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TRANSMITTAL 515
THERAPY CODE LISTS
Transmittal 515 of April 1, 2005 replaces Transmittal 463 and will be implemented July 5, 2005. The effective date is January 3, 2005.
The Medicare physician fee schedule is used as a method of payment for outpatient rehabilitation and certain audiology services furnished as an outpatient in a hospital setting.
CMS identifies the chart below as codes for therapy services. Therapy services include: physical therapy, occupational therapy and speech-language pathology services.
| 64550 |
90901 |
92506 |
92507 |
92508 |
92526 |
| 92597 |
92605 |
92606 |
92607 |
92608 |
92609 |
| 92610 |
92611 |
92612 |
92614 |
92616 |
95831 |
| 95832 |
95833 |
95834 |
95851 |
95852 |
96105 |
| 96110√ |
96111√ |
96115√ |
97001 |
97002 |
97003 |
| 97004 |
97010 |
97012 |
97016 |
97018 |
97020 |
| 97022 |
97024 |
97026 |
97028 |
97032 |
97033 |
| 97034 |
97035 |
97036 |
97039 |
97110 |
97112 |
| 97113 |
97116 |
97124 |
97139 |
97140 |
97150 |
| 97504 |
97520 |
97530 |
97532 |
97533 |
97535 |
| 97537 |
97542 |
97597 |
97598 |
97602 |
97605 |
| 97606 |
97703 |
97750 |
97755 |
97799 |
G0279 |
| G0280 |
G0281 |
G0283 |
G0329 |
0029T |
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Codes on the above list always represent therapy services when performed by a therapist; and always require a therapy modifier (GP = physical therapist, GO = occupational therapist, GN = speech-language pathologist).
Codes that are not on the list above should NOT be listed on the bill with a modifier. Examples of these codes include: 95860, 95861, 95863, 95864, 95867, 95869, 95870, 95900, 95903, 95904, 95934, G0237, G0238 and G0239.
If codes listed on the chart with a “√” are billed by an outpatient hospital department, these codes are paid using the outpatient prospective payment system
(OPPS).
Modifiers -GP, -GO and -GN refer to services provided under a plan of care for physical therapy, occupational therapy or speech-language pathology services. They should never be used with codes that are not on the list of applicable therapy services.
Review your hospital’s CDM and be sure that rehabilitation modifiers are listed correctly!
OHIO MEDICAID OBSERVATION SERVICES
Reminder! Effective October 16, 2003 coding changes for reporting observation services to ODJFS were made due to the implementation of HIPAA. To summarize:
- Local level X codes were no longer valid and hospitals were required to use the appropriate CPT codes.
- The following CPT codes were added to the outpatient fee schedule:
99218 Initial obs care, per day, low complexity
99219 Initial obs care, per day, moderate complexity
99220 Initial obs care, per day, high complexity
99234 Obs, admit and discharge same date, low complexity
99235 Obs, admit and discharge same date, moderate complexity
99236 Obs, admit and discharge same date, high complexity
It is important to note that CPT codes 99218-99220 should be reported with 1 unit per day. CPT codes 99234-99236 should only be reported with 1 unit. The CPT definitions should be used when reporting these observation codes.
ODJFS des not edit the number of units for these observation codes so be sure the CPT code is reported with the appropriate number of units, or your facility could be receiving an overpayment from
ODJFS.
TRANSMITTAL 18
BILLING FOR BLOOD AND BLOOD PRODUCTS
Section 231. on Billing and Payment for Blood and Blood Products was added to the Medicare Claims Processing Manual. Implementation for the proper coding of blood and blood products is July 5, 2005.
The following paragraphs will summarize this new section of the Manual:
A provider should use revenue code 0390 (blood processing/storage) or 0399 (blood processing/storage, other processing and storage) when an OPPS provider processes blood or a blood product from a community blood bank for which it is charged only the processing and storage costs incurred by the community blood bank along with the blood HCPCS code, number of units transfused and the date of service.
If a provider pays for the actual blood in addition to paying for processing and storage costs when blood is supplied by a community blood bank or the provider’s own blood bank, the provider must separate the charge for the units of blood from the charge for processing and storage. The charges for the blood should be reported with revenue code 38X, date of service, number of units transfused, blood projects (HCPCS code) and modifier –BL. The charges for processing and storage should be reported on a separate line with revenue code 0390/0399, the date of service, number of units transfused, blood product (HCPCS code) and modifier –BL.
Whenever a charge is reported for the blood product using revenue code 38X, the provider must also report a charge for processing and storage services on a separate line with revenue code 0390-0399. The same date of service, number of units, HCPCS code and modifier –BL must be reported on both lines.
When autologous or directed-donor transfusion is performed, the provider should bill for the transfusion service and the number of units of the appropriate HCPCS code that describes the blood product. This service should be billed on the date the transfusion occurred. When an autologous blood product is collected but not transfused, providers should bill CPT code 86890 (autologous blood or component, collection, processing and storage, predeposited) or CPT code 86891 (autologous blood or component, collection, processing and storage, intra- or post-operative salvage) and the number of units collected but not transfused. CPT codes 86890 or 86891 should be billed on the date when the provider is certain the blood will not be transfused.
HCPCS code P9011 (blood, split unit) was created to be reported when a unit of blood or blood product is split. When the patient receives a transfusion of a split unit of blood, the provider should bill P9011 for the blood product transfused and CPT code 86985 for each splitting procedure performed to prepare the blood product for a patient.
When a patient receives a transfusion of an irradiated product, if a code exists, the provider should bill the HCPCS code, which specifically describes the irradiated product. If a specific code does not exist then the HCPCS code for the blood product should be listed along with CPT code 86945 (irradiation of blood product, each unit).
When blood has been frozen and thawed for the patient prior to a transfusion, a HCPCS code that describes the frozen and thawed product should be reported. If a specific code does not exist, then report HCPCS code for the blood product and CPT codes for freezing and thawing that are not already in the description of the blood product code.
Apheresis/pheresis services are billed on a per visit basis, not on a per unit basis.
To report the charge for the transfusion service, the CPT code for the transfusion service provided should be listed with revenue code 391. Transfusion services are billed on a per service basis not by the number of products transfused. A blood product code is required when billing a transfusion code.
For clarification or further details, refer to Section 231 of the Medicare Claims Processing Manual.
NEW EDIT 73
A new edit, 73 (incorrect billing of blood and blood products), will be initiated July 5, 2005. The claim will be returned to the provider (RTP) if blood products are billed with revenue code 39X and modifier –BL without a corresponding line item with revenue code 38X.
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