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    August 16, 2018

    Physical Rehabilitation

    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
    https://mtwc.optum.com/documentations/2018ProfessionalFeeScheduleInstructionFinalafterRules.pdf


    Montana Facility Fee Schedule

    http://erd.dli.mt.gov/Portals/54/Documents/Work-Comp-Claims/Medical-Regs/FacilityFeeSchedules/FY2019/2018FacilityFeeScheduleInstructionSet.pdf.

    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.


    Passive Modalities

    CPT CodeDescription
    97010Hot or cold packs – one or more regions
    97012Traction – mechanical
    97014Electrical stimulation (unattended)
    97016Vasopneumatic devices
    97018Paraffin bath
    97022Whirlpool
    97024Diathermy (e.g. microwave)
    97026Infrared
    97028Ultraviolet
    97032Electrical stimulation (manual) one or more areas, ea 15 minutes
    97033Iontophoresis, ea 15 minutes
    97034Contrast Baths, ea 15 minutes
    97035Ultrasound, ea 15 minutes
    97036Hubbard tank, ea 15 minutes
    97039Unlisted modality, specify type and time if constant attendance

    Active/Passive Therapeutic Procedures:

    CPT CodeDescriptionPassive or Active
    97110Therapeutic Procedure, 1 or more areas, each 15 minutes. Therapeutic exercises to develop strength, endurance, range of motion and flexibility.Active
    97112Neuromuscular re-educationActive
    97113Aquatic therapy with therapeutic exercisesActive
    97116Gait training (includes stair climbing)Active
    97124MassagePassive
    97139Unlisted therapeutic procedure. ** Passive or Active will depend upon the procedure.Passive or Active**
    97140Manual therapy, ea 15 minutes. NOTE: This is passive unless billed with an active procedure – in that case it would be considered active.Passive
    97150Therapeutic procedure(s), group (2 or more individuals)Active
    97530Therapeutic activities, direct (one-on-one) pt contact, ea 15 minutes.Active
    97532Development of cognitive skills to improve attention, memory, problem solving, direct (one-on-one) pt contact, ea 15 minutes.Active
    97533Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) pat contact, ea 15 minutes.Active
    97535Self-care/home management training, direct (one-on-one) pt contact, ea 15 minutes.Active
    97537Community/Work reintegration training, direct (one-on-one) pt contact, ea 15 minutes.Active
    97542Wheelchair management ea 15 minutesActive
    97545Work hardening/conditioning, initial 2 hoursActive
    97546Work hardening/conditioning, ea addl hourActive
    9779997799 Unlisted physical medicine/rehabilitation service or procedure. **Passive or Active will depend upon the procedure.Passive or Active**
    98940Chiropractic manipulative treatment, spinal 1-2 regionsPassive
    98941Chiropractic manipulative treatment, spinal 3-4 regionsPassive
    98942Chiropractic manipulative treatment, spinal 5 regionsPassive
    98943Extraspinal, 1 or more regionsPassive