Allowable Fees

(1) Fee Schedule. Special Otorhinolaryngologic Services Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual (maximum one unit per visit) Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals (maximum one unit per visit) Evaluation of speech fluency (e.g., stuttering, cluttering) 92521 HA Evaluation of speech fluency (e.g., stuttering, cluttering) (for patients aged 21 or younger) 92521 TF Evaluation of speech fluency (e.g., stuttering, cluttering) (for developmentally disabled adults aged 22 or older) Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) 92522 HA Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) (for patients aged 21 or younger) 92522 TF Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) (for developmentally disabled adults aged 22 or older) Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) 92523 HA Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) (for patients aged 21 or younger) 92523 TF Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) (for developmentally disabled adults aged 22 or older) Behavioral and qualitative analysis of voice and resonance 92524 HA Behavioral and qualitative analysis of voice and resonance (for patients aged 21 or younger) 92524 TF Behavioral and qualitative analysis of voice and resonance (for developmentally disabled adults aged 22 or older) Treatment of swallowing dysfunction and/or oral function for feeding (maximum one unit per visit) Evaluative and Therapeutic Services Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face- to-face with the patient; first hour Therapeutic service(s) for the use of non-speech- generating device, including programming and modification Evaluation for prescription for speech-generating augmentative and alternative communication device, face- to-face with the patient; first hour Evaluation for prescription for speech-generating augmentative and alternative communication device, face- to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure) Therapeutic services for the use of speech-generating device, including programming and modification Evaluation of oral and pharyngeal swallowing function (per hour, maximum of one hour) Auditory rehabilitation; prelingual hearing loss Auditory rehabilitation; postlingual hearing loss Physical Medicine and Rehabilitation Physical therapy evaluation – Low complex – 20 min Physical therapy evaluation- Mod complex – 30 min Physical therapy evaluation High complex – 45 min Physical therapy re-evaluation Est Plan Care – 20 min Occupational therapy evaluation Low complex – 30 min Occupational therapy evaluation Mod complex – 45 min Occupational therapy evaluation High complex – 60 min Occupational therapy re-evaluation Est Plan Care – 30 min Modalities—Supervised Application of a modality to one or more areas; hot or cold packs Application of a modality to one or more areas; traction, mechanical Application of a modality to one or more areas; electrical stimulation (unattended) Application of a modality to one or more areas; vasopneumatic devices Application of a modality to one or more areas; paraffin bath Application of a modality to one or more areas; whirlpool Application of a modality to one or more areas; diathermy (e.g., microwave) Application of a modality to one or more areas; infrared Application of a modality to one or more areas; ultraviolet Modalities—Constant Attendance Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes Application of a modality to one or more areas; iontophoresis, each 15 minutes Application of a modality to one or more areas; contrast baths, each 15 minutes Application of a modality to one or more areas; ultrasound, each 15 minutes Application of a modality to one or more areas; Hubbard tank, each 15 minutes Unlisted modality (specify type and time if constant attendance) Therapeutic Procedures Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 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 Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing) Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) Unlisted therapeutic procedure (specify) (each 15 minutes) Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes Therapeutic procedure(s), group (two or more individuals) (services delivered under an outpatient plan of care) (maximum one unit per visit ) Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes Community/work reintegration training (e.g., shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment) direct one-on-one contact, each 15 minutes Wheelchair management (e.g., assessment, fitting, training), each 15 minutes Work hardening/conditioning; initial two hours Work hardening/conditioning; each additional hour (list separately in addition to code for primary procedure) (use in conjunction with 97545) Active Wound Care Management Debridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less Debridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure) IC Removal of devitalized tissue from wound(s), non- selective debridement, without anesthesia (e.g., wet-to- moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters Tests and Measurements Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes Assistive technology assessment (e.g., to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 15 minutes Orthotic Management and Prosthetic Management Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes Prosthetic training, upper and/or lower extremity(s), each 15 minutes Checkout for orthotic/prosthetic use, established patient, each 15 minutes Other Procedures Unlisted physical medicine/rehabilitation service or procedure (each 15 minutes, maximum six units per visit) Evaluation and Management—Office or Other Outpatient Services Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: - a detailed history; - a detailed examination; and - medical decision making of low complexity Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components (written report required): - a comprehensive history; - a comprehensive examination; and - medical decision making of high complexity Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: - a problem focused history; - a problem focused examination; and - straightforward medical decision making Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components (written report required): - a detailed history; - a detailed examination; and - medical decision making of moderate complexity Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components (written report required): - a comprehensive history; - a comprehensive examination; and - medical decision making of high complexity Caregiver Training Codes Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; initial 30 minutes Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; each additional 15 minutes (Use 97551 in conjunction with 97550) Group caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face with multiple sets of caregivers (2) Hourly Rates for IC Designated Services, Special Contracts, and Unlisted Procedures. As a guideline, rates for restorative and rehabilitation center services for aquatic therapy, nautilus training, work evaluations/job site analysis, work hardening programs, and other unlisted services are determined by applying the appropriate portion of the hourly rate specified in 101 CMR 339.04(2). Diagnostic procedures that require specialized machinery, such as muscle testing during isometric and isokinetic exercises (e.g., use of cybex machine), should be reimbursed with consideration for additional equipment costs and technical assistance, in addition to the prorated hourly fee for therapists' services and routine overhead expenses. Rehabilitation Center Physical Therapist $64.41hr. Rehabilitation Center Occupational Therapist $64.41hr. Rehabilitation Center Speech Therapist $64.41hr. Restorative Physical Therapy office visit $64.41hr. Restorative Occupational Therapy office visit $64.41hr. Restorative Speech Therapy office visit $64.41hr. Restorative Physical Therapy out-of-office visit $74.07hr. Restorative Occupational Therapy out-of-office visit $74.07hr. Restorative Speech Therapy out-of-office visit $74.07hr.