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SHS Programe Services Equpment
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Possible CPT Codes for MDs, DOs, DPMs & DCs
For Serenity Health Systems' Programs

LIMITATIONS

Serenity Health Systems (SHS) does not guaranty in any manner the truth or accuracy of any information contained herein.  The information contained herein was compiled from anecdotal information furnished by various users of physical rehabilitation equipment, and no attempt was made by SHS or any other party to confirm such.  No person should rely on the information contained herein in any manner, including for billing purposes, but instead should perform their own independent investigation.

SHS makes no representation whatsoever, as to the current or future reimbursement status, or what level of reimbursement payers may provide (if any) in connection with the provision of rehabilitation services.

SHS HEREBY SPECIFICALLY DISCLAIMS ANY LIABILITY OR RESPONSIBILTY TO ANY PERSON FOR THEIR USE OF THIS DOCUMENT OR THE INFORMATION CONTAINED THEREON
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INITIAL EXAMINATIONS:

#99202:  Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: (1) an expanded problem focused history; (2) an expanded problem focused examination; and (3) straightforward medical decision making.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family.

#99203:  Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: (1) a detailed history; (2) a detailed examination; and (3) medical decision making of low complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.

#99204:  Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: (1) a comprehensive history; (2) a comprehensive examination; and (3) medical decision making of moderate complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family.

WEEKLY FOLLOW-UP EXAMINATIONS:

#99212:  Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: (1) a problem focused history; (2) a problem focused examination; (3) straightforward medical decision making.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family.

#99213:  Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: (1) an expanded problem focused history; (2) an expanded problem focused examination; (3) medical decision making of low complexity.

Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.

#99214:  Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: (1) a detailed history; (2) a detailed examination; (3) medical decision making of moderate complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.

POTENTIAL TREATMENTS for MEDICAL DOCTORS with a PT*:

The following services may be billed if performed:

#97010:    Application of a modality to one or more areas; hot or cold packs.
#97012:    Application of a modality to one or more areas; traction, mechanical.
#97014:    Application of a modality to one or more areas; electrical stimulation (unattended), each 15 minutes.


CPT Code: Charges: Collected:    
Treatment Billed Medicare In-Network Out-Network
97010: Heat/Ice*  $25       $0      $0-$10     $18-$20
97012: Traction/Mechanical*  $45     $15    $20-$30     $32-$36
7014: Unattended E-Stem*  $45       $0    $20-$30     $32-$36

CONSTANT ATTENDANCE:

The following services may be billed if performed:

#97032:    Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes.
#97033:    Application of a modality to one or more areas; iontophoresis, each 15 minutes
#97035:    Application of a modality to one or more areas; ultrasound, each 15 minutes



CPT Code: Charges: Collected:    
Treatment Billed Medicare In-Network Out-Network
97032: Electric Stem*  $45      $16    $20-$30     $32-$36
97033: Iontophoresis*  $45      $16    $20-$30     $32-$36
97035: Ultrasound*  $45      $13    $20-$30     $32-$36

THERAPEUTIC PROCEDURES:

The following services may be billed if performed:

#97110:  Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility.

#97112:  Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

#97124:  Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion), each 15 minutes

#97140:  Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.

#97150:  Therapeutic procedure(s), group (2 or more individuals), each 15 minutes. [Report 97150 for each member of the group.]

#97530:  Therapeutic activities, direct (one on one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes.



CPT Code: Charges: Collected:    
Treatment Billed Medicare In-Network Out-Network
97110: Therapeutic Exercise*  $60      $29    $30-$40     $42-$48
97212: Neuromuscular Re-ed.*  $60      $29    $30-$40     $42-$48
97140: Manual Therapy*  $60      $29    $30-$40     $42-$48
97530: Therapeutic Activities*  $60      $29    $30-$40     $42-$48

* Depending on the physician's determination of medical necessity, these codes could be recommended to the physical therapist as treatments to be provided to a patient.  These codes have been chosen simply as an example of the possible treatments that could be used during a typical SHS session.  Each physician is responsible for their appropriate recommendations.
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