ARM 24.29.1581. PROVIDER FEES--OCCUPATIONAL AND PHYSICAL THERAPY SPECIALTY AREA FOR SERVICES PROVIDED FROM APRIL 1, 1993 THROUGH JUNE 30, 2002

(1) Services rendered by occupational therapists and physical therapists from April 1, 1993 through June 30, 2002 are payable only for the procedure codes listed in (7) of this rule. None of the procedure codes, descriptions, or unit values in Relative Values for Physicians apply to occupational therapy and physical therapy services. (2) Nothing in this rule is to be construed so as to broaden the scope of a provider's practice. Each provider is to limit their services to those which can be performed within the limits and restrictions of the provider's professional licensure. Providers may only charge for services performed that are consistent with the scope of their practice and licensure. (3) The conversion factor used depends on the date the service was rendered: (a) Effective April 1, 1993, the conversion factor for occupational therapists and physical therapists is $5.87. (b) Effective January 1, 1994, and each year annually thereafter, the conversion factor will increase in the manner specified by ARM 24.29.1536 . (4) Occupational and physical therapists must obtain prior authorization for any of the following procedures: (a) 97544, work hardening; (b) 97546, work conditioning; (c) 97750, off-site therapy; (d) 97751, off-site equipment; (e) 97764, job site visit; or (f) 97770, physical capacity evaluation. (5) The unit value for each procedure listed in (7) includes the value for the associated office visit. (6) Where the fee for a procedure depends on the time spent by the provider, the time spent on the completion of reports is already included within the procedure code unless otherwise noted. (7) The following special procedure codes, with the associated description and unit values, are recognized for physical medicine services: Procedure Code Description Unit Value (a) 97010 treatment to one area; hot or cold packs 2.0 97012 traction, mechanical 2.0 97014 electrical stimulation (unattended) 2.0 97016 vasopneumatic devices 2.0 97018 paraffin bath 2.0 (b) 97020 microwave 2.0 97022 whirlpool 2.0 97024 diathermy 2.0 97026 infrared 2.0 97028 ultraviolet 2.0 (c) 97039 unlisted modality, equivalent in level of service to 97010-97028 (specify) 2.0 (d) 97050 treatment to one area involving two or more procedures from series 97010-97039 2.4 (e) 97110 treatment to one area, each visit; therapeutic exercises (teaching and supervision of exercises which will improve or enhance strength, range of motion, flexibility, and endurance, including passive, isotonic [concentric and eccentric], isometric, relaxation, posture, and endurance training) 5.6 97112 neuromuscular reeducation (incorporating the concepts of motor control and motor learning to improve movement, balance, proprioceptive sense, kinesthetic sense, and perceptual motor skills [for example, neuromuscular treatment approaches, facilitation procedures, closed kinetic chain activities, developmental approaches, and sensory integration approaches]) 5.6 97114 functional activities (teaching of skills which will improve or enhance an individual's ability to perform functional activities [for example, bed mobility, transfers, gait, lifting, use of adaptive devices, joint protection and cognitive re-education] which are goal directed and task specific) 5.6 97116 gait training (specific instructions in the proper patterns and components of walking and/or running; can be applied along a continuum from crutch training for very simple gait deviations to the application and instruction in complicated gait techniques for very complex gait dysfunctions) 5.6 97118 electrical stimulation (manual) 5.6 (f) 97120 iontophoresis 5.6 97121 phonophoresis 5.6 97122 traction, manual 5.6 97124 massage 5.6 97126 contrast baths 5.6 97128 ultrasound 5.6 (g) 97130 soft tissue mobilization 5.6 97132 joint mobilization 5.6 97133 rehabilitation taping 5.6 97134 spray/stretch 5.6 97136 postural drain 5.6 97139 unlisted procedure, equivalent in level of service to 97110-97136 (specify) 5.6 (h) 97200 treatment involving one or more procedures from group A below, and at least one procedure also in group B 6.8 Group A Group B 97010-97039 97118-97139 97118-97139 97260 (minutes n/a) 97260 (minutes n/a) 97261 (minutes n/a) 97261 (minutes n/a) (i) 97220 hubbard tank; each visit 7.2 (j) 97240 individual pool therapy or hubbard tank with therapeutic exercises; each visit (practitioner-supervised exercises and activities performed in a pool to enhance flexibility, coordination, strength, and/or cardiovascular capacity where buoyancy and/or decreased weight bearing are indicated) 8.8 97241 group pool therapy or hubbard tank with therapeutic exercises, per person supervised; each visit 4.4 (k) 97260 manipulation (cervical, thoracic, lumbosacral, sacroiliac, hand, wrist) (separate procedure); one area 5.6 97261 each additional area 2.6 (l) 97301 treatment involving one or more procedures from group A below, and at least one procedure also in group B 9.5 Group A Group B 97110 97118-97139 97112 97260 (minutes n/a) 97114 97261 (minutes n/a) 97116 (m) 97500 orthotics training (dynamic bracing splinting), upper extremities; each visit 6.6 (n) 97520 prosthetic training; each visit 6.6 (o) 97530 kinetic activities to increase coordination, strength and/or range of motion, one area (any two extremities or trunk); each visit (mechanized/computerized therapeutic exercise or activity to rehabilitate joint/muscle function using, for example, isokinetic, isotonic, isoinertial and/or isometric equipment) 7.4 (p) 97540 training in activities of daily living (self care skills and/or daily life management skills); each visit 6.6 97544 work hardening; each one hour [an individualized therapist-supervised, work-oriented treatment process involving the worker in simulated or actual work tasks which are structured and graded to progressively increase physical tolerances, adaptability, pacing, knowledge of task performance, body-mechanics, efficiency, endurance, and productivity to return-to-work goals. To be conducted only when a job has been identified for the worker to return to and specific job demands have been identified through a job analysis.] Other services are billable separately from work hardening. 8.5 97546 work conditioning; each one hour [an individualized, therapist-established and -supervised therapeutic exercise program which may include aerobic conditioning, education, limited work tasks and simulation, and progressive resistive functional exercises.] 8.5 (q) 97705 orthotic/prosthetic evaluation--deleted; to report use evaluation procedure code applicable to profession of provider 97708 activities of daily living evaluation--deleted; to report use evaluation procedure code applicable to profession of provider (r) 97719 face-to-face conference by therapist with payor representative(s) to update status of patient, upon request of payor or payor's authorized representative (content must be documented) BR (s) 97720 extremity testing for strength, dexterity, or stamina--deleted; to report use evaluation procedure code applicable to profession of provider (t) 97750 physical or occupational therapy provided outside usual location of practice 12.0 97751 physical or occupational therapy equipment and personnel provided outside usual location of practice 12.0 97752 muscle testing with torque curves during isometric and isokinetic exercise, mechanized or computerized evaluations with printout (includes representation in graph form of muscle-joint measurements of velocity, acceleration, power, range of motion, endurance, and work) 9.0 (u) 97762 computerized movement analysis testing-- kinematic and/or kinetic (includes computerized measurement and analysis of functional human movement and the forces [velocity, acceleration, displacement, and muscle and joint reaction] involved in movement; can include interfacing or individual measurement of electromyogram muscle activity and/or force plate analysis [three-dimensional analysis of ground reaction forces during weight-bearing activities and movements]) 9.0 97764 job site visit, each 60 minutes (includes report) 12.0 (v) 97770 physical capacity evaluation, each 60 minutes, up to six hours (includes report) [Objective, directly observed measurement of a worker's ability to perform a variety of physical tasks combined with statements of abilities by worker and evaluator. Includes 97772 if requested along with physical capacity evaluation by insurer. Also called "physical tolerance screening", "functional capacity evaluation", "functional capacity assessment", or "work tolerance screening".] 14.0 (w) 97799 unlisted physical medicine service BR (x) 97800 New patient; routine level of service (one body part or localized area in otherwise generally healthy patient with few or no pre-existing conditions; service includes abbreviated history, clarifying tests, diagnosis, and limited treatment plan) 6.7 97801 intermediate level of service (one or more body parts, areas, or systems affected in patient with significant but not complicated history or lengthy but not extended condition duration; service includes intermediate history, intermediate examination with up to three clarifying tests, diagnosis, and appropriate treatment plan) 9.9 97802 complex level of service (two or more body parts, areas, or systems affected, complicated history, extended condition duration, severe injury, or complicating or precautionary circumstances; service includes extensive history, comprehensive examination with four or more clarifying tests, diagnosis, and comprehensive treatment plan) 13.0 (y) 97810 Established patient; routine level of level of service (see 97800) 4.0 97811 intermediate level of service (see 97801) 6.7 97812 complex level of service (see 97802) 9.9 (z) 97880 physical medicine supplies and durable medical equipment (including but not limited to corsets, heel lifts, lumbar rolls, ankle wraps, taping supplies, TENS electrodes, knee immobilizer or other braces, cervical collars, Thera-Band, surgical tubing, and prescription medicines) BR (aa) 98951 Report associated with nonphysician conference, required by payor 3.4 (ab) 99085 Completion of job description or job analysis forms; initial 30 minutes 4.2 99086 each additional 15 minutes 2.1