15 minutes.||Active|
|97537||Community/Work reintegration training, direct (one-on-one) pt contact, ea 15 minutes.||Active|
|97542||Wheelchair management ea 15 minutes||Active|
|97545||Work hardening/conditioning, initial 2 hours||Active|
|97546||Work hardening/conditioning, ea addl hour||Active|
|97799||97799 Unlisted physical medicine/rehabilitation service or procedure. **Passive or Active will depend upon the procedure.||Passive or Active**|
|98940||Chiropractic manipulative treatment, spinal 1-2 regions||Passive|
|98941||Chiropractic manipulative treatment, spinal 3-4 regions||Passive|
|98942||Chiropractic manipulative treatment, spinal 5 regions||Passive|
|98943||Extraspinal, 1 or more regions||Passive|