Physical Therapy in the Outpatient Hospital Setting
As of 7/1/14, outpatient hospital physical therapy services must follow the same rules as outpatient clinical services. Providers must follow the “Rule of 8” so all timed procedures and modalities must have time documented by code (in minutes – not units) within the record. See the Facility Fee Schedule Instruction Set Effective July 1, 2014 for instructions at http://assets.dli.mt.gov/erd/mrdocs/dli-erd-mr029.pdf page 13.
Passive Therapeutic Procedures versus Passive Modalities
Passive modalities utilize a tool to cause an effect (i.e. electrical stimulation, hot/cold packs, iontophoresis, ultrasound, etc.).
Passive therapeutic proceduresare 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.
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 1 unit 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, services must be pre-authorized by Montana State Fund.
|97010||Hot or cold packs – one or more regions|
|97012||Traction – mechanical|
|97014||Electrical stimulation (unattended)|
|97024||Diathermy (e.g. microwave)|
|97032||Electrical stimulation (manual) one or more areas, each 15 minutes|
|97033||Iontophoresis, each 15 minutes|
|97034||Contrast Baths, each 15 minutes|
|97035||Ultrasound, each 15 minutes|
|97036||Hubbard tank, each 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, each 15 minutes. Therapeutic exercises to develop strength, endurance, range of motion and flexibility.||Active|
|97113||Aquatic therapy with therapeutic exercises||Active|
|97116||Gait training (includes stair climbing)||Active|
|97139||Unlisted therapeutic procedure. ** Passive or Active will depend upon the procedure.||Passive or Active**|
|97140||Manual therapy, each 15 minutes||Passive|
|97150||Therapeutic procedure(s), group (2 or more individuals)||Active|
|97530||Therapeutic activities, direct (one-on-one) pt contact, each 15 minutes.||Active|
|97532||Development of cognitive skills to improve attention, memory, problem solving, direct (one-on-one) pt contact, each 15 minutes.||Active|
|97533||Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) pat contact, each 15 minutes.||Active|
|97535||Self-care/home management training, direct (one-on-one) pt contact, each 15 minutes.||Active|
|97537||Community/Work reintegration training, direct (one-on-one) pt contact, each 15 minutes.||Active|
|97542||Wheelchair management each 15 minutes||Active|
|97545||Work hardening/conditioning, initial 2 hours||Active|
|97546||Work hardening/conditioning, each 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|