HCPCS Level II Definitions and Guidelines - OptumCoding.com

HCPCS Level II Definitions and GuidelinesIntroductionOne of the keys to gaining accurate reimbursement lies inunderstanding the multiple coding systems that are used to identifyservices and supplies. To be well versed in reimbursement practices,coders should be familiar not only with the American MedicalAssociation’s (AMA) Physicians’ Current Procedural Terminology(CPT®) coding system (HCPCS Level I) but also with HCPCS Level IIcodes, which are becoming increasingly important toreimbursement as they are extended to a wider array of medicalservices.HCPCS Level II—National CodesHCPCS Level II codes commonly are referred to as national codes orby the acronym HCPCS (pronounced “hik-piks”), which stands forthe Healthcare Common Procedure Coding System. HCPCS codesare used for billing Medicare and Medicaid patients and have beenadopted by some third-party payers.These codes, updated and published annually by the Centers forMedicare and Medicaid Services (CMS), are intended to supplementthe CPT coding system by including codes for nonphysicianservices, administration of injectable drugs, durable medicalequipment (DME), and office supplies.When using HCPCS Level II codes, keep the following in mind:• CMS does not use consistent terminology for unlisted servicesor procedures. The code descriptions may include any one ofthe following terms: unlisted, not otherwise classified (NOC),unspecified, unclassified, other and miscellaneous.• If billing for specific supplies and materials, avoid CPT code99070 (General supplies), and be as specific as possible unlessthe local carrier directs otherwise.• Coding and billing should be based on the service provided.Documentation should describe the patient’s problems and theservice provided to enable the payer to determinereasonableness and necessity of care.• Refer to the Online CMS Manual System(www.cms.hhs.gov/home/regsguidance.asp) or third-partypayment policy to determine whether the care provided is acovered service.• When both a CPT and HCPCS Level II code share nearlyidentical narratives, apply the CPT code. If the narratives arenot identical, select the code with the narrative that betterdescribes the service. Generally, for Medicare claims, theHCPCS Level II code is more specific and takes precedence overthe CPT code.Structure and Use of HCPCS Level II CodesThe main terms are in boldface type in the index. Main term entriesinclude tests, services, supplies, orthotics, prostheses, medicalequipment, drugs, therapies, and some medical and surgicalprocedures. Where possible, entries are listed under a commonmain term. In some instances, the common term is a noun; inothers, the main term is a descriptor.Searching the IndexThe steps to follow for searching the index are:1. Analyze the statement or description provided that designatesthe item to be coded.2. Identify the main term.3. Locate the main term in the index.4. Check for relevant subterms under the main term. Verify themeaning of any unfamiliar abbreviations.5. Note the codes found after the selected main term or subterm.6. Locate the code in the alphanumeric list to ensure thespecificity of the code. If a code range is provided, locate thecode range and review all code narratives in that code rangefor specificity.In some cases, an entry may be listed under more than one mainterm.Never code directly from the index. Always verify the code choice inthe alphanumeric list and the index.HCPCS Level II Codes: Sections A–VLevel II codes consist of one alphabetic character (letters A throughV) and four numbers. Similar to CPT codes, they also can havemodifiers, which can be alphanumeric or two letters. Nationalmodifiers can be used with all levels of HCPCS codes.The HCPCS coding system is arranged in 17 sections:A codes A0021–A9999 Transportation Services IncludingAmbulance, Medical/SurgicalSupplies, and Administrative,Miscellameous, and InvestigationalB codes B4034–B9999 Enteral and Parenteral TherapyC codes C1300–C9999 Outpatient PSSE codes E0100–E8002 Durable Medical EquipmentG codes G0008–G9140 Procedures/Professional Services(Temporary Codes)H codes H0001–H2037 Alcohol and Drug Abuse TreatmentServicesJ codes J0120–J9999 Drugs Administered Other Than OralMethod, Chemotherapy Drugs(Exception: Oral ImmunosuppressiveDrugs)K codes K0001–K0899 Durable Medical Equipment forMedicare Administrative Contractors(DME MACs) (Temporary Codes)L codes L0112–L9900 Orthotic and Prosthetic Procedures,DevicesM codes M0064–M0301 Medical ServicesP codes P2028–P9615 Pathology and Laboratory ServicesQ codes Q0035–Q9967 Miscellaneous Services (TemporaryCodes)R codes R0070–R0076 Radiology Services© 2010 Ingenix ● New Codes ▲ Revised Codes MED: Medicare Reference 1

HCPCS Level II Definitions and GuidelinesS codes S0012–S9999 Commercial Payers (TemporaryCodes)T codes T1000–T9999 Medicaid ServicesV codes V2020–V5364 Vision, Hearing and Speech-LanguagePathology ServicesDental CodesThe Centers for Medicare and Medicaid Services is no longerincluding the D codes as part of the HCPCS Level II code seteffective January 1, 2011. These codes are published andmaintained by the American Dental Association and can beobtained through that association.Coding and Payment Guide for the Physical TherapistAlthough both alpha and numeric modifiers are commonthroughout the country, some regional carriers do not recognizetheir use due to software limitations. It may be necessary to providea cover letter, an invoice or other specific documentation with theclaim for clarification.Modifiers for Reporting Physical Therapy ServicesThe following HCPCS Level II modifiers are commonly used byphysical therapy providers.A1 Dressing for one woundA2A3Dressing for two woundsDressing for three woundsSection GuidelinesExamine the instructions found at the beginning of each of the 17sections. Instructions include the guidelines, notes, unlistedprocedures, special reports and the modifiers that pertain to eachsection.Use the alphabetic index to initially locate a code by looking for thetype of service or procedure performed. The same rule applies:never code directly from the index. Always check the specific codein the appropriate section.The Conventions: Symbols and ModifiersSymbols used in the HCPCS Level II coding system may bepresented in various ways, depending on the vendor. In thispublication the pattern established by the AMA in the CPT codebook is followed. For example, bullets and triangles signify new andrevised codes, respectively.When a code is new to the HCPCS Level II system, a bullet (l)appears to the left of the code. This symbol is consistent with theCPT coding system’s symbol for new codes. The bullet represents acode never before seen in the HCPCS coding system.ExampleA4566 Shoulder sling or vest design, abduction restrainer,with or without swatheA triangle (s) is used (as in the CPT coding system) to indicate thata change in the narrative of a code has been made from theprevious year’s edition. The change made may be slight orsignificant, but it usually changes the application of the code.ExampleA6248 Hydrogel dressing, wound filler, gel, per fluid ounceIn certain circumstances, modifiers must be used to report thealteration of a procedure or service or to furnish additionalinformation about the service, supply or procedure that wasprovided. In the HCPCS Level I (CPT) coding system, modifiers aretwo-digit suffixes that usually directly follow the five-digit procedureor service code.In HCPCS Level II, modifiers are composed of two alpha oralphanumeric characters that range from AA to VP.E0260-NUHospital bed, semi-electric (head and footadjustment), with any type side rails, with mattressNU = identifies the hospital bed as new equipmentA4A5A6A7A8A9AVAWBPBRBUCCF1F2F3F4F5F6F7F8F9FAFBFCDressing for four woundsDressing for five woundsDressing for six woundsDressing for seven woundsDressing for eight woundsDressing for nine or more woundsItem furnished in conjunction with a prosthetic device,prosthetic or orthoticItem furnished in conjunction with a surgical dressingThe beneficiary has been informed of the purchase andrental options and has elected to purchase the itemThe beneficiary has been informed of the purchase andrental options and has elected to rent the itemThe beneficiary has been informed of the purchase andrental options and after 30 days has not informed thesupplier of his/her decisionProcedure code change (use ‘CC’ when the procedurecode submitted was changed either for administrativereasons or because an incorrect code was filed)Left hand, second digitLeft hand, third digitLeft hand, fourth digitLeft hand, fifth digitRight hand, thumbRight hand, second digitRight hand, third digitRight hand, fourth digitRight hand, fifth digitLeft hand, thumbItem provided without cost to provider, supplier orpractitioner, or full credit received for replaced device(examples, but not limited to, covered under warranty,replaced due to defect, free samples)Partial credit received for replaced device2 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix

Coding and Payment Guide for the Physical TherapistHCPCS Level II Definitions and GuidelinesGAGBWaiver of liability statement on fileClaim being resubmitted for payment because it is nolonger covered under a global payment demonstrationLTM2Left side (used to identify procedures performed on theleft side of the body)Medicare Secondary Payer (MSP)GKGLGNGOGPGUGXGYGZHJJ4K0K1K2K3K4Reasonable and necessary item/service associated with aGA or GZ modifierMedically unnecessary upgrade provided instead ofnon-upgraded item, no charge, no advance beneficiarynotice (ABN)Services delivered under an outpatient speech languagepathology plan of careServices delivered under an outpatient occupationaltherapy plan of careServices delivered under an outpatient physical therapyplan of careWaiver of liability statement issued as required by payerpolicy, routine noticeNotice of liability issued, voluntary under payer policyItem or service statutorily excluded, does not meet thedefinition of any Medicare benefit or, for non-Medicareinsurers, is not a contract benefitItem or service expected to be denied as not reasonableand necessaryEmployee assistance programDMEPOS item subject to DMEPOS competitive biddingprogram that is furnished by a hospital upon dischargeLower extremity prosthesis functional level 0—does nothave the ability or potential to ambulate or transfer safelywith or without assistance and a prosthesis does notenhance their quality of life or mobility.Lower extremity prosthesis functional level 1—has theability or potential to use a prosthesis for transfers orambulation on level surfaces at fixed cadence. Typical ofthe limited and unlimited household ambulator.Lower extremity prosthesis functional level 2—has theability or potential for ambulation with the ability totraverse low level environmental barriers such as curbs,stairs or uneven surfaces. Typical of the limitedcommunity ambulator.Lower extremity prosthesis functional level 3—has theability or potential for ambulation with variable cadence.Typical of the community ambulator who has the abilityto traverse most environmental barriers and may havevocational, therapeutic, or exercise activity that demandsprosthetic utilization beyond simple locomotion.Lower extremity prosthesis functional level 4—has theability or potential for prosthetic ambulation that exceedsthe basic ambulation skills, exhibiting high impact, stress,or energy levels, typical of the prosthetic demands of thechild, active adult, or athlete.RARPRTSTT1T2T3T4T5T6T7T8T9TAU1U2U3U4U5U6U7U8U9UAUBUCUDReplacement of a DME itemRepair and replacement of a DME itemRight side (used to identify procedures performed on theright side of the body)Related to trauma or injuryLeft foot, second digitLeft foot, third digitLeft foot, fourth digitLeft foot, fifth digitRight foot, great toeRight foot, second digitRight foot, third digitRight foot, fourth digitRight foot, fifth digitLeft foot, great toeMedicaid level of care 1, as defined by each stateMedicaid level of care 2, as defined by each stateMedicaid level of care 3, as defined by each stateMedicaid level of care 4, as defined by each stateMedicaid level of care 5, as defined by each stateMedicaid level of care 6, as defined by each stateMedicaid level of care 7, as defined by each stateMedicaid level of care 8, as defined by each stateMedicaid level of care 9, as defined by each stateMedicaid level of care 10, as defined by each stateMedicaid level of care 11, as defined by each stateMedicaid level of care 12, as defined by each stateMedicaid level of care 13, as defined by each stateHCPCS Level II Codes and the PhysicalTherapistCMS permits physical therapists billing independently to code witheither CPT or HCPCS Level II codes for services delivered toMedicare beneficiaries. However, more recently, there has been aneffort to reduce duplication between CPT and HCPCS Level II codes,and physical therapists should use CPT codes when they areavailable, choosing HCPCS Level II codes when there is noappropriate CPT code.© 2010 Ingenix ● New Codes ▲ Revised Codes MED: Medicare Reference 3

HCPCS Level II Definitions and GuidelinesA Codes: Medical and Surgical Supplies(A0021–A9999)This section covers a wide variety of medical and surgical supplies,as well as some DME-related supplies and accessories. Medicaregenerally covers DME-related supplies, accessories, maintenance,and repair under the prosthetic devices provision.A4265Paraffin, per poundMED: Pub. 100-3, Section 280.1Coding TipPortable paraffin bath units and supplies may be covered when thepatient has undergone a successful trial period of paraffin therapyordered by a provider and the patient’s condition is expected to berelieved by long term use of this modality.Additional Miscellaneous SuppliesA4290 Sacral nerve stimulation test lead, eachA4450 Tape, non-waterproof, per 18 sq inMED: Pub. 100-2, Chapter 15, Section 120A4452A4455A4456A4461A4463A4465A4466A4490A4495A4500A4510A4556A4558A4559Tape, waterproof, per 18 sq inMED: Pub. 100-2, Chapter 15, Section 120Adhesive remover or solvent (for tape, cement orother adhesive), per ounceMED: Pub. 100-2, Chapter 15, Section 120Adhesive remover, wipes, any type, eachSurgical dressing holder, nonreusable, eachSurgical dressing holder, reusable, eachNonelastic binder for extremityGarment, belt, sleeve or other covering, elastic orsimilar stretchableSurgical stocking above knee length, eachMED: Pub. 100-2, Chapter 15, Section 100, 130; Pub.100-3, Section 280.1Surgical stocking thigh length, eachMED: Pub. 100-2, Chapter 15, Section 100, 130; Pub.100-3, Section 280.1Surgical stocking below knee length, eachMED: Pub. 100-2, Chapter 15, Section 100, 130; Pub.100-3, Section 280.1Surgical stocking full length, eachMED: Pub. 100-2, Chapter 15, Section 100 , 130; Pub.100-3, Section 280.1Electrodes (e.g., Apnea monitor), per pairConductive gel or paste, for use with electricaldevice (e.g., TENS, NMES), per ounceCoupling gel or paste, for use with ultrasounddevice, per ounceA4565l A4566Coding and Payment Guide for the Physical TherapistSlingsShoulder sling or vest design, abduction restrainer,with or without swatheCoding TipThe initial casting of the fracture is considered part of the fracturecare, inherent in the fracture care code. The sling, however, is notincluded in the global package for fracture care. Some carriers willpay for this additional patient care item; some will not. If the providerordered the sling secondary to high probability of patient self-harmwith a flailing, casted limb, or if the patient is a child who requiresimmobilization of the casted limb to avert further injury,reimbursement may be considered by some carriers. Clear evidenceof these situations must be reflected in the medical documentationand should be submitted with the claim. In any case, it would beprudent to secure an advance beneficiary notice (ABN) from thepatient in case a medical necessity denial is received.A4570A4580A4590A4595A4600A4630A4635A4636A4637A4649SplintMED: Pub. 100-2, Chapter 15, Section 100Cast supplies (e.g., plaster)MED: Pub. 100-2, Chapter 15, Section 100Special casting material (e.g., fiberglass)Electrical stimulator supplies, 2 lead, per month,(e.g. TENS, NMES)MED: Pub. 100-3, Section 270.3Sleeve for intermittent limb compression device,replacement only, eachReplacement batteries, medically necessary,transcutaneous electrical stimulator, owned bypatientUnderarm pad, crutch, replacement, eachReplacement, handgrip, cane, crutch, or walker,eachReplacement, tip, cane, crutch, walker, eachSurgical supply; miscellaneousCoding TipDetermine if an alternative national HCPCS Level II code or a localHCPCS Level III code better describes the supply being reported.Code A4649 should be used only if a more specific code isunavailable.A5113A5114Leg strap; latex, replacement only, per setMED: Pub. 100-2, Chapter 15, Section 120Leg strap; foam or fabric, replacement only, per setMED: Pub. 100-2, Chapter 15, Section 120DressingsMedicare claims fall under the jurisdiction of the durable medicalequipment Medicare administrative contractor (DME MAC) unlessotherwise noted.4 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix

Coding and Payment Guide for the Physical TherapistA6000Non-contact wound warming wound cover for usewith the non-contact wound warming device andwarming cardMED: Pub. 100-3, Section 270.2Coding TipNoncontact normothermic wound therapy (NNWT) encourageswound healing by warming a wound to a preset temperature. Thedevice consists of a noncontact wound cover that contains a flexible,battery-powered infrared heating card. Benefits are not availableunder Medicare for this therapy based on a national coveragedecision.A6021A6022A6023A6024A6025A6154A6196A6197A6198A6199A6203Collagen dressing, sterile, pad size 16 sq in or less,eachMED: Pub. 100-2, Chapter 15, Section 100Collagen dressing, sterile, pad size more than 16 sqin but less than or equal to 48 sq in, eachMED: Pub. 100-2, Chapter 15, Section 100Collagen dressing, sterile, pad size more than 48 sqin, eachMED: Pub. 100-2, Chapter 15, Section 100Collagen dressing wound filler, sterile, per 6 inMED: Pub. 100-2, Chapter 15, Section 100Gel sheet for dermal or epidermal application, (e.g.,silicone, hydrogel, other), eachMED: Pub. 100-2, Chapter 15, Section 100Wound pouch, eachMED: Pub. 100-2, Chapter 15, Section 100Alginate or other fiber gelling dressing, woundcover, sterile, pad size 16 sq in or less, each dressingMED: Pub. 100-2, Chapter 15, Section 100Alginate or other fiber gelling dressing, woundcover, sterile, pad size more than 16 sq in but lessthan or equal to 48 sq in, each dressingMED: Pub. 100-2, Chapter 15, Section 100Alginate or other fiber gelling dressing, woundcover, sterile, pad size more than 48 sq in, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Alginate or other fiber gelling dressing, woundfiller, sterile, per 6 inchesMED: Pub. 100-2, Chapter 15, Section 100Composite dressing, sterile, pad size 16 sq in or less,with any size adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100A6204 Composite dressing, sterile, pad size more than 16sq in but less than or equal to 48 sq in, with any sizeadhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100HCPCS Level II Definitions and GuidelinesA6205 Composite dressing, sterile, pad size more than 48sq in, with any size adhesive border, each dressingA6206A6207A6208A6209A6210A6211A6212A6213A6214A6215A6216A6217A6218MED: Pub. 100-2, Chapter 15, Section 100Contact layer, sterile, 16 sq in or less, each dressingMED: Pub. 100-2, Chapter 15, Section 100Contact layer, sterile, more than 16 sq in but lessthan or equal to 48 sq in, each dressingMED: Pub. 100-2, Chapter 15, Section 100Contact layer, sterile, more than 48 sq in, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Foam dressing, wound cover, sterile, pad size 16 sqin or less, without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Foam dressing, wound cover, sterile, pad size morethan 16 sq in but less than or equal to 48 sq in,without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Foam dressing, wound cover, sterile, pad size morethen 48 sq in, without adhesive border, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Foam dressing, wound cover, sterile, pad size 16 sqin or less, with any size adhesive border, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Foam dressing, wound cover, sterile, pad size morethan 16 sq in but less than or equal to 48 sq in, withany size adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Foam dressing, wound cover, sterile, pad size morethan 48 sq in, with any size adhesive border, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Foam dressing, wound filler, sterile, per gramMED: Pub. 100-2, Chapter 15, Section 100Gauze, non-impregnated, non-sterile, pad size 16 sqin or less, without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, non-impregnated, non-sterile, pad size morethan 16 sq in but less than or equal to 48 sq in,without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, non-impregnated, non-sterile, pad size morethan 48 sq in, without adhesive border, eachdressingMED: Pub. 100-2, Chapter 15, Section 100© 2010 Ingenix ● New Codes ▲ Revised Codes MED: Medicare Reference 5

HCPCS Level II Definitions and GuidelinesCoding and Payment Guide for the Physical TherapistA6219A6220A6221A6222A6223A6224A6228A6229A6230A6231A6232A6233A6234Gauze, non-impregnated, sterile, pad size 16 sq inor less, with any size adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, non-impregnated, sterile, pad size morethan 16 sq in but less than or equal to 48 sq in, withany size adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, non-impregnated, sterile, pad size morethan 48 sq in, with any size adhesive border, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated with other than water, normalsaline, or hydrogel, sterile, pad size 16 sq in or less,without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated with other than water, normalsaline, or hydrogel, sterile, pad size more than 16 sqin but less than or equal to 48 sq in, withoutadhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated with other than water, normalsaline, or hydrogel, sterile, pad size more than 48 sqin, without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated, water or normal saline, sterile,pad size 16 sq in or less, without adhesive border,each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated, water or normal saline, sterile,pad size more than 16 sq in but less than or equal to48 sq in, without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated, water or normal saline, sterile,pad size more than 48 sq in, without adhesiveborder, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated, hydrogel, for direct woundcontact, sterile, pad size 16 sq in or less, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated, hydrogel, for direct woundcontact, sterile, pad size greater than 16 sq in, butless than or equal to 48 sq in, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated, hydrogel for direct woundcontact, sterile, pad size more than 48 sq in, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Hydrocolloid dressing, wound cover, sterile, padsize 16 sq in or less, without adhesive border, eachdressingMED: Pub. 100-2, Chapter 15, Section 100A6235A6236A6237A6238A6239A6240A6241Hydrocolloid dressing, wound cover, sterile, padsize more than 16 sq in but less than or equal to 48sq in, without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Hydrocolloid dressing, wound cover, sterile, padsize more than 48 sq in, without adhesive border,each dressingMED: Pub. 100-2, Chapter 15, Section 100Hydrocolloid dressing, wound cover, sterile, padsize 16 sq in or less, with any size adhesive border,each dressingMED: Pub. 100-2, Chapter 15, Section 100Hydrocolloid dressing, wound cover, sterile, padsize more than 16 sq in but less than or equal to 48sq in, with any size adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Hydrocolloid dressing, wound cover, sterile, padsize more than 48 sq in, with any size adhesiveborder, each dressingMED: Pub. 100-2, Chapter 15, Section 100Hydrocolloid dressing, wound filler, paste, sterile,per fluid ounceMED: Pub. 100-2, Chapter 15, Section 100Hydrocolloid dressing, wound filler, dry form,sterile, per gramMED: Pub. 100-2, Chapter 15, Section 100A6242 Hydrogel dressing, wound cover, sterile, pad size 16sq in or less, without adhesive border, each dressingA6243A6244MED: Pub. 100-2, Chapter 15, Section 100Hydrogel dressing, wound cover, sterile, pad sizemore than 16 sq in but less than or equal to 48 sq in,without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Hydrogel dressing, wound cover, sterile, pad sizemore than 48 sq in, without adhesive border, eachdressingMED: Pub. 100-2, Chapter 15, Section 100A6245 Hydrogel dressing, wound cover, sterile, pad size 16sq in or less, with any size adhesive border, eachdressingA6246A6247s A6248MED: Pub. 100-2, Chapter 15, Section 100Hydrogel dressing, wound cover, sterile, pad sizemore than 16 sq in but less than or equal to 48 sq in,with any size adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Hydrogel dressing, wound cover, sterile,pad sizemore than 48 sq in, with any size adhesive border,each dressingMED: Pub. 100-2, Chapter 15, Section 100Hydrogel dressing, wound filler, gel, per fluid ounceMED: Pub. 100-2, Chapter 15, Section 1006 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix

Coding and Payment Guide for the Physical TherapistHCPCS Level II Definitions and GuidelinesA6250Skin sealants, protectants, moisturizers, ointments,any type, any sizeA6407Packing strips, non-impregnated, sterile, up to twoinches in width, per linear yardA6251A6252A6253MED: Pub. 100-2, Chapter 15, Section 100Specialty absorptive dressing, wound cover, sterile,pad size 16 sq in or less, without adhesive border,each dressingMED: Pub. 100-2, Chapter 15, Section 100Specialty absorptive dressing, wound cover, sterile,pad size more than 16 sq in but less than or equal to48 sq in, without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Specialty absorptive dressing, wound cover, sterile,pad size more than 48 sq in, without adhesiveborder, each dressingMED: Pub. 100-2, Chapter 15, Section 100A6441A6442A6443A6444A6445Padding bandage, non-elastic,non-woven/non-knitted, width greater than orequal to three inches and less than five inches, peryardConforming bandage, non-elastic, knitted/woven,non-sterile, width less than three inches, per yardConforming bandage, non-elastic, knitted/woven,non-sterile, width greater than or equal to threeinches and less than five inches, per yardConforming bandage, non-elastic, knitted/woven,non-sterile, width greater than or equal to fiveinches, per yardConforming bandage, non-elastic, knitted/woven,sterile, width less than three inches, per yardA6254Specialty absorptive dressing, wound cover, sterile,pad size 16 sq in or less, with any size adhesiveborder, each dressingA6446Conforming bandage, non-elastic, knitted/woven,sterile, width greater than or equal to three inchesand less than five inches, per yardA6255A6256A6257A6258A6259A6266A6402A6403A6404MED: Pub. 100-2, Chapter 15, Section 100Specialty absorptive dressing, wound cover, sterile,pad size more than 16 sq in but less than or equal to48 sq in, with any size adhesive border, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Specialty absorptive dressing, wound cover, sterile,pad size more than 48 sq in, with any size adhesiveborder, each dressingMED: Pub. 100-2, Chapter 15, Section 100Transparent film, sterile, 16 sq in or less, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Transparent film, sterile, more than 16 sq in but lessthan or equal to 48 sq in, each dressingMED: Pub. 100-2, Chapter 15, Section 100Transparent film, sterile, more than 48 sq in, eachdressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, impregnated, other than water, normalsaline, or zinc paste, sterile, any width, per linearyardMED: Pub. 100-2, Chapter 15, Section 100Gauze, non-impregnated, sterile, pad size 16 sq inor less, without adhesive border, each dressingMED: Pub. 100-2, Chapter 15, Section 100Gauze, non-impregnated, sterile, pad size morethan 16 sq in less than or equal to 48 sq in, withoutadhesive border, each dressingGauze, non-impregnated, sterile, pad size morethan 48 sq in, without adhesive border, eachdressingA6447A6448A6449A6450A6451A6452A6453A6454A6455A6456A6457Conforming bandage, non-elastic, knitted/woven,sterile, width greater than or equal to five inches,per yardLight compression bandage, elastic, knitted/woven,width less than three inches, per yardLight compression bandage, elastic, knitted/woven,width greater than or equal to three inches and lessthan five inches, per yardLight compression bandage, elastic, knitted/woven,width greater than or equal to five inches, per yardModerate compression bandage, elastic,knitted/woven, load resistance of 1.25 to 1.34 footpounds at 50 percent maximum stretch, widthgreater than or equal to three inches and less thanfive inches, per yardHigh compression bandage, elastic, knitted/woven,load resistance greater than or equal to 1.35 footpounds at 50 percent maximum stretch, widthgreater than or equal to three inches and less thanfive inches, per yardSelf-adherent bandage, elastic,non-knitted/non-woven, width less than threeinches, per yardSelf-adherent bandage, elastic,non-knitted/non-woven, width greater than orequal to three inches and less than five inches, peryardSelf-adherent bandage, elastic,non-knitted/non-woven, width greater than orequal to five inches, per yardZinc paste impregnated bandage, non-elastic,knitted/woven, width greater than or equal to threeinches and less than five inches, per yardTubular dressing with or without elastic, any width,per linear yard© 2010 Ingenix ● New Codes ▲ Revised Codes MED: Medicare Reference 7

HCPCS Level II Definitions and GuidelinesCoding and Payment Guide for the Physical TherapistA6501A6502A6503A6504A6505A6506A6507Compression burn garment, bodysuit (head tofoot), custom fabricatedMED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, chin strap, customfabricatedMED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, facial hood, customfabricatedMED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, glove to wrist, customfabricatedMED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, glove to elbow, customfabricatedMED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, glove to axilla, customfabricatedMED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, foot to knee length,custom fabricatedMED: Pub. 100-2, Chapter 15, Section 100A6535 Gradient compression stocking, thigh length, 40-50mm Hg, eachA6536 Gradient compression stocking, full length/chapstyle, 18-30 mm Hg, eachA6537 Gradient compression stocking, full length/chapstyle, 30-40 mm Hg, eachA6538 Gradient compression stocking, full length/chapstyle, 40-50 mm Hg, eachA6539 Gradient compression stocking, waist length, 18-30mm Hg, eachA6540 Gradient compression stocking, waist length, 30-40mm Hg, eachA6541 Gradient compression stocking, waist length, 40-50mm Hg, eachA6544 Gradient compression stocking, garter beltA6545 Gradient compression wrap, non-elastic, belowknee, 30-50 mm Hg, eachA6550 Dressing set for negative pressure wound therapyelectrical pump, stationary or portable, eachA9270MED: Pub. 100-2, Chapter 15, Section 100Noncovered item or serviceMED: Pub. 100-2, Chapter 16, Section 20A6508Compression burn garment, foot to thigh length,custom fabricatedl A9273Hot water bottle, ice cap or collar, heat and/or coldwrap, any typeA6509A6510A6511A6512MED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, upper trunk to waistincluding arm openings (vest), custom fabricatedMED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, trunk, including armsdown to leg openings (leotard), custom fabricatedMED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, lower trunk includingleg openings (panty), custom fabricatedMED: Pub. 100-2, Chapter 15, Section 100Compression burn garment, not otherwise classifiedMED: Pub. 100-2, Chapter 15, Section 100A6513 Compression burn mask, face and/or neck, plastic orequal, custom fabricatedA6530 Gradient compression stocking, below knee, 18-30mm Hg, eachA6531 Gradient compression stocking, below knee, 30-40mm Hg, eachA6532 Gradient compression stocking, below knee, 40-50mm Hg, eachA6533 Gradient compression stocking, thigh length, 18-30mm Hg, eachA6534 Gradient compression stocking, thigh length, 30-40mm Hg, eachA9281A9283A9300Reaching/grabbing device, any type, any length,eachFoot pressure off-loading/supportive device, anytype, eachExercise equipmentMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1E Codes: Durable Medical Equipment(E0100–E9999)Before an item can be considered DME, it must meet all of thefollowing requirements:• It must be able to withstand repeated use.• It must be primarily and customarily used to serve a medicalpurpose.• It must be generally not useful to a person in the absence of anillness or injury.• It must be appropriate for use in the home.All E codes fall under the jurisdiction of the DME MAC unlessotherwise noted.CanesE0100Cane, includes canes of all materials, adjustable orfixed, with tipMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1, 280.2; Pub. 100-4, Chapter 20,Section 10.18 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix

Coding and Payment Guide for the Physical TherapistHCPCS Level II Definitions and GuidelinesE0105Cane, quad or three-prong, includes canes of allmaterials, adjustable or fixed, with tipsE0140Walker, with trunk support, adjustable or fixedheight, any typeMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 20.9, 280.1; Pub. 100-4, Chapter 20,Section 10.1MED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1CrutchesE0110 Crutches, forearm, includes crutches of variousmaterials, adjustable or fixed, pair, complete withtips and handgripsE0111E0112E0113E0114E0116E0117E0118MED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Crutch, forearm, includes crutches of variousmaterials, adjustable or fixed, each, with tip andhandgripMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Crutches, underarm, wood, adjustable or fixed, pair,with pads, tips and handgripsMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Crutch, underarm, wood, adjustable or fixed, each,with pad, tip and handgripMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Crutches, underarm, other than wood, adjustable orfixed, pair, with pads, tips and handgripsMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Crutch, underarm, other than wood, adjustable orfixed, each, with pad, tip and handgripMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Crutch, underarm, articulating, spring assisted, eachCrutch substitute, lower leg platform, with orwithout wheels, eachE0141E0143E0144E0147Walker, rigid, wheeled, adjustable or fixed heightMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Walker, folding, wheeled, adjustable or fixed heightMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Walker, enclosed, four sided framed, rigid orfolding, wheeled with posterior seatMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Walker, heavy duty, multiple braking system,variable wheel resistanceMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 20.9; Pub. 100-4, Chapter 20, Section10.1E0148 Walker, heavy duty, without wheels, rigid or folding,any type, eachE0149 Walker, heavy duty, wheeled, rigid or folding, anytypeE0153 Platform attachment, forearm crutch, eachE0154 Platform attachment, walker, eachE0155 Wheel attachment, rigid pick-up walker, per pairseat attachment, walkerE0156 Seat attachment, walkerE0157 Crutch attachment, walker, eachE0158 Leg extensions for walker, per set of four (4)E0159 Brake attachment for wheeled walker, replacement,eachE0185 Gel or gel-like pressure pad for mattress, standardmattress length and widthMED: Pub. 100-3, Section 256, 280.1WalkersE0130Walker, rigid (pickup), adjustable or fixed heightMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1E0190E0191E0197Positioning cushion/pillow/wedge, any shape orsize, includes all components and accessoriesHeel or elbow protector, eachAir pressure pad for mattress, standard mattresslength and widthE0135Walker, folding (pickup), adjustable or fixed heightMED: Pub. 100-3, Section 280.1MED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1E0198Water pressure pad for mattress, standard mattresslength and widthMED: Pub. 100-3, Section 280.1© 2010 Ingenix ● New Codes ▲ Revised Codes MED: Medicare Reference 9

HCPCS Level II Definitions and GuidelinesCoding and Payment Guide for the Physical TherapistE0199Dry pressure pad for mattress, standard mattresslength and widthMED: Pub. 100-3, Section 280.1E0239Hydrocollator unit, portableMED: Pub. 100-2, Chapter 15, Section 230.3; Pub.100-3, Section 280.1Heat/Cold ApplicationE0200 Heat lamp, without stand (table model), includesbulb, or infrared elementE0205E0210E0215E0217E0218E0225E0231E0232MED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Heat lamp, with stand, includes bulb, or infraredelementMED: Pub. 100-2, Chapter 15, Section 110.1; Pub.100-3, Section 280.1; Pub. 100-4, Chapter 20, Section10.1Electric heat pad, standardMED: Pub. 100-3, Section 280.1Electric heat pad, moistMED: Pub. 100-3, Section 280.1Water circulating heat pad with pumpWater circulating cold pad with pumpHydrocollator unit, includes padsMED: Pub. 100-2, Chapter 15, Section 230.3; Pub.100-3, Section 280.1Non-contact wound warming device (temperaturecontrol unit, AC adapter and power cord) for usewith warming card and wound coverWarming card for use with the non-contact woundwarming device and non-contact wound warmingwound coverCoding TipNoncontact normothermic wound therapy (NNWT) encourageswound healing by warming a wound to a preset temperature. Thedevice consists of a noncontact wound cover that contains a flexible,battery-powered infrared heating card. Benefits are not availableunder Medicare for this therapy based on a national coveragedetermination or NCD.E0235Paraffin bath unit, portable (see medical supplycode A4265 for paraffin)MED: Pub. 100-2, Chapter 15, Section 230.3; Pub.100-3, Section 280.1Coding TipPortable paraffin bath units and supplies may be covered when thepatient has undergone a successful trial period of paraffin therapyordered by a provider and the patient’s condition is expected to berelieved by long-term use of this modality.E0236Pump for water circulating padMED: Pub. 100-3, Section 280.1Bath and Toilet AidsE0240 Bath/shower chair, with or without wheels, any sizeE0247E0248MED: Pub. 100-3, Section 280.1Transfer bench for tub or toilet with or withoutcommode openingTransfer bench, heavy duty, for tub or toilet with orwithout commode openingHospital Beds and AccessoriesE0277 Powered pressure-reducing air mattressE0280E0371E0372E0373MED: Pub. 100-3, Section 280.1Bed cradle, any typeNonpowered advanced pressure reducing overlayfor mattress, standard mattress length and widthPowered air overlay for mattress, standard mattresslength and widthNonpowered advanced pressure reducing mattressSuction Pump/Room VaporizersE0606 Postural drainage boardTranscutaneous and/or NeuromuscularElectrical Nerve Stimulators—TENSE0720 Transcutaneous electrical nerve stimulation (TENS)device, two lead, localized stimulationE0730E0731E0744E0745E0746E0747E0748MED: Pub. 100-3, Section 160.2, 160.3, 160.7.1, 256Transcutaneous electrical nerve stimulation (TENS)device, four or more leads, for multiple nervestimulationMED: Pub. 100-3, Section 160.2, 160.3, 160.7.1, 256Form-fitting conductive garment for delivery ofTENS or NMES (with conductive fibers separatedfrom the patient’s skin by layers of fabric)MED: Pub. 100-3, Section 270.3Neuromuscular stimulator for scoliosisNeuromuscular stimulator, electronic shock unitMED: Pub. 100-3, Section 150.4, 160.12Electromyography (EMG), biofeedback deviceMED: Pub. 100-3, Section 30.1Osteogenesis stimulator, electrical, noninvasive,other than spinal applicationsMED: Pub. 100-3, Section 150.2, 160.11Osteogenesis stimulator, electrical, noninvasive,spinal applicationsMED: Pub. 100-3, Section 150.2, 160.1110 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix

Coding and Payment Guide for the Physical TherapistE0762E0764E0769E0770TractionE0849E0855E0860E0944E0945E1035E1036E1037E1038E1039E1399Transcutaneous electrical joint stimulation devicesystem, includes all accessoriesFunctional neuromuscular stimulator,transcutaneous stimulation of muscles ofambulation with computer control, used for walkingby spinal cord injured, entire system, aftercompletion of training programElectrical stimulation or electromagnetic woundtreatment device, not otherwise classifiedFunctional electrical stimulator, transcutaneousstimulation of nerve and/or muscle groups, anytype, complete system, not otherwise specifiedTraction equipment, cervical, free-standingstand/frame, pneumatic, applying traction force toother than mandibleCervical traction equipment not requiringadditional stand or frameTraction equipment, overdoor, cervicalMED: Pub. 100-3, Section 280.1Pelvic belt/harness/bootExtremity belt/harnessMulti-positional patient transfer system, withintegrated seat, operated by care giver patientweight capacity up to and including 300 lbsMED: Pub. 100-2, Chapter 15, Section 110; Pub.100-4, Chapter 20, Section 10Multi-positional patient transfer system, extra-wide,with integrated seat, operated by caregiver, patientweight capacity greater than 300 lbsTransport chair, pediatric sizeTransport chair, adult size, patient weight capacityup to and including 300 poundsTransport chair, adult size, heavy duty, patientweight capacity greater than 300 poundsDurable medical equipment, miscellaneousOther Orthopedic DevicesE1800 Dynamic adjustable elbow extension/flexion device,includes soft interface materialE1801 Static progressive stretch elbow device, extensionand/or flexion, with or without range of motionadjustment, includes all components andaccessoriesE1802 Dynamic adjustable forearm pronation/supinationdevice, includes soft interface materialE1806 Static progressive stretch wrist device, flexionand/or extension, with or without range of motionadjustment, includes all components andaccessoriesE1811 Static progressive stretch knee device, extensionand/or flexion, with or without range of motionadjustment, includes all components andaccessoriesHCPCS Level II Definitions and GuidelinesE1816 Static progressive stretch ankle device, flexionand/or extension, with or without range of motionadjustment, includes all components andaccessoriesE1818 Static progressive stretch forearmpronation/supination device, with or without rangeof motion adjustment, includes all components andaccessoriesE1820 Replacement soft interface material, dynamicadjustable extension/flexion deviceE2402 Negative pressure wound therapy electrical pump,stationary or portableE2500 Speech generating device, digitized speech, usingpre-recorded messages, less than or equal to 8minutes recording timeE2502E2504E2506E2508E2510E2511E2512E2599E2611MED: Pub. 100-3, Section 50.1Speech generating device, digitized speech, usingpre-recorded messages, greater than 8 minutes butless than or equal to 20 minutes recording timeMED: Pub. 100-3, Section 50.1Speech generating device, digitized speech, usingpre-recorded messages, greater than 20 minutesbut less than or equal to 40 minutes recording timeMED: Pub. 100-3, Section 50.1Speech generating device, digitized speech, usingpre-recorded messages, greater than 40 minutesrecording timeMED: Pub. 100-3, Section 50.1Speech generating device, synthesized speech,requiring message formulation by spelling andaccess by physical contact with the deviceMED: Pub. 100-3, Section 50.1Speech generating device, synthesized speech,permitting multiple methods of messageformulation and multiple methods of device accessMED: Pub. 100-3, Section 50.1Speech generating software program, for personalcomputer or personal digital assistantMED: Pub. 100-3, Section 50.1Accessory for speech generating device, mountingsystemMED: Pub. 100-3, Section 50.1Accessory for speech generating device, nototherwise classifiedMED: Pub. 100-3, Section 50.1General use wheelchair back cushion, width lessthan 22 inches, any height, including any typemounting hardwareE2612 General use wheelchair back cushion, width 22inches or greater, any height, including any typemounting hardware© 2010 Ingenix ● New Codes ▲ Revised Codes MED: Medicare Reference 11

HCPCS Level II Definitions and GuidelinesCoding and Payment Guide for the Physical TherapistE2613E2614E2615E2616E2619E8000E8001E8002Positioning wheelchair back cushion, posterior,width less than 22 inches, any height, including anytype mounting hardwarePositioning wheelchair back cushion, posterior,width 22 in. or greater, any height, including anytype mounting hardwarePositioning wheelchair back cushion,posterior-lateral, width less than 22 inches, anyheight, including any type mounting hardwarePositioning wheelchair back cushion,posterior-lateral, width 22 inches or greater, anyheight, including any type mounting hardwareReplacement cover for wheelchair seat cushion orback cushion, eachGait trainer, pediatric size, posterior support,includes all accessories and componentsGait trainer, pediatric size, upright support, includesall accessories and componentsGait trainer, pediatric size, anterior support,includes all accessories and componentsG0281G0282G0283G0295G0329Electrical stimulation, (unattended), to one or moreareas, for chronic stage III and stage IV pressureulcers, arterial ulcers, diabetic ulcers, and venousstatsis ulcers not demonstrating measurable signs ofhealing after 30 days of conventional care, as part ofa therapy plan of careElectrical stimulation, (unattended), to one or moreareas, for wound care other than described inG0281Electrical stimulation (unattended), to one or moreareas for indication(s) other than wound care, aspart of a therapy plan of careElectromagnetic therapy, to one or more areas, forwound care other than described in G0329 or forother usesElectromagnetic therapy, to one or more areas forchronic Stage III and Stage IV pressure ulcers,arterial ulcers, diabetic ulcers and venous stasisulcers not demonstrating measurable signs ofhealing after 30 days of conventional care as part ofa therapy plan of careG Codes: Procedures/Professional Services(G0255–G0329)Temporary G codes are assigned to services and procedures that areunder review before being included in the CPT coding system.Payment for these services is under the jurisdiction of the localcarriers.G0151G0152G0153l G0157l G0158l G0159l G0160l G0161G0255Services performed by a qualified physical therapistin home health or hospice settings, each 15 minutesServices performed by a qualified occupationaltherapist in home health or hospice settings, each15 minutesServices performed by a qualified speech andlanguage pathologist in home health or hospicesettings, each 15 minutesServices performed by a qualified physical therapistassistant in the home health or hospice setting,each 15 minutesServices performed by a qualified occupationaltherapist assistant in the home health or hospicesetting, each 15 minutesServices performed by a qualified physical therapist,in the home health setting, in the establishment ordelivery of a safe and effective therapy maintenanceprogram, each 15 minutesServices performed by a qualified occupationaltherapist, in the home health setting, in theestablishment or delivery of a safe and effectivetherapy maintenance program, each 15 minutesServices performed by a qualified speech-languagepathologist, in the home health setting, in theestablishment or delivery of a safe and effectivetherapy maintenance program, each 15 minutesCurrent perception threshold/sensory nerveconduction test (SNCT), per limb, any nerveMED: Pub. 100-3, Section 220.7Coding TipsOn November 18, 1997, the U.S. District Court in Massachusettsissued a preliminary injunction against CMS to the effect that CMSmust cease enforcement of its national noncoverage determination(NCD) that prohibited any Medicare coverage of, or reimbursementfor, electrical stimulation (ES) therapy for the treatment of wounds.As a result of the injunction, Medicare carriers and intermediarieswere authorized to cover and reimburse ES therapy in those cases inwhich they determined that such therapy is reasonable andnecessary.After considerable study and review, the agency issued a decisionmemorandum on July 23, 2002, regarding electrical stimulation forthe treatment of wounds. Another decision memorandum was issuedon December 17, 2003, regarding electromagnetic stimulation forwound treatment. Effective July 1, 2004, Medicare will allow eitherone covered ES therapy or one covered electromagnetic therapy forwound treatment. Electrical stimulation and electromagnetic therapyfor wound treatment will not be covered as an initial intervention(the NCD uses the term “modality”); however, the use of electricaland electromagnetic stimulation will be covered as an adjunctivetherapy only after there are no measurable signs of healing for at least30 days of treatment with standard therapy. These interventions areapplicable only for chronic stage III and stage IV pressure ulcers,arterial ulcers, diabetic ulcers, and venous stasis ulcers. ES andelectromagnetic stimulation are only covered when administered bya physician, physical therapist, or incident to a physician service.Wounds must be evaluated at least every 30 days by the treatingphysician during administration of ES or electromagnetic therapy;continued treatment is not covered if measurable signs of healinghave not been demonstrated within any 30-day period. Thesetreatment modalities must be discontinued when the wound bed hascompleted epithelialization.For purposes of this NCD, the following wound stages arerecognized. A chronic ulcer is defined as one that has not healedwithin 30 days of onset.Stage I: Observable pressure-related alteration of intact skin that mayinclude one or more of the following: skin temperature (warm orcool), consistency of tissue (firm, boggy), and sensation (pain,itching). The ulcer presents as an area of persistent redness in patients12 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix

Coding and Payment Guide for the Physical Therapistwith light skin, or as an area with red, blue, or purple hues in thosewith darker skin.Stage II: The ulcer is superficial and appears as an abrasion, blister, orshallow crater. There is partial skin loss that involves the dermis,epidermis, or both.Stage III: The ulcer appears as a deep crater with or withoutundermining of adjacent tissue. There is full-thickness skin loss thatinvolves damage to or necrosis of subcutaneous tissue. It may extendto, but not through, the underlying fascia.Stage IV: The ulcer presents with full-thickness skin loss. There iswidespread destruction including tissue necrosis or damage tomuscles, bones, or supporting structures such as tendons and jointcapsules. Undermining of adjacent tissue and sinus tracts also may bepresent.All other uses of ES and electromagnetic therapy not otherwisespecified for wound treatment will be at the discretion of the localcontractor.L0170L0172L0174L0180L0190L0200HCPCS Level II Definitions and GuidelinesCervical, collar, molded to patient modelCervical, collar, semi-rigid thermoplastic foam, twopieceCervical, collar, semi-rigid, thermoplastic foam, twopiece with thoracic extensionCervical, multiple post collar, occipital/mandibularsupports, adjustableCervical, multiple post collar, occipital/mandibularsupports, adjustable cervical bars (SOMI, Guilford,Taylor types)Cervical, multiple post collar, occipital/mandibularsupports, adjustable cervical bars, and thoracicextensionThoracicL0220 Thoracic, rib belt, custom fabricatedK Codes: Temporary Codes (K0734–K0737)Temporary K codes are developed by the DME MACs to reportsupplies and other products for which a national code has not yetbeen developed. Payment jurisdiction lies with the DME MACsunless otherwise specified.K0734K0735K0736K0737Skin protection wheelchair seat cushion, adjustable,width less than 22 inches, any depthSkin protection wheelchair seat cushion, adjustablewidth 22 inches or greater, any depthSkin protection and positioning wheelchair seatcushion, adjustable, width less than 22 inches, anydepthSkin protection and positioning wheelchair seatcushion, adjustable, width 22 inches or greater, anydepthL Codes: Orthotic Procedures, Devices(L0120–L4398)Braces; trusses; and artifical legs, arms, and eyes are covered whenfurnished incident to a physician’s services or on a physician’s order.A brace includes rigid and semirigid devices used for the purpose ofsupporting a weak or deformed body member or restricting oreliminating motion in a diseased or injured part of the body. Backbraces include, but are not limited to, sacroiliac, sacrolumbar,dorsolumbar corsets, and belts. Stump stockings and harnesses(including replacements) are also covered when these appliancesare essential to the effective use of an artificial limb. Adjustments toan artificial limb or other appliance required by wear or by a changein the patient’s condition are covered when ordered by a physician.Adjustments, repairs, and replacements are covered so long as thedevice continues to be medically required.CervicalL0120 Cervical, flexible, nonadjustable (foam collar)L0140 Cervical, semi-rigid, adjustable (plastic collar)L0150 Cervical, semi-rigid, adjustable molded chin cup(plastic collar with mandibular/occipital piece)L0160 Cervical, semi-rigid, wire frameoccipital/mandibular supportL0450L0454L0456L0458L0460TLSO, flexible, provides trunk support, upperthoracic region, produces intracavitary pressure toreduce load on the intervertebral disks with rigidstays or panel(s), includes shoulder straps andclosures, prefabricated, includes fitting andadjustmentTLSO flexible, provides trunk support, extends fromsacrococcygeal junction to above T-9 vertebra,restricts gross trunk motion in the sagittal plane,produces intracavitary pressure to reduce load onthe intervertebral disks with rigid stays or panel(s),includes shoulder straps and closures, prefabricated,includes fitting and adjustmentTLSO, flexible, provides trunk support, thoracicregion, rigid posterior panel and soft anteriorapron, extends from the sacrococcygeal junctionand terminates just inferior to the scapular spine,restricts gross trunk motion in the sagittal plane,produces intracavitary pressure to reduce load onthe intervertebral disks, includes straps andclosures, prefabricated, includes fitting andadjustmentTLSO, triplanar control, modular segmented spinalsystem, two rigid plastic shells, posterior extendsfrom the sacrococcygeal junction and terminatesjust inferior to the scapular spine, anterior extendsfrom the symphysis pubis to the xiphoid, soft liner,restricts gross trunk motion in the sagittal, coronal,and transverse planes, lateral strength is providedby overlapping plastic and stabilizing closures,includes straps and closures, prefabricated, includesfitting and adjustmentTLSO, triplanar control, modular segmented spinalsystem, two rigid plastic shells, posterior extendsfrom the sacrococcygeal junction and terminatesjust inferior to the scapular spine, anterior extendsfrom the symphysis pubis to the sternal notch, softliner, restricts gross trunk motion in the sagittal,coronal, and transverse planes, lateral strength isprovided by overlapping plastic and stabilizingclosures, includes straps and closures, prefabricated,includes fitting and adjustment© 2010 Ingenix ● New Codes ▲ Revised Codes MED: Medicare Reference 13

HCPCS Level II Definitions and GuidelinesCoding and Payment Guide for the Physical TherapistL0462L0464L0466TLSO, triplanar control, modular segmented spinalsystem, three rigid plastic shells, posterior extendsfrom the sacrococcygeal junction and terminatesjust inferior to the scapular spine, anterior extendsfrom the symphysis pubis to the sternal notch, softliner, restricts gross trunk motion in the sagittal,coronal, and transverse planes, lateral strength isprovided by overlapping plastic and stabilizingclosures, includes straps and closures, prefabricated,includes fitting and adjustmentTLSO, triplanar control, modular segmented spinalsystem, four rigid plastic shells, posterior extendsfrom sacrococcygeal junction and terminates justinferior to scapular spine, anterior extends fromsymphysis pubis to the sternal notch, soft liner,restricts gross trunk motion in sagittal, coronal, andtransverse planes, lateral strength is provided byoverlapping plastic and stabilizing closures, includesstraps and closures, prefabricated, includes fittingand adjustmentTLSO, sagittal control, rigid posterior frame andflexible soft anterior apron with straps, closures andpadding, restricts gross trunk motion in sagittalplane, produces intracavitary pressure to reduceload on intervertebral disks, includes fitting andshaping the frame, prefabricated, includes fittingand adjustmentTLSO, sagittal-coronal control, rigid posterior frameand flexible soft anterior apron with straps, closuresand padding, extends from sacrococcygeal junctionover scapulae, lateral strength provided by pelvic,thoracic, and lateral frame pieces, restricts grosstrunk motion in sagittal, and coronal planes,produces intracavitary pressure to reduce load onintervertebral disks, includes fitting and shaping theframe, prefabricated, includes fitting andadjustmentTLSO, triplanar control, rigid posterior frame andflexible soft anterior apron with straps, closures andpadding, extends from sacrococcygeal junction toscapula, lateral strength provided by pelvic,thoracic, and lateral frame pieces, rotationalstrength provided by subclavicular extensions,restricts gross trunk motion in sagittal, coronal, andtransverse planes, produces intracavitary pressureto reduce load on the intervertebral disks, includesfitting and shaping the frame, prefabricated,includes fitting and adjustmentTLSO, triplanar control, hyperextension, rigidanterior and lateral frame extends from symphysispubis to sternal notch with two anteriorcomponents (one pubic and one sternal), posteriorand lateral pads with straps and closures, limitsspinal flexion, restricts gross trunk motion insagittal, coronal, and transverse planes, includesfitting and shaping the frame, prefabricated,includes fitting and adjustmentL0488L0490L0491TLSO, triplanar control, one piece rigid plastic shellwith interface liner, multiple straps and closures,posterior extends from sacrococcygeal junction andterminates just inferior to scapular spine, anteriorextends from symphysis pubis to sternal notch,anterior or posterior opening, restricts gross trunkmotion in sagittal, coronal, and transverse planes,prefabricated, includes fitting and adjustmentTLSO, sagittal-coronal control, one piece rigidplastic shell, with overlapping reinforced anterior,with multiple straps and closures, posterior extendsfrom sacrococcygeal junction and terminates at orbefore the T-9 vertebra, anterior extends fromsymphysis pubis to xiphoid, anterior opening,restricts gross trunk motion in sagittal and coronalplanes, prefabricated, includes fitting andadjustmentTLSO, sagittal-coronal control, modular segmentedspinal sytem, two rigid plastic shells, posteriorextends from the sacrococcygeal junction andterminates just inferior to the scapular spine,anterior extends from the symphysis pubis to thexiphoid, soft liner, restricts gross trunk motion inthe sagittal and coronal planes, lateral strength isprovided by overlapping plastic and stabilizingclosures, includes straps and closures, prefabricated,includes fitting and adjustmentTLSO, sagittal-coronal control, modular segmentedspinal system, three rigid plastic shells, posteriorextends from the sacrococcygeal junction andterminates just inferior to the scapular spine,anterior extends from the symphysis pubis to thexiphoid, soft liner, restricts gross trunk motion inthe sagittal and coronal planes, lateral strength isprovided by overlapping plastic and stabilizingclosures, includes straps and closures, prefabricated,includes fitting and adjustmentSacroiliac orthosis, flexible, provides pelvic-sacralsupport, reduces motion about the sacroiliac joint,includes straps, closures, may include pendulousabdomen design, prefabricated, includes fitting andadjustmentSacroiliac orthosis, provides pelvic-sacral support,with rigid or semi-rigid panels over the sacrum andabdomen, reduces motion about the sacroiliac joint,includes straps, closures, may include pendulousabdomen design, prefabricated, includes fitting andadjustmentL0468L0492L0470L0472L0621L0623L0625Lumbar orthosis, flexible, provides lumbar support,posterior extends from L-1 to below L-5 vertebra,produces intracavitary pressure to reduce load onthe intervertebral discs, includes straps, closures,may include pendulous abdomen design, shoulderstraps, stays, prefabricated, includes fitting andadjustment14 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix

Coding and Payment Guide for the Physical TherapistHCPCS Level II Definitions and GuidelinesL0626L0627L0628L0630L0631L0633L0635Lumbar orthosis, sagittal control, with rigidposterior panel(s), posterior extends from L-1 tobelow L-5 vertebra, produces intracavitary pressureto reduce load on the intervertebral discs, includesstraps, closures, may include padding, stays,shoulder straps, pendulous abdomen design,prefabricated, includes fitting and adjustmentLumbar orthosis, sagittal control, with rigid anteriorand posterior panels, posterior extends from L-1 tobelow L-5 vertebra, produces intracavitary pressureto reduce load on the intervertebral discs, includesstraps, closures, may include padding, shoulderstraps, pendulous abdomen design, prefabricated,includes fitting and adjustmentLSO, flexible, provides lumbo-sacral support,posterior extends from sacrococcygeal junction toT-9 vertebra, produces intracavitary pressure toreduce load on the intervertebral discs, includesstraps, closures, may include stays, shoulder straps,pendulous abdomen design, prefabricated, includesfitting and adjustmentLSO, sagittal control, with rigid posterior panel(s),posterior extends from sacrococcygeal junction toT-9 vertebra, produces intracavitary pressure toreduce load on the intervertebral discs, includesstraps, closures, may include padding, stays,shoulder straps, pendulous abdomen design,prefabricated, includes fitting and adjustmentLSO, sagittal control, with rigid anterior andposterior panels, posterior extends fromsacrococcygeal junction to T-9 vertebra, producesintracavitary pressure to reduce load on theintervertebral discs, includes straps, closures, mayinclude padding, shoulder straps, pendulousabdomen design, prefabricated, includes fitting andadjustmentLSO, sagittal-coronal control, with rigid posteriorframe/panel(s), posterior extends fromsacrococcygeal junction to T-9 vertebra, lateralstrength provided by rigid lateral frame/panels,produces intracavitary pressure to reduce load onintervertebral discs, includes straps, closures, mayinclude padding, stays, shoulder straps, pendulousabdomen design, prefabricated, includes fitting andadjustmentLSO, sagittal-coronal control, lumbar flexion, rigidposterior frame/panel(s), lateral articulating designto flex the lumbar spine, posterior extends fromsacrococcygeal junction to T-9 vertebra, lateralstrength provided by rigid lateral frame/panel(s),produces intracavitary pressure to reduce load onintervertebral discs, includes straps, closures, mayinclude padding, anterior panel, pendulousabdomen design, prefabricated, includes fitting andadjustmentL0637L0639LSO, sagittal-coronal control, with rigid anterior andposterior frame/panels, posterior extends fromsacrococcygeal junction to T-9 vertebra, lateralstrength provided by rigid lateral frame/panels,produces intracavitary pressure to reduce load onintervertebral discs, includes straps, closures, mayinclude padding, shoulder straps, pendulousabdomen design, prefabricated, includes fitting andadjustmentLSO, sagittal-coronal control, rigid shell(s)/panel(s),posterior extends from sacrococcygeal junction toT-9 vertebra, anterior extends from symphysis pubisto xyphoid, produces intracavitary pressure toreduce load on the intervertebral discs, overallstrength is provided by overlapping rigid materialand stabilizing closures, includes straps, closures,may include soft interface, pendulous abdomendesign, prefabricated, includes fitting andadjustmentHalo ProcedureL0810 Halo procedure, cervical halo incorporated intojacket vestL0820 Halo procedure, cervical halo incorporated intoplaster body jacketL0830 Halo procedure, cervical halo incorporated intoMilwaukee type orthosisL0861 Addition to halo procedure, replacementliner/interface materialAdditions to Spinal OrthosisL0970 TLSO, corset frontCoding TipTLSO guidelines: The orthosis must comprise a rigid plastic shell thatencircles the trunk and provides a high degree of immobility. Thevest-like orthoses that contain flexible components are not classifiedas TLSOs.L0972L0974L0976L0999LSO, corset frontTLSO, full corsetLSO, full corsetAddition to spinal orthosis, not otherwise specifiedCoding TipDetermine if an alternative national HCPCS Level II code betterdescribes the service being reported. Code L0999 should be usedonly if a more specific code is unavailable.L1000L1001CTLSO (Milwaukee), inclusive of furnishing initialorthosis, including modelCTLSO, immobilizer, infant size, prefabricated,includes fitting and adjustmentL1005Tension based scoliosis orthosis and accessory pads,includes fitting and adjustment© 2010 Ingenix ● New Codes ▲ Revised Codes MED: Medicare Reference 15

HCPCS Level II Definitions and GuidelinesL1600–L2999 Orthotic Devices, Lower LimbThe procedures in L1600–L2999 are considered base or basicprocedures and may be modified by listing procedures from theadditions sections and adding them to the base procedures. ForMedicare, file claims for codes in this section with DME MAC.L1600L1610L1620L1650L1652L1660L1686L1690L1810L1820L1830L1831L1832L1836L1843L1845HO, abduction control of hip joints, flexible, Frejkatype with cover, prefabricated, includes fitting andadjustmentHO, abduction control of hip joints, flexible, (Frejkacover only), prefabricated, includes fitting andadjustmentHO, abduction control of hip joints, flexible, (Pavlikharness), prefabricated, includes fitting andadjustmentHO, abduction control of hip joints, static,adjustable (Ilfled type), prefabricated, includesfitting and adjustmentHO, bilateral thigh cuffs with adjustable abductorspreader bar, adult size, prefabricated, includesfitting and adjustment, any typeHO, abduction control of hip joints, static, plastic,prefabricated, includes fitting and adjustmentHO, abduction control of hip joint, postoperativehip abduction type, prefabricated, includes fittingand adjustmentsCombination, bilateral, lumbo-sacral, hip, femurorthosis providing adduction and internal rotationcontrol, prefabricated, includes fitting andadjustmentKO, elastic with joints, prefabricated, includesfitting and adjustmentKO, elastic with condylar pads and joints, with orwithout patellar control, prefabricated, includesfitting and adjustmentKO, immobilizer, canvas longitudinal, prefabricated,includes fitting and adjustmentKO, locking knee joint(s), positional orthosis,prefabricated, includes fitting and adjustmentKO, adjustable knee joints (unicentric orpolycentric), positional orthosis, rigid support,prefabricated, includes fitting and adjustmentKO, rigid, without joint(s), includes soft interfacematerial, prefabricated, includes fitting andadjustmentKO, single upright, thigh and calf, with adjustableflexion and extension joint (unicentric orpolycentric), medial-lateral and rotation control,with or without varus/valgus adjustment,prefabricated, includes fitting and adjustmentKO, double upright, thigh and calf, with adjustableflexion and extension joint (unicentric orpolycentric), medial-lateral and rotation control,with or without varus/valgus adjustment,prefabricated, includes fitting and adjustmentL1847L1850L1902L1906L1910L1930L1932L1951L1971L2005L2035L2112L2114L2116L2132L2134L2136Coding and Payment Guide for the Physical TherapistKO, double upright with adjustable joint, withinflatable air support chamber(s), prefabricated,includes fitting and adjustmentKO, Swedish type, prefabricated, includes fittingand adjustmentAFO, ankle gauntlet, prefabricated, includes fittingand adjustmentAFO, multiligamentus ankle support, prefabricated,includes fitting and adjustmentAFO, posterior, single bar, clasp attachment to shoecounter, prefabricated, includes fitting andadjustmentAFO, plastic or other material, prefabricated,includes fitting and adjustmentAFO, rigid anterior tibial section, total carbon fiberor equal material, prefabricated, includes fitting andadjustmentAFO, spiral, (Institute of Rehabilitative Medicinetype), plastic or other material, prefabricated,includes fitting and adjustmentAFO, plastic or other material with ankle joint,prefabricated, includes fitting and adjustmentKAFO, any material, single or double upright, stancecontrol, automatic Lock and swing phase release,mechanical activation, includes ankle joint, anytype, custom fabricatedKAFO, full plastic, static (pediatric size), without freemotion ankle, prefabricated, includes fitting andadjustmentAFO, fracture orthosis, tibial fracture orthosis, soft,prefabricated, includes fitting and adjustmentAFO, fracture orthosis, tibial fracture orthosis,semi-rigid, prefabricated, includes fitting andadjustmentAFO, fracture orthosis, tibial fracture orthosis, rigid,prefabricated, includes fitting and adjustmentKAFO, fracture orthosis, femoral fracture castorthosis, soft, prefabricated, includes fitting andadjustmentKAFO, fracture orthosis, femoral fracture castorthosis, semi-rigid, prefabricated, includes fittingand adjustmentKAFO, fracture orthosis, femoral fracture castorthosis, rigid, prefabricated, includes fitting andadjustmentCoding TipsA custom-fitted orthotic is a premanufactured orthotic that can beadjusted to fit the patient.A custom-fabricated orthotic is made from basic materials on anindividual basis by using actual measurements or positive molds of16 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix

Coding and Payment Guide for the Physical Therapistthe patient. Generally, only the patient who was measured will beable to use a custom-fabricated orthotic.Code 97760 Orthotic(s) management and training (includingassessment and fitting when not otherwise reported), upperextremity(s), lower extremity(s), and/or trunk, each 15 minutes, wasdeveloped to include the training aspect of the management of apatient being assessed and fitted for an orthotic. If a HCPCS Level IIcode is reported and its description includes assessment and fitting,then documentation must also support the training aspect of theskilled services in order to also report CPT code 97760.L2232Addition to lower extremity orthosis, rocker bottomfor total contact ankle foot orthosis, for customfabricated orthosis onlyL3000–L3649 Orthotic ShoesFor Medicare, file claims for codes in this section with DME MAC.L3430L3440L3450L3455L3460L3465L3470L3480L3485Heel, counter, plastic reinforcedHeel, counter, leather reinforcedHeel, SACH cushion typeHeel, new leather, standardHeel, new rubber, standardHeel, Thomas with wedgeHeel, Thomas extended to ballHeel, pad and depression for spurMED: MCM 2323Heel, pad, removable for spurMED: MCM 2323L3650–L3999 Orthotic Devices, Upper LimbThe procedures from L3650–L3956 are considered base or basicprocedures and may be modified by listing procedures from theadditions sections and adding them to the base procedure. ForMedicare, file claims for codes in this section with DME MAC.L3650l L3674L3677L3710L3760L3762SO, figure of eight design abduction restrainer,prefabricated, includes fitting and adjustmentShoulder orthosis, abduction positioning (airplanedesign), thoracic component and support bar, withor without nontorsion joint/turnbuckle, may includesoft interface, straps, custom fabricated, includesfitting and adjustmentSO, hard plastic, shoulder stabilizer, pre-fabricated,includes fitting and adjustmentMED: Pub. 100-2, Chapter 15, Section 120EO, elastic with metal joints, prefabricated, includesfitting and adjustmentEO, with adjustable position locking joint(s),prefabricated, includes fitting and adjustments, anytypeEO, rigid, without joints, includes soft interfacematerial, prefabricated, includes fitting andadjustmentL3806L3807L3808L3908L3912L3914L3915L3917L3923L3925L3929L3931L3956L3960L3962L3964L3965L3966L3968HCPCS Level II Definitions and GuidelinesWHFO, includes one or more nontorsion joint(s),turnbuckles, elastic bands/springs, may include softinterface material, straps, custom fabricated,includes fitting and adjustmentWHFO, without joint(s), prefabricated, includesfitting and adjustments, any typeWHFO, rigid without joints, may include softinterface material; straps, custom fabricated,includes fitting and adjustmentWHO, wrist extension control cock-up, nonmolded,prefabricated, includes fitting and adjustmentHFO, flexion glove with elastic finger control,prefabricated, includes fitting and adjustmentWHO, wrist extension cock-up, prefabricated,includes fitting and adjustmentWHO, includes one or more nontorsion joint(s),elastic bands, turnbuckles, may include softinterface, straps, prefabricated, includes fitting andadjustmentHO, metacarpal fracture orthosis, prefabricated,includes fitting and adjustmentHFO, without joints, may include soft interface,straps, prefabricated, includes fitting andadjustmentFO, proximal interphalangeal (PIP)/distalinterphalangeal (DIP), nontorsion joint/spring,extension/flexion, may include soft interfacematerial, prefabricated, includes fitting andadjustmentHFO, includes one or more nontorsion joint(s),turnbuckles, elastic bands/springs, may include softinterface material, straps, prefabricated, includesfitting and adjustmentWHFO, includes one or more nontorsion joint(s),turnbuckles, elastic bands/springs, may include softinterface material, straps, prefabricated, includesfitting and adjustmentAddition of joint to upper extremity orthosis, anymaterial; per jointSEWHO, abduction positioning, airplane design,prefabricated, includes fitting and adjustmentSEWHO, abduction positioning, Erb’s palsy design,prefabricated, includes fitting and adjustmentSEO, mobile arm support attached to wheelchair,balanced, adjustable, prefabricated, includes fittingand adjustmentSEO, mobile arm support attached to wheelchair,balanced, adjustable Rancho type, prefabricated,includes fitting and adjustmentSEO, mobile arm support attached to wheelchair,balanced, reclining, prefabricated, includes fittingand adjustmentSEO, mobile arm support attached to wheelchair,balanced, friction arm support (friction dampeningto proximal and distal joints), prefabricated,includes fitting and adjustment© 2010 Ingenix ● New Codes ▲ Revised Codes MED: Medicare Reference 17

HCPCS Level II Definitions and GuidelinesL3969L3980L3982L3984SEO, mobile arm support, monosuspension arm andhand support, overhead elbow forearm hand slingsupport, yoke type arm suspension support,prefabricated, includes fitting and adjustmentUpper extremity fracture orthosis, humeral,prefabricated, includes fitting and adjustmentUpper extremity fracture orthosis, radius/ulnar,prefabricated, includes fitting and adjustmentUpper extremity fracture orthosis, wrist,prefabricated, includes fitting and adjustmentOrthotic Supplies, MiscellaneousL4000 Replace girdle for spinal orthosis (CTLSO or SO)L4002 Replacement strap, any orthosis, includes allcomponents, any length, any typeCoding and Payment Guide for the Physical TherapistThis section contains national codes assigned by CMS on atemporary basis. This list contains current codes.Q codes fall under the jurisdiction of the local carrier unless theyrepresent an incidental service or are otherwise specified.Q4049Q4051Finger splint, staticSplint supplies, miscellaneous (includesthermoplastics, strapping, fasteners, padding andother supplies)Coding TipsSince Q codes are under the jurisdiction of local Medicare carriers,coverage and coding guidelines may vary.Check your Medicare carrier’s coding guidelines and coverage issuesbefore reporting services using these codes.L4350L4360Ankle control orthosis, stirrup style, rigid, includesany type interface (e.g., pneumatic, gel),prefabricated, includes fitting and adjustmentWalking boot, pneumatic, and/or vacuum, with orwithout joints, with or without interface material,prefabricated, includes fitting and adjustmentS Codes: Temporary National Codes(Non-Medicare) (S5000–S9999)Blue Cross/Blue Shield and other commercial payers develop Scodes to report drugs, services, and supplies. These codes may notbe used to bill services paid under any Medicare payment system.Medicare does not reimburse for services under S codes.L4370Pneumatic full leg splint, prefabricated, includesfitting and adjustmentS8450Splint, prefabricated, digit (specify digit by use ofmodifier)L4380L4386L4392L4394Pneumatic knee splint, prefabricated, includesfitting and adjustmentWalking boot, nonpneumatic, with or withoutjoints, with or without interface material,prefabricated, includes fitting and adjustmentReplacement soft interface material, static AFOReplace soft interface material, foot drop splintS8451S8452S8948S8990Splint, prefabricated, wrist or ankleSplint, prefabricated, elbowApplication of a modality (requiring constantprovider attendance) to one or more areas;low-level laser; each 15 minutesPhysical or manipulative therapy performed formaintenance rather than restorationL4396Static ankle foot orthosis, including soft interfacematerial, adjustable for fit, for positioning, pressurereduction, may be used for minimal ambulation,prefabricated, includes fitting and adjustmentS9131S9476Physical therapy; in the home, per diemVestibular rehabilitation program, non-physicianprovider, per diemL4398Foot drop splint, recumbent positioning device,prefabricated, includes fitting and adjustmentQ Codes: Temporary Q0000–Q9999CMS assigns Q codes to procedures, services, and supplies on atemporary basis. When a permanent code is assigned, the Q code isdeleted and cross-referenced.Coding TipS codes are not valid for reporting services performed on Medicarepatients. Before reporting services with S codes to commercialinsurance carriers, verify with your carrier that the selected code iscovered.18 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix