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.
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.