101 CMR, § 339.04
Service Code | Allowable Fee | Service Description |
Special Otorhinolaryngologic Services | ||
92507 | $73.64 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual (maximum one unit per visit) |
92508 | $31.53 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals (maximum one unit per visit) |
92521 | $79.52 | Evaluation of speech fluency (e.g., stuttering, cluttering) |
92521 HA | $79.52 | Evaluation of speech fluency (e.g., stuttering, cluttering) (for patients younger than 21 years old) |
92521 TF | $79.52 | Evaluation of speech fluency (e.g., stuttering, cluttering) (for developmentally disabled adults 22 years of age or older) |
92522 | $64.41 | Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) |
92522 HA | $64.41 | Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) (for patients younger than 21 years old) |
92522 TF | $64.41 | Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) (for developmentally disabled adults 22 years of age or older) |
92523 | $133.99 | Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) |
92523 HA | $133.99 | Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) (for patients younger than 21 years old) |
92523 TF | $133.99 | Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) (for developmentally disabled adults 22 years of age or older) |
92524 | $66.82 | Behavioral and qualitative analysis of voice and resonance |
92524 HA | $66.82 | Behavioral and qualitative analysis of voice and resonance (for patients younger than 21 years old) |
92524 TF | $66.82 | Behavioral and qualitative analysis of voice and resonance (for developmentally disabled adults 22 years of age or older) |
92526 | $28.15 | Treatment of swallowing dysfunction and/or oral function for feeding (maximum one unit per visit) |
Evaluative and Therapeutic Services | ||
92605 | $64.41 | Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour |
92606 | $16.11 | Therapeutic service(s) for the use of non-speech-generating device, including programming and modification |
92607 | $64.41 | Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour |
92608 | $32.21 | Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure) |
92609 | $16.11 | Therapeutic services for the use of speech-generating device, including programming and modification |
92610 | $64.41 | Evaluation of oral and pharyngeal swallowing function (per hour, maximum of one hour) |
92630 | $14.68 | Auditory rehabilitation; prelingual hearing loss |
92633 | $14.68 | Auditory rehabilitation; postlingual hearing loss |
Physical Medicine and Rehabilitation | ||
97161 | $64.41 | Physical therapy evaluation - Low complex 20 min |
97162 | $64.41 | Physical therapy evaluation - Mod complex - 30 min |
97163 | $64.41 | Physical therapy evaluation High complex - 45 min |
97164 | $64.41 | Physical therapy reevaluation Est. Plan Care - 20 min |
97165 | $64.41 | Occupational therapy evaluation Low complex - 30 min |
97166 | $64.41 | Occupational therapy evaluation Mod complex - 45 min |
97167 | $64.41 | Occupational therapy evaluation High complex - 60 min |
97168 | $64.41 | Occupational therapy re-evaluation Est. Plan Care - 30 min |
Modalities - Supervised | ||
97010 | $4.27 | Application of a modality to one or more areas; hot or cold packs |
97012 | $12.63 | Application of a modality to one or more areas; traction, mechanical |
97014 | $12.69 | Application of a modality to one or more areas; electrical stimulation (unattended) |
97016 | $13.04 | Application of a modality to one or more areas; vasopneumatic devices |
97018 | $6.47 | Application of a modality to one or more areas; paraffin bath |
97022 | $4.64 | Application of a modality to one or more areas; whirlpool |
97024 | $4.27 | Application of a modality to one or more areas; diathermy (e.g., microwave) |
97026 | $5.24 | Application of a modality to one or more areas; infrared |
97028 | $4.27 | Application of a modality to one or more areas; ultraviolet |
Modalities - Constant Attendance | ||
97032 | $14.68 | Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes |
97033 | $14.68 | Application of a modality to one or more areas; iontophoresis, each 15 minutes |
97034 | $14.68 | Application of a modality to one or more areas; contrast baths, each 15 minutes |
97035 | $14.68 | Application of a modality to one or more areas; ultrasound, each 15 minutes |
97036 | $14.68 | Application of a modality to one or more areas; Hubbard tank, each 15 minutes |
97039 | $14.68 | Unlisted modality (specify type and time if constant attendance) |
Therapeutic Procedures | ||
97110 | $16.11 | Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility |
97112 | $16.11 | Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities |
97113 | $16.11 | Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercises |
97116 | $16.11 | Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing) |
97124 | $16.11 | Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) |
97139 | $16.11 | Unlisted therapeutic procedure (specify) (each 15 minutes) |
97140 | $16.11 | Manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes |
97150 | $25.56 | Therapeutic procedure(s), group (two or more individuals) (services delivered under an outpatient plan of care) (maximum one unit per visit) |
97530 | $16.11 | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes |
97532 | $14.68 | Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes |
97533 | $14.68 | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes |
97535 | $16.11 | Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes |
97537 | $14.68 | Community/work reintegration training (e.g., shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment) direct one-on-one contact, each 15 minutes |
97542 | $14.68 | Wheelchair management (e.g., assessment, fitting, training), each 15 minutes |
97545 | $117.41 | Work hardening/conditioning; initial two hours |
97546 | $58.70 | Work hardening/conditioning; each additional hour (list separately in addition to code for primary procedure) (use in conjunction with 97545) |
Active Wound Care Management | ||
97597 | $47.06 | Debridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 square centimeters or less |
97598 | $58.90 | Debridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq. cm., or part thereof (list separately in addition to code for primary procedure) |
97602 | I.C. | Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session |
97605 | $30.44 | Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters |
97606 | $32.58 | Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters |
Tests and Measurements | ||
97750 | $14.68 | Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes |
97755 | $14.68 | Assistive technology assessment (e.g., to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 15 minutes |
Orthotic Management and Prosthetic Management | ||
97760 | $16.11 | Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes |
97761 | $16.11 | Prosthetic training, upper and/or lower extremity(s), each 15 minutes |
97762 | $14.68 | Checkout for orthotic/prosthetic use, established patient, each 15 minutes |
Other Procedures | ||
97799 | $16.11 | Unlisted physical medicine/rehabilitation service or procedure (each 15 minutes, maximum six units per visit) |
Evaluation and Management - Office or Other Outpatient Services | ||
99203 | $84.41 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: - a detailed history; - a detailed examination; and - medical decision making of low complexity |
99205 | $160.33 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components (written report required): - a comprehensive history; - a comprehensive examination; and - medical decision making of high complexity |
99212 | $34.20 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: - a problem focused history; - a problem focused examination; and - straightforward medical decision making |
99214 | $82.96 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components (written report required): - a detailed history; - a detailed examination; and - medical decision making of moderate complexity |
99215 | $112.01 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components (written report required): - a comprehensive history; - a comprehensive examination; and - medical decision making of high complexity |
Rehabilitation Center Physical Therapist | $64.41/hr. |
Rehabilitation Center Occupational Therapist | $64.41/hr. |
Rehabilitation Center Speech Therapist | $64.41/hr. |
Restorative Physical Therapy office visit | $64.41/hr. |
Restorative Occupational Therapy office visit | $64.41/hr. |
Restorative Speech Therapy office visit | $64.41/hr. |
Restorative Physical Therapy out-of-office visit | $74.07/hr. |
Restorative Occupational Therapy out-of-office visit | $74.07/hr. |
Restorative Speech Therapy out-of-office visit | $74.07/hr. |
101 CMR, § 339.04