Statutes, codes, and regulations
California Code Of Regulations
Title 22 - Social SecurityDivision 3 - Health Care ServicesSubdivision 1 - California Medical Assistance ProgramChapter 3 - Health Care Services
Article 7 - Payment for Services and Supplies
Section 51507 - Physical Therapy

Cal. Code Regs. tit. 22 § 51507

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Current through Register 2024 Notice Reg. No. 23, June 7, 2024
Section 51507 - Physical Therapy
(a) Reimbursement for physical therapy services shall be the usual charges made to the general public not to exceed the maximum reimbursement rates listed in this section.
(b) The following definitions shall apply to the reimbursement of physical therapy services under this section.
(1) Modality means any physical therapy treatment, unless listed separately which does not require the continuous attention of the therapist. Examples are:

a.Hot or cold packsf.Microwave
b.Traction, mechanicalg.Whirlpool
c.Electrical stimulationh.Diathermy
(unattended)i.Infrared
d.Vasopneumatic devicesj.Ultraviolet
e.Paraffin bathk.Ultrasound

(2) Procedure means any physical therapy treatment, unless listed separately which requires the continuous attention of the therapist. Examples are:

a.Therapeutic exerciseh.Electrical stimulation
b.Neuromuscular reeducation(motor point)
c.Rehabilitation servicesi.Ionotophoresis
d.Functional activitiesj.Traction, manual
e.Gait trainingk.Massage
f.Orthotics trainingl.Contrast baths
g.Prosthetics training

(3) Tests and measurements mean individually administered, observed and recorded procedures and include a written report of the tests and measurements involved. Examples are:

a.Orthotic "check out"c.Activities of daily living
b.Prosthetic "check out""check out"

(4) Case Conference means participation in organized conference with other health team members, who are immediately involved in the care or recovery of the patient, concerning status, or progress, of the patient under treatment and includes required charting entries. Case conferences shall be limited to one per patient per month.
(5) Additional 15-minute period means any 15-minute period or major portion thereof, 7 minutes or more, immediately following the initial 30 minutes.
(6) The maximum allowance for home or long-term care facility visit is payable only for visits to the first patient receiving services at any given location on the same day.
(c) Maximum reimbursement rates for physical therapy services shall be as follows:

Procedure CodeMaximum Allowance
X3900Single modality to one area--initial 30 minutes$17.04
X3902Single modality to one area--each additional 15 minutes3.63
X3904Single procedure to one area--initial 30 minutes21.19
X3906Single procedure to one area--each additional 15 minutes6.86
X3908Treatment including a combination of any modalities and procedures (one or more areas)--initial 30 minutes21.19
X3910Treatment including a combination of any modalities and procedures (one or more areas)--each additional 15 minutes6.86
X3912Hubbard Tank--initial 30 minutes34.84
X3914Hubbard Tank--each additional 15 minutes6.86
X3916Hubbard Tank or pool therapy with therapeutic exercise--initial 30 minutes41.69
X3918Hubbard Tank or pool therapy with therapeutic exercise--each additional 15 minutes6.86
X3920Any of the tests and measurements--initial 30 minutes, plus report34.84
X3922Any of the tests and measurements--each additional 15 minutes, plus report17.04
X3924Physical therapy preliminary evaluation in a rehabilitation center, SNF, ICF, or subacute care facility34.84
X3926Case conference and report--initial 30 minutes21.19
X3928Case consultation and report21.19
X3930Case conference and report--each additional 15 minutes6.86
X3932Home or long-term care facility visit--add6.57
X3934Mileage, per mile one-way beyond ten-mile radius of point of origin (office or home)1.77
X3936Unlisted ServicesBy Report

Cal. Code Regs. Tit. 22, § 51507

1. Amendment of subsection (c) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84. For prior history, see Register 81, No. 52.
2. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
3. Amendment of subsection (c) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
4. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
5. Amendment of subsection (c) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
7. Amendment of subsection (c), new subsection (d) and amendment of NOTE filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52, Items 4260-101-0001 and 0890 (Register 2002, No. 29).
8. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (d), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14105, Welfare and Institutions Code; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; Statutes of 1985, Chapter 111, Items 4260-106-001 and 890; and Statutes of 2000, Chapter 52, Items 4260-101-0001 and 0890.

1. Amendment of subsection (c) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84. For prior history, see Register 81, No. 52.
2. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
3. Amendment of subsection (c) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
4. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
5. Amendment of subsection (c) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
7. Amendment of subsection (c), new subsection (d) and amendment of Note filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52 Items 4260-101-0001 and 0890 (Register 2002, No. 29).
8. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (d), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).