Therapy Editing

20.2.2 - Therapy Editing (Rev. 12608; Issued: 05-02-24; Effective:10-01-24; Implementation:10-07-24) On claims submitted by providers using the institutional claim format, CWF enforces consolidated billing for outpatient therapies by recognizing as therapies all services billed under revenue codes 042x, 043x, 044x. These revenue codes are subject to consolidated billing when submitted on types of bill 013x, 023x, 034x, 074x, 075x or 085x. Consolidated billing edits do not apply on TOB 034x when the HHA is billing for disposable negative pressure wound therapy services during an HH period of care. On claims submitted by practitioners using the professional claim format, CWF enforces consolidated billing for outpatient therapies using a list of HCPCS codes which represent therapy services. Therapy services on professional claims are not subject to the home health consolidated billing methodology when performed by a physician. Therefore, CWF bypasses the therapy edit if the HCPCS code is a therapy code subject to home health consolidated billing but the specialty code on the claim indicates a physician. The following specialty codes indicate a physician for purposes of this edit: Code Physician Specialty 01 General Practice 02 General Surgery 03 Allergy/Immunology 04 Otolaryngology 05 Anesthesiology 06 Cardiology 07 Dermatology 08 Family Practice 09 Interventional Pain Management 10 Gastroenterology 11 Internal Medicine Code Physician Specialty 12 Osteopathic Manipulative Therapy 13 Neurology 14 Neurosurgery 16 Obstetrics/Gynecology 18 Ophthalmology 19 Oral Surgery (dentists only) 20 Orthopedic Surgery 22 Pathology 24 Plastic and Reconstructive Surgery 25 Physical Medicine and Rehabilitation 26 Psychiatry 28 Colorectal Surgery (formerly proctology) 29 Pulmonary Disease 30 Diagnostic Radiology 33 Thoracic Surgery 34 Urology 35 Chiropractic 36 Nuclear Medicine 37 Pediatric Medicine 38 Geriatric Medicine 39 Nephrology 40 Hand Surgery 41 Optometry 44 Infectious Disease 46 Endocrinology 48 Podiatry 66 Rheumatology 70 Single or Multispecialty Clinic or Group Practice 72 Pain Management 76 Peripheral Vascular Disease 77 Vascular Surgery 78 Cardiac Surgery Code Physician Specialty 79 Addiction Medicine 81 Critical Care (Intensivists) 82 Hematology 83 Hematology/Oncology 84 Preventive Medicine 85 Maxillofacial Surgery 86 Neuropsychiatry 90 Medical Oncology 91 Surgical Oncology 92 Radiation Oncology 93 Emergency Medicine 94 Interventional Radiology 98 Gynecological/Oncology 99 Unknown Physician Specialty F6 Epileptologists