Provider Connection

Medical Bill Coding

Dry Needling – The Code Dilemma
Billing for dry needling tends to bring up questions regarding code selection as there isn’t a code that specifically describes this procedure.  Some publications advise using 97140 (manual therapy techniques) or 97112 (neuromuscular re-education) depending upon the purpose of the service.  Others advise using 97799 (unlisted physical medicine/rehabilitation service or procedure) or 97139 (unlisted therapeutic procedure).  Montana State Fund has determined that 97139 may be billed for dry needling services when billing Montana State Fund.   NOTE:  This is only a Montana State Fund recommendation and may be different from other carriers.


Physical Therapy Timed Codes
Time is an element of many physical rehabilitation modalities and procedure codes.  When billing these services, time for each timed code must be documented in the record to support what is billed.  If the time spent on a timed code is less than 8 minutes and is not the only timed service billed, then the time can be added to the total time to determine the number of units that can be billed:

8-22 minutes = 1 unit

23-37 minutes = 2 units

38-52 minutes = 3 units

53-67 minutes = 4 units etc

Note:  Please bill for services provided – do not combine total time and bill for the highest reimbursed service only, this will result in a denial.

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 actual time spent 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 and must be related to the injury. 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, please include the flow sheet with the bill and other documentation.

Rule of Eights:  Providers are allowed a total of 8 units of active/passive therapeutic procedures per visit with these exceptions:

  • If active/passive therapeutic procedures are utilized:
    • only 2 units may be a passive modality per visit.
  • If only passive modalities and/or passive therapeutic procedures are being utilized, only 4 units

may be billed per visit.

NOTE:  If a physical therapy/modality is not listed in the Utilization and Treatment Guideline (U&T) or goes over the maximum threshold, be sure to get pre-authorization.

 

Passive Modalities

CPT Code Description
97010 Hot or cold packs – one or more regions
97012 Traction – mechanical
97014 Electrical stimulation (unattended)
97016 Vasopneumatic devices
97018 Paraffin bath
97022 Whirlpool
97024 Diathermy (e.g. microwave)
97026 Infrared
97028 Ultraviolet
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, ea 15 minutes.  Therapeutic exercises to develop strength, endurance, range of motion and flexibility. Active
97112 Neuromuscular re-education, ea 15 minutes Active
97113 Aquatic therapy with therapeutic exercises, ea 15 minutes Active
97116 Gait training (includes stair climbing), ea 15 minutes Active
97124 Massage, ea 15 minutes Passive
97139 Unlisted therapeutic procedure.  ** Passive or Active will depend upon the procedure. Passive or Active**
97140 Manual therapy, ea 15 minutesNOTE:  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

 

 

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Bill Status – 1-866-274-7464

Main Phone Number 406-495-5000 or 800-332-6102

Main Fax  406-495-5020

Medical Team – 406-495-5011

Submit your Claims and/or Correspondence To
Montana State Fund
PO Box 4759
Helena, MT  59604

RMS (Bill Status)
Phone  866-274-7464
Email customer.care@risingms.com

For questions about information in this bulletin, call 800-332-6102 and ask for a member of the Medical Team.
For questions about Advanced Nurse Review contact Kym Vonada at 406-495-5389.


Medical Team

Michele Fairclough
Medical Team Leader
406-495-5362

Justin Kennedy
Nurse Manager
406-495-5417

Shannon Hadley
Provider Relations Specialist
406-495-5245

Kym Vonada
Medical Auditor
406-495-5389

Annalyn Stewart
Medical Payment Auditor
406-495-5367

Sheryl Semans
Pharmacy Liaison
406-495-5010

Susan Bomar
Medical Payment Auditor
406-495-5271

Cindy Gallus
Medical Customer Service Liaison
406-495-5189

Sherri Sprenger
Medical Customer Service Liaison
406-495-5420

Shannon Mergenthaler
Medical Customer Service Liaison
406-495-5185

Maggie Pentecost
Medical Customer Service Liaison
406-495-5322

Jamie Statton
Medical Customer Service Liaison
406-495-5386

Website Information

Montana State Fund montanastatefund.com

Department of LaborDepartment of Labor and Industry (DLI) website.
The website includes the Facility and Non-Facility Fee Schedule information as well as the Administrative Rules of Montana (ARM) and the instruction set for the Non-Facility Fee Schedule. Historical fee schedule information can also be found on this website.

If you have questions regarding the fee schedules call 406-444-6530 and someone will direct you to a DLI representative. For NPI information click here National Plan and Provider Enumeration System (NPPES)