Medicare Claims Processing Manual

Chapter 5 - Part B Outpatient Rehabilitation

and CORF/OPT Services

Table of Contents

(Rev. 11129, 11-22-21)

Transmittals for Chapter 5

10 - Part B Outpatient Rehabilitation and Comprehensive Outpatient Rehabilitation

Facility (CORF) Services - General

10.1 - New Payment Requirement for A/B MACs (A)

10.2 - The Financial Limitation Legislation

10.3 - Application of Financial Limitations

10.3.1 - Exceptions to Therapy Caps – General

10.3.2 - Exceptions Process

10.3.3 - Use of the KX Modifier

10.3.4 - Manual Review Threshold to Ensure Appropriate Therapy

10.3.5 - Identifying the Certifying Physician

10.3.6 - MSN Messages Regarding the Therapy Cap

10.4 - Claims Processing Requirements for Financial Limitations

10.5 - Notification for Beneficiaries Exceeding Financial Limitations

10.6 - Functional Reporting

10.7 - Multiple Procedure Payment Reductions for Outpatient Rehabilitation

Services

20 - HCPCS Coding Requirement

20.1 - Discipline Specific Outpatient Rehabilitation Modifiers - All Claims

20.2 - Reporting of Service Units With HCPCS

20.3 - Determining What Time Counts Towards 15-Minute Timed Codes -

All Claims

20.4 - Coding Guidance for Certain CPT Codes – All Claims

20.5 - CORF/OPT Edit for Billing Inappropriate Supplies

30 - Special Claims Processing Rules for Outpatient Rehabilitation Claims - Form

CMS-1500

30.1 - Determining Payment Amounts

30.2 - Applicable A/B MAC (B) CWF Type of Service Codes

40 - Special Claims Processing Rules for Institutional Outpatient Rehabilitation Claims

40.1 - Determining Payment Amounts - Institutional Claims

40.2 - Applicable Types of Bill

40.3 - Applicable Revenue Codes

40.4 - Edit Requirements for Revenue Codes

40.5 - Line Item Date of Service Reporting

40.6 – Non-covered Charge Reporting

40.7 - Billing for Biofeedback Training for the Treatment of Urinary Incontinence

40.8 – Rebilling Therapy Services for Hospital Inpatients

50 - CWF and PS&R Requirements - A/B MAC (A)

100 - Special Rules for Comprehensive Outpatient Rehabilitation Facilities (CORFs)

100.1 - General

100.1.1 - Allowable Revenue Codes on CORF 75X Bill Types

100.2 - Obtaining Fee Schedule Amounts

100.3 - Proper Reporting of Nursing Services by CORFs - A/B MAC (A)

100.4 - Outpatient Mental Health Treatment Limitation

100.5 - Off-Site CORF Services

100.6 - Notifying Patient of Service Denial

100.7 - Payment of Drugs, Biologicals, and Supplies in a CORF

100.8 - Billing for DME, Prosthetic and Orthotic Devices, and Surgical

Dressings

100.10 - Group Therapy Services (Code 97150)

100.10.1 - Therapy Students

100.11 - Billing for Social Work and Psychological Services in a CORF

100.12 - Billing for Respiratory Therapy Services in a CORF

Exhibit 1 - Physician Fee Schedule Abstract File

Addendum A - Chapter 5, Section 20.4 – Coding Guidance for Certain CPT Codes – All

Claims

10 - Part B Outpatient Rehabilitation and Comprehensive Outpatient

Rehabilitation Facility (CORF) Services - General

(Rev. 3454, Issued: 02-04-16, Effective: 07-01-16, Implementation: 07-05-16)

Language in this section is defined or described in Pub. 100-02, chapter 15, sections 220

and 230.

Section §1834(k)(5) to the Social Security Act (the Act), requires that all claims for

outpatient rehabilitation services and comprehensive outpatient rehabilitation facility

(CORF) services, be reported using a uniform coding system. The CMS chose HCPCS

(Healthcare Common Procedure Coding System) as the coding system to be used for the

reporting of these services. This coding requirement is effective for all claims for

outpatient rehabilitation services and CORF services submitted on or after April 1, 1998.

The Act also requires payment under a prospective payment system for outpatient

rehabilitation services including CORF services. Effective for claims with dates of

service on or after January 1, 1999, the Medicare Physician Fee Schedule (MPFS)

became the method of payment for outpatient therapy services furnished by:

• Comprehensive outpatient rehabilitation facilities (CORFs);

• Outpatient physical therapy providers (OPTs), also known as rehabilitation

agencies;

• Hospitals (to outpatients and inpatients who are not in a covered Part A stay);

• Skilled nursing facilities (SNFs) (to residents not in a covered Part A stay and to

nonresidents who receive outpatient rehabilitation services from the SNF); and

• Home health agencies (HHAs) (to individuals who are not homebound or

otherwise are not receiving services under a home health plan of care (POC)).

NOTE: No provider or supplier other than the SNF will be paid for therapy services

during the time the beneficiary is in a covered SNF Part A stay. For information

regarding SNF consolidated billing see chapter 6, section 10 of this manual.

Similarly, under the HH prospective payment system, HHAs are responsible to provide,

either directly or under arrangements, all outpatient rehabilitation therapy services to

beneficiaries receiving services under a home health POC. No other provider or supplier

will be paid for these services during the time the beneficiary is in a covered Part A stay.

For information regarding HH consolidated billing see chapter10, section 20 of this

manual.

Section 143 of the Medicare Improvements for Patients and Provider’s Act of 2008

(MIPPA) authorizes the Centers for Medicare & Medicaid Services (CMS) to enroll

speech-language pathologists (SLP) as suppliers of Medicare services and for SLPs to

begin billing Medicare for outpatient speech-language pathology services furnished in

private practice beginning July 1, 2009. Enrollment will allow SLPs in private practice to

bill Medicare and receive direct payment for their services. Previously, the Medicare

program could only pay SLP services if an institution, physician or nonphysician

practitioner billed them.

In Chapter 23, as part of the CY 2009 Medicare Physician Fee Schedule Database, the

descriptor for PC/TC indicator “7”, as applied to certain HCPCS/CPT codes, is described

as specific to the services of privately practicing therapists. Payment may not be made if

the service is provided to either a hospital outpatient or a hospital inpatient by a physical

therapist, occupational therapist, or speech-language pathologist in private practice.

The MPFS is used as a method of payment for outpatient rehabilitation services furnished

under arrangement with any of these providers.

In addition, the MPFS is used as the payment system for CORF services identified by the

HCPCS codes in §20. Assignment is mandatory.

Services that are paid subject to the MPFS are adjusted based on the applicable payment

locality. Rehabilitation agencies and CORFs with service locations in different payment

localities shall follow the instructions for multiple service locations in chapter 1, section

170.1.1.

The Medicare allowed charge for the services is the lower of the actual charge or the

MPFS amount. The Medicare payment for the services is 80 percent of the allowed

charge after the Part B deductible is met. Coinsurance is made at 20 percent of the lower

of the actual charge or the MPFS amount. The general coinsurance rule (20 percent of

the actual charges) does not apply when making payment under the MPFS. This is a final

payment.

The MPFS does not apply to outpatient rehabilitation services furnished by critical access

hospitals (CAHs) or hospitals in Maryland. CAHs are to be paid on a reasonable cost

basis. Maryland hospitals are paid under the Maryland All-Payer Model.

Contractors process outpatient rehabilitation claims from hospitals, including CAHs,

SNFs, HHAs, CORFs, outpatient rehabilitation agencies, and outpatient physical therapy

providers for which they have received a tie in notice from the Regional Office (RO).

These provider types submit their claims to the contractors using the ASC X12 837

institutional claim format or the CMS-1450 paper form when permissible. Contractors

also process claims from physicians, certain nonphysician practitioners (NPPs),

therapists in private practices (TPPs), (which are limited to physical and occupational

therapists, and speech-language pathologists in private practices), and physician-directed

clinics that bill for services furnished incident to a physician’s service (see Pub. 100-02,

Medicare Benefit Policy Manual, chapter 15, for a definition of “incident to”). These

provider types submit their claims to the contractor using the ASC X 12 837 professional

claim format or the CMS-1500 paper form when permissible.

There are different fee rates for nonfacility and facility services. Chapter 23 describes the

differences in these two rates. (See fields 28 and 29 of the record therein described).

Facility rates apply to professional services performed in a facility other than the

professional’s office. Nonfacility rates apply when the service is performed in the

professional’s office. The nonfacility rate (that is paid when the provider performs the

services in its own facility) accommodates overhead and indirect expenses the provider

incurs by operating its own facility. Thus it is somewhat higher than the facility rate.

Contractors pay the nonfacility rate on institutional claims for services performed in the

provider’s facility. Contractors may pay professional claims using the facility or

nonfacility rate depending upon where the service is performed (place of service on the

claim), and the provider specialty.

Contractors pay the codes in §20 under the MPFS on professional claims regardless of

whether they may be considered rehabilitation services. However, contractors must use

this list for institutional claims to determine whether to pay under outpatient

rehabilitation rules or whether payment rules for other types of service may apply, e.g.,

OPPS for hospitals, reasonable costs for CAHs.

Note that because a service is considered an outpatient rehabilitation service does not

automatically imply payment for that service. Additional criteria, including coverage,

plan of care and physician certification must also be met. These criteria are described in

Pub. 100-02, Medicare Benefit Policy Manual, chapters 1 and 15.

Payment for rehabilitation services provided to Part A inpatients of hospitals or SNFs is

included in the respective PPS rate. Also, for SNFs (but not hospitals), if the beneficiary

has Part B, but not Part A coverage (e.g., Part A benefits are exhausted), the SNF must

bill for any rehabilitation service.

Payment for rehabilitation therapy services provided by home health agencies under a

home health plan of care is included in the home health PPS rate. HHAs may submit bill

type 34X and be paid under the MPFS if there are no home health services billed under a

home health plan of care at the same time, and there is a valid rehabilitation POC (e.g.,

the patient is not homebound).

An institutional employer (other than a SNF) of the TPPs, or physician performing

outpatient services, (e.g., hospital, CORF, etc.), or a clinic billing on behalf of the

physician or therapist may bill the contractor on a professional claim.

The MPFS is the basis of payment for outpatient rehabilitation services furnished by

TPPs, physicians, and certain nonphysician practitioners or for diagnostic tests provided

incident to the services of such physicians or nonphysician practitioners. (See Pub. 100-

02, Medicare Benefit Policy Manual, Chapter 15, for a definition of “incident to,

therapist, therapy and related instructions.") Such services are billed to the contractor on

the professional claim format. Assignment is mandatory.

The following table identifies the provider and supplier types, and identifies which claim

format they may use to submit claims for outpatient therapy services to the contractor.

“Provider/Supplier Service”

Type

Format

Bill Type

Comment

Inpatient SNF Part A

Institutional

21X

Included in PPS

Inpatient hospital Part B

Institutional

12X

Hospital may obtain services

under arrangements and bill, or

rendering provider may bill.

Inpatient SNF Part B

(audiology tests are not

included)

Institutional

22X

SNF must provide and bill, or

obtain under arrangements and

bill.

Outpatient hospital

Institutional

13X

Hospital may provide and bill

or obtain under arrangements

and bill.

Outpatient SNF

Institutional

23X

SNF must provide and bill or

obtain under arrangements and

bill.

HHA billing for services not

rendered under a Part A or

Part B home health plan of

care, but rendered under a

therapy plan of care.

Institutional

34X

Service not under home health

plan of care.

Outpatient physical therapy

providers (OPTs), also known

as rehabilitation agencies

Institutional

74X

Paid MPFS for outpatient

rehabilitation services.

Comprehensive Outpatient

Rehabilitation Facility

(CORF)

Institutional

75X

Paid MPFS for outpatient

rehabilitation services and all

other services except drugs.

Drugs are paid 95% of the

AWP.

Physician, NPPs, TPPs,

(therapy services in hospital

or SNF)

Professional

See Chapter

26 for place

of service

coding.

Payment may not be made for

therapy services to Part A

inpatients of hospitals or SNFs,

or for Part B SNF residents.

NOTE: Payment may be made

to physicians and NPPs for

their professional services

defined as “sometimes therapy”

(not part of a therapy plan) in

certain situations; for example,

when furnished to a beneficiary

“Provider/Supplier Service”

Type

Format

Bill Type

Comment

registered as an outpatient of a

hospital.

Physician/NPP/TPPs office,

or patient’s home

Professional

See Chapter

26 for place

of service

coding.

Paid via MPFS.

Critical Access Hospital -

inpatient Part B

Institutional

12X

Rehabilitation services are paid

at cost.

Critical Access Hospital –

outpatient Part B

Institutional

85X

Rehabilitation services are paid

at cost.

For a list of the outpatient rehabilitation HCPCS codes see §20.

If a contractor receives an institutional claim for one of these HCPCS codes with dates of

service on or after July 1, 2003, that does not appear on the supplemental file it currently

uses to pay the therapy claims, it contacts its professional claims area to obtain the non-

facility price in order to pay the claim.

NOTE: The list of codes in §20 contains commonly utilized codes for outpatient

rehabilitation services. Contractors may consider other codes on institutional claims for

payment under the MPFS as outpatient rehabilitation services to the extent that such

codes are determined to be medically reasonable and necessary and could be performed

within the scope of practice of the therapist providing the service.

10.1 - New Payment Requirement for A/B MACs (A)

(Rev. 1, 10-01-03)

Effective with claims with dates of service on or after July 1, 2003, OPTs/outpatient

rehabilitation facilities (ORFs), (74X and 75X bill type) are required to report all their

services utilizing HCPCS. A/B MACs (A) are required to make payment for these

services under the MPFS unless the item or service is currently being paid under the

orthotic fee schedule or the item is a drug, biological, supply or vaccine (see below for an

explanation of these services).

The CMS currently provides A/B MACs (A) with a CORF supplemental file that

contains all physician fee schedule services and their related prices. A/B MACs (A) use

this file to price and pay OPT claims. The format of the record layout is provided in

Attachment E of PM A-02-090, dated September 27, 2002. This is located in Chapter 23,

section 50.3.

A/B MACs (A) will be notified in a one-time instruction of updates to this file and when

it will be available for retrieval.

If an A/B MAC (A) receives a claim for one of the above HCPCS codes with dates of

service on or after July 1, 2003, that does not appear on the CORF supplemental file it

currently uses to pay the CORF claims, it contacts its local A/B MAC (B) to obtain the

price in order to pay the claim. When requesting the pricing data, it advises the A/B

MAC (B) to provide it with the nonfacility fee.

10.2 - The Financial Limitation Legislation

(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19)

A. Legislation on Limitations

The dollar amount of the limitations (caps) on outpatient therapy services is established

by statute. The updated amount of the caps is released annually via Recurring Update

Notifications and posted on the CMS Website www.cms.gov/TherapyServices, on

contractor Websites, and on each beneficiary’s Medicare Summary Notice. Medicare

contractors shall publish the financial limitation amount in educational articles. It is also

available at 1-800-Medicare.

Section 4541(a)(2) of the Balanced Budget Act (BBA) (P.L. 105-33) of 1997, which added

§1834(k)(5) to the Act, required payment under a prospective payment system (PPS) for

outpatient rehabilitation services (except those furnished by or under arrangements with a

hospital). Outpatient rehabilitation services include the following services:

• Physical therapy

• Speech-language pathology; and

• Occupational therapy.

Section 4541(c) of the BBA required application of financial limitations to all outpatient

rehabilitation services (except those furnished by or under arrangements with a hospital).

In 1999, an annual per beneficiary limit of $1,500 was applied, including all outpatient

physical therapy services and speech-language pathology services. A separate limit

applied to all occupational therapy services. The limits were based on incurred expenses

and included applicable deductible and coinsurance. The BBA provided that the limits be

indexed by the Medicare Economic Index (MEI) each year beginning in 2002.

Since the limitations apply to outpatient services, they do not apply to skilled nursing

facility (SNF) residents in a covered Part A stay, including patients occupying swing

beds. Rehabilitation services are included within the global Part A per diem payment that

the SNF receives under the prospective payment system (PPS) for the covered stay.

Also, limitations do not apply to any therapy services covered under prospective payment

systems for home health or inpatient hospitals, including critical access hospitals.

The limitation is based on therapy services the Medicare beneficiary receives, not the

type of practitioner who provides the service. Physical therapists, speech-language

pathologists, and occupational therapists, as well as physicians and certain nonphysician

practitioners, could render a therapy service.

B. Moratoria and Exceptions for Therapy Claims

Since the creation of therapy caps, Congress has enacted several moratoria. The Deficit

Reduction Act of 2005 directed CMS to develop exceptions to therapy caps for calendar

year 2006 and the exceptions have been extended periodically. The cap exception for

therapy services billed by outpatient hospitals was part of the original legislation and

applies as long as caps are in effect. Exceptions to caps based on the medical necessity of

the service are in effect only when Congress legislates the exceptions.

C. Repeal of Original Legislation and Replacement with Thresholds to Ensure

Appropriate Therapy.

Section 50202 of the Bipartisan Budget Act of 2018 repeals application of the Medicare

outpatient therapy caps but retains the former cap amounts as a threshold of incurred

expenses above which claims must include a modifier as a confirmation that services are

medically necessary as justified by appropriate documentation in the medical record. This

is termed the KX modifier threshold.

Along with this KX modifier threshold, the new law retains the targeted medical review

process but at a lower threshold amount of $3,000. For more information about the

medical review (MR) threshold see the below section 10.3.4.

10.3 - Application of Financial Limitations

(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19)

(Additions, deletions or changes to the therapy code list are updated via a Recurring

Update Notification)

Financial limitations on outpatient therapy services, as described above, began for

therapy services rendered on or after on January 1, 2006. References and polices relevant

to the exceptions process in this chapter apply only when exceptions to therapy caps are

in effect. For dates of service before October 1, 2012, limits apply to outpatient Part B

therapy services furnished in all settings except outpatient hospitals, including hospital

emergency departments. These excluded hospital services are reported on types of bill

12x or 13x, or 85x. Effective for dates of service on or after October 1, 2012, the limits

also apply to outpatient Part B therapy services furnished in outpatient hospitals other

than CAHs and hospitals in Maryland. During this period, only type of bill 12x claims

with a CMS certification number in the CAH range, type of bill 12x and 13x claims with

a CMS certification number beginning with the State code for Maryland, and type of bill

85x claims are excluded.

Effective for dates of service on or after January 1, 2014, the limits also apply to CAHs.

Effective for dates of service on or after January 1, 2016, the limits also apply to hospitals

in Maryland. Effective for dates of service on or after January 1, 2018, the KX modifier

threshold applies to all the therapy provider types to which the limits applied.

Contractors apply the financial limitations or thresholds to the MPFS amount (or the

amount charged if it is smaller) for therapy services for each beneficiary.

As with any Medicare payment, beneficiaries pay the coinsurance (20 percent) and any

deductible that may apply. Medicare will pay the remaining 80 percent of the limit after

the deductible is met. These amounts will change each calendar year.

Medicare shall apply these financial limitations or KX modifier thresholds in order,

according to the dates when the claims were received. When limitations or KX modifier

thresholds apply, the Common Working File (CWF) tracks them. Shared system

maintainers are not responsible for tracking the dollar amounts of incurred expenses.

In processing claims where Medicare is the secondary payer, the shared system takes the

lowest secondary payment amount from MSPPAY and sends this amount on to CWF as

the amount applied to therapy limits or KX modifier thresholds.

10.3.1 - Exceptions to Therapy Caps – General

(Rev. 3367 Issued: 10-07-15, Effective: 01-01-16, Implementation: 01-04-16)

The following policies concerning exceptions to caps due to medical necessity apply only

when the exceptions process is in effect. Except for the requirement to use the KX

modifier, the guidance in this section concerning medical necessity applies as well to

services provided before caps are reached.

Provider and supplier information concerning exceptions is in this chapter and in Pub.

100-02, Chapter 15, section 220.3. Exceptions shall be identified by a modifier on the

claim and supported by documentation.

The beneficiary may qualify for use of the cap exceptions process at any time during the

episode when documented medically necessary services exceed caps. All covered and

medically necessary services qualify for exceptions to caps. All requests for exception

are in the form of a KX modifier added to claim lines. (See subsection D. for use of the

KX modifier.)

Use of the exception process does not exempt services from manual or other medical

review processes as described in Pub. 100-08. Rather, atypical use of the exception

process may invite contractor scrutiny, for example, when the KX modifier is applied to

all services on claims that are below the therapy caps or when the KX modifier is used

for all beneficiaries of a therapy provider. To substantiate the medical necessity of the

therapy services, document in the medical record (see Pub. 100-02, chapter 15, sections

220.2, 220.3, and 230).

The KX modifier, described in subsection D., is added to claim lines to indicate that the

clinician attests that services at and above the therapy caps are medically necessary and

justification is documented in the medical record.

10.3.2 - Exceptions Process

(Rev. 3670, Issued: 12-01-16, Effective: 01-01-17, Implementation: 01-03-17)

An exception may be made when the patient’s condition is justified by documentation

indicating that the beneficiary requires continued skilled therapy, i.e., therapy beyond the

amount payable under the therapy cap, to achieve their prior functional status or

maximum expected functional status within a reasonable amount of time.

No special documentation is submitted to the contractor for exceptions. The clinician is

responsible for consulting guidance in the Medicare manuals and in the professional

literature to determine if the beneficiary may qualify for the exception because

documentation justifies medically necessary services above the caps. The clinician’s

opinion is not binding on the Medicare contractor who makes the final determination

concerning whether the claim is payable.

Documentation justifying the services shall be submitted in response to any Additional

Documentation Request (ADR) for claims that are selected for medical review. Follow

the documentation requirements in Pub. 100-02, chapter 15, section 220.3. If medical

records are requested for review, clinicians may include, at their discretion, a summary

that specifically addresses the justification for therapy cap exception.

In making a decision about whether to utilize the exception, clinicians shall consider, for

example, whether services are appropriate to--

The patient’s condition, including the diagnosis, complexities, and severity;

The services provided, including their type, frequency, and duration;

The interaction of current active conditions and complexities that directly and

significantly influence the treatment such that it causes services to exceed caps.

In addition, the following should be considered before using the exception process:

1. Exceptions for Evaluation Services

Evaluation. The CMS will accept therapy evaluations from caps after the therapy caps

are reached when evaluation is necessary, e.g., to determine if the current status of the

beneficiary requires therapy services. For example, the following CPT codes for

evaluation procedures may be appropriate:

92521, 92522, 92523, 92524, 92597, 92607, 92608, 92610, 92611, 92612, 92614,

92616, 96105, 96125. 97161, 97162, 97163, 97164, 97165, 97166, 97167, and

97168.

These codes will continue to be reported as outpatient therapy procedures as listed in the

Annual Therapy Update for the current year at:

http://www.cms.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage.

They are not diagnostic tests. Definitions of evaluations and documentation are found in

Pub. 100-02, chapter 15, sections 220 and 230.

Other Services. There are a number of sources that suggest the amount of certain

services that may be typical, either per service, per episode, per condition, or per

discipline. For example, see the CSC - Therapy Cap Report, 3/21/2008, and CSC –

Therapy Edits Tables 4/14/2008 at www.cms.hhs.gov/TherapyServices (Studies and

Reports), or more recent utilization reports. Professional literature and guidelines from

professional associations also provide a basis on which to estimate whether the type,

frequency, and intensity of services are appropriate to an individual. Clinicians and

contractors should utilize available evidence related to the patient’s condition to justify

provision of medically necessary services to individual beneficiaries, especially when

they exceed caps. Contractors shall not limit medically necessary services that are

justified by scientific research applicable to the beneficiary. Neither contractors nor

clinicians shall utilize professional literature and scientific reports to justify payment for

continued services after an individual’s goals have been met earlier than is typical.

Conversely, professional literature and scientific reports shall not be used as justification

to deny payment to patients whose needs are greater than is typical or when the patient’s

condition is not represented by the literature.

2. Exceptions for Medically Necessary Services

Clinicians may utilize the process for exception for any diagnosis or condition for which

they can justify services exceeding the cap. Regardless of the diagnosis or condition, the

patient must also meet other requirements for coverage.

Bill the most relevant diagnosis. As always, when billing for therapy services, the

diagnosis code that best relates to the reason for the treatment shall be on the claim,

unless there is a compelling reason to report another diagnosis code. For example, when

a patient with diabetes is being treated with therapy for gait training due to amputation,

the preferred diagnosis is abnormality of gait (which characterizes the treatment). Where

it is possible in accordance with State and local laws and the contractors’ local coverage

determinations, avoid using vague or general diagnoses. When a claim includes several

types of services, or where the physician/NPP must supply the diagnosis, it may not be

possible to use the most relevant therapy diagnosis code in the primary position. In that

case, the relevant diagnosis code should, if possible, be on the claim in another position.

Codes representing the medical condition that caused the treatment are used when there is

no code representing the treatment. Complicating conditions are preferably used in non-

primary positions on the claim and are billed in the primary position only in the rare

circumstance that there is no more relevant code.

The condition or complexity that caused treatment to exceed caps must be related to the

therapy goals and must either be the condition that is being treated or a complexity that

directly and significantly impacts the rate of recovery of the condition being treated such

that it is appropriate to exceed the caps. Documentation for an exception should indicate

how the complexity (or combination of complexities) directly and significantly affects

treatment for a therapy condition.

If the contractor has determined that certain codes do not characterize patients who

require medically necessary services, providers/suppliers may not use those codes, but

must utilize a billable diagnosis code allowed by their contractor to describe the patient’s

condition. Contractors shall not apply therapy caps to services based on the patient’s

condition, but only on the medical necessity of the service for the condition. If a service

would be payable before the cap is reached and is still medically necessary after the cap

is reached, that service is excepted.

Contact your contractor for interpretation if you are not sure that a service is applicable

for exception.

It is very important to recognize that most conditions would not ordinarily result in

services exceeding the cap. Use the KX modifier only in cases where the condition of

the individual patient is such that services are APPROPRIATELY provided in an episode

that exceeds the cap. Routine use of the KX modifier for all patients with these

conditions will likely show up on data analysis as aberrant and invite inquiry. Be sure

that documentation is sufficiently detailed to support the use of the modifier.

In justifying exceptions for therapy caps, clinicians and contractors should not only

consider the medical diagnoses and medical complications that might directly and

significantly influence the amount of treatment required. Other variables (such as the

availability of a caregiver at home) that affect appropriate treatment shall also be

considered. Factors that influence the need for treatment should be supportable by

published research, clinical guidelines from professional sources, and/or clinical or

common sense. See Pub. 100-02, chapter 15, section 220.3 for information related to

documentation of the evaluation, and section 220.2 on medical necessity for some factors

that complicate treatment.

NOTE: The patient’s lack of access to outpatient hospital therapy services alone, when

outpatient hospital therapy services are excluded from the limitation, does not justify

excepted services. Residents of skilled nursing facilities prevented by consolidated

billing from accessing hospital services, debilitated patients for whom transportation to

the hospital is a physical hardship, or lack of therapy services at hospitals in the

beneficiary’s county may or may not qualify as justification for continued services above

the caps. The patient’s condition and complexities might justify extended services, but

their location does not. For dates of service on or after October 1, 2012, therapy services

furnished in an outpatient hospital are not excluded from the limitation.

10.3.3 - Use of the KX Modifier

(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19)

NOTE: Effective for dates of service on or after January 1, 2018, the KX modifier

continues to be used. It no longer represents an exception request but serves as a

confirmation that services are medically necessary after the beneficiary has exceeded the

KX modifier threshold of incurred expenses. Medicare claims systems process claims

with and without the KX modifier in the same manner described below and in section

10.4.

When exceptions are in effect and the beneficiary qualifies for a therapy cap exception,

the provider shall add a KX modifier to the therapy HCPCS code subject to the cap

limits. The KX modifier shall not be added to any line of service that is not a medically

necessary service; this applies to services that, according to a local coverage

determination by the contractor, are not medically necessary services.

The codes subject to the therapy cap tracking requirements for a given calendar year are

listed at:

http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage.

The GN, GO, or GP therapy modifiers are currently required to be appended to therapy

services. In addition to the KX modifier, the GN, GP and GO modifiers shall continue to

be used. Providers may report the modifiers on claims in any order. If there is

insufficient room on a claim line for multiple modifiers, additional modifiers may be

reported in the remarks field. Follow the routine procedure for placing HCPCS modifiers

on a claim as described below.

• For professional claims, sent to the A/B MAC(B), refer to:

o Pub.100-04, Medicare Claims Processing Manual, chapter 26, for more

detail regarding completing Form CMS 1500, including the placement of

HCPCS modifiers. NOTE: The Form CMS 1500 currently has space for

providing four modifiers in block 24D, but, if the provider has more than

four to report, he/she can do so by placing the -99 modifier (which

indicates multiple modifiers) in block 24D and placing the additional

modifiers in block 19.

o The ASC X12N 837 Health Care Claim: Professional Implementation

Guide for more detail regarding how to electronically submit a health care

claim transaction, including the placement of HCPCS modifiers. The

ASC X12N 837 implementation guides are the standards adopted under

the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

for submitting health care claims electronically. The 837 professional

transaction currently permits the placement of up to four modifiers, in the

2400 loop, SV1 segment, and data elements SV101-3, SV101-4, SV101-5,

and SV101-6. Copies of the ASC X12N 837 implementation guides may

be obtained from the Washington Publishing Company.

o For claims paid by a carrier or an A/B MAC(B), it is only appropriate to

append the KX modifier to a service that reasonably may exceed the cap.

Use of the KX modifier when there is no indication that the cap is likely to

be exceeded is abusive. For example, use of the KX modifier for low cost

services early in an episode when there is no evidence of a previous

episode that might have exceeded the cap is inappropriate.

• For institutional claims, sent to the A/B MAC(A):

o When the cap is exceeded by at least one line on the claim, use the KX

modifier on all of the lines on that institutional claim that refer to the same

therapy cap (PT/SLP or OT), regardless of whether the other services

exceed the cap. For example, if one PT service line exceeds the cap, use

the KX modifier on all the PT and SLP service lines (also identified with

the GP or GN modifier) for that claim. When the PT/SLP cap is exceeded

by PT services, the SLP lines on the claim may meet the requirements for

an exception due to the complexity of two episodes of service.

o Use the KX modifier on either all or none of the SLP lines on the claim, as

appropriate. In contrast, if all the OT lines on the claim are below the cap,

do not use the KX modifier on any of the OT lines, even when the KX

modifier is appropriately used on all of the PT lines. Refer to Pub.100-04,

Medicare Claims Processing Manual, chapter 25, for more detail.

By appending the KX modifier, the provider is attesting that the services billed:

• Are reasonable and necessary services that require the skills of a therapist; (See

Pub. 100-02, chapter 15, section 220.2); and

• Are justified by appropriate documentation in the medical record, (See Pub.

100-02, chapter 15, section 220.3); and

• Qualify for an exception using the automatic process exception.

If this attestation is determined to be inaccurate, the provider/supplier is subject to

sanctions resulting from providing inaccurate information on a claim.

When the KX modifier is appended to a therapy HCPCS code, the contractor will

override the CWF system reject for services that exceed the caps and pay the claim if it is

otherwise payable.

Providers and suppliers shall continue to append correct coding initiative (CCI) HCPCS

modifiers under current instructions.

If a claim is submitted without KX modifiers and the cap is exceeded, those services will

be denied. In cases where appending the KX modifier would have been appropriate,

contractors may reopen and/or adjust the claim, if it is brought to their attention.

Services billed after the cap has been exceeded which are not eligible for exceptions may

be billed for the purpose of obtaining a denial using condition code 21.

10.3.4 - Therapy Cap Manual Review Threshold to Ensure Appropriate

Therapy

(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19)

Section 50202 of the Bipartisan Budget Act of 2018 retains the targeted medical review

(MR) process (first established through Section 202 of the Medicare Access and CHIP

Reauthorization Act of 2015 (MACRA)), but at a lower threshold amount of $3,000. For

CY 2018 (and each calendar year until 2028 at which time it is indexed annually by the

MEI), the MR threshold is $3,000 for PT and SLP services and $3,000 for OT services.

The targeted MR process means that not all claims exceeding the MR threshold amount

are subject to review as they once were. For a general overview of the MR process, go to

the Medical Review and Education website at: https://www.cms.gov/Research-Statistics-

Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-

Review/index.html

10.3.5 - Identifying the Certifying Physician

(Rev. 3367 Issued: 10-07-15, Effective: 01-01-16, Implementation: 01-04-16)

Therapy plans of care must be certified by a physician or non-physician practitioner

(NPP), per the requirements in the Pub. 100-02, Medicare Benefit Policy Manual, chapter

15, section 220.1.3. Further, the National Provider Identifier (NPI) of the certifying

physician/NPP identified for a therapy plan of care must be included on the therapy

claim.

For the purposes of processing professional claims, the certifying physician/NPP is

considered a referring provider. At the time the certifying physician/NPP is identified for

a therapy plan of care, private practice therapists (PPTs), physicians or NPPs, as

appropriate, submitting therapy claims, are to treat it as if a referral has occurred for

purposes of completing the claim and to follow the instructions in the appropriate ASC

X12 837 Professional Health Care Claim Technical Report 3 (TR3) for reporting a

referring provider (for paper claims, they are to follow the instructions for identifying

referring providers per chapter 26 of this manual). These instructions include

requirements for reporting NPIs.

Currently, in the 5010 version of the ASC X12 837 Professional Health Care Claim TR3,

referring providers are first reported at the claim level; additional referring providers are

reported at the line level only when they are different from that identified at the claim

level. Therefore, there will be at least one referring provider identified at the claim level

on the ASC X12 837 Professional claim for therapy services. However, because of the

hierarchical nature of the ASC X12 837 health care claim transaction, and the possibility

of other types of referrals applying to the claim, the number of referring providers

identified on a professional claim may vary. For example, on a claim where one

physician/NPP has certified all the therapy plans of care, and there are no other referrals,

there would be only one referring provider identified at the claim level and none at the

line levels. Conversely, on a claim also containing a non-therapy referral made by a

different physician/NPP than the one certifying the therapy plan of care, the billing

provider may elect to identify either the nontherapy or the therapy referral at the claim

level, with the other referral(s) at the line levels. Similarly, on a claim having different

certifying physician/NPPs for different therapy plans of care, only one of these

physician/NPPs will be identified at the claim level, with the remainder identified at the

line levels. These scenarios are only examples: there may be other patterns of

representing referring providers at the claim and line levels depending upon the

circumstances of the care and the manner in which the provider applies the requirements

of the ASC X12 837 Professional Health Care Claim TR3.

For situations where the physician/NPP is both the certifier of the plan of care and

furnishes the therapy service, he/she supplies his/her own information, including the NPI,

in the appropriate referring provider loop (or, appropriate block on Form CMS 1500).

This is applicable to those therapy services that are personally furnished by the

physician/NPP as well as to those services that are furnished incident to their own and

delivered by “qualified personnel” (see section 230.5 of this manual for qualifications for

incident to personnel).

Contractors shall edit to ensure that there is at least one claim-level referring provider

identified on professional therapy claims, and shall use the presence of the therapy

modifiers (GN, GP, GO) to identify those claims subject to this requirement.

For the purposes of processing institutional claims, the certifying physician/NPP and their

NPI are reported in the Attending Provider fields on institutional claim formats. Since

the physician/NPP is certifying the therapy plan of care for the services on the claim, this

is consistent with the National Uniform Billing Committee definition of the Attending

Provider as “the individual who has overall responsibility for the patient’s medical care

and treatment” that is reported on the claim. In cases where a patient is receiving care

under more than one therapy plan of care (OT, PT, or SLP) with different certifying

physicians/NPPs, the second certifying physicians/NPP and their NPI are reported in the

Referring Physician fields on institutional claim formats.

10.3.6 - MSN Messages Regarding the Therapy Cap

(Rev. 3367 Issued: 10-07-15, Effective: 01-01-16, Implementation: 01-04-16)

Existing MSN messages 17.13, 17.18 and 17.19 shall be issued on all claims containing

outpatient rehabilitation services. Contractors add the applied amount for individual

beneficiaries and the generic limit amount to all MSNs that require them. For details of

these MSNs, see: http://www.cms.gov/MSN/02_MSN%20Messages.asp.

10.4 - Claims Processing Requirements for Financial Limitations

(Rev. 3995, Issued: 03-09-18, Effective: 06-11- 18, Implementation: 06-11-18)

A. Requirements – Institutional Claims

Regardless of financial limits on therapy services, CMS requires modifiers (See section

20.1 of this chapter) on specific codes for the purpose of data analysis. Beneficiaries may

not be simultaneously covered by Medicare as an outpatient of a hospital and as a patient

in another facility. When outpatient hospital therapy services are excluded from the

limitation, the beneficiary must be discharged from the other setting and registered as a

hospital outpatient in order to receive payment for outpatient rehabilitation services in a

hospital outpatient setting after the limitation has been reached.

A hospital may bill for services of a facility as hospital outpatient services if that facility

meets the requirements of a department of the provider (hospital) under 42 CFR 413.65.

Facilities that do not meet those requirements are not considered to be part of the hospital

and may not bill under the hospital’s provider number, even if they are owned by the

hospital. For example, services of a Comprehensive Outpatient Rehabilitation Facility

(CORF) must be billed as CORF services and not as hospital outpatient services, even if

the CORF is owned by the hospital.

The CWF applies the financial limitation to the following bill types 12X (with Critical

Access Hospital CMS Certification Numbers), 22X, 23X, 34X, 74X, 75X and 85X using

the lesser of the MPFS allowed amount (before adjustment for beneficiary liability) or the

amount charged.

For SNFs, the financial limitation does apply to rehabilitation services furnished to those

SNF residents in noncovered stays (bill type 22X) who are in a Medicare-certified section

of the facility, i.e., one that is either certified by Medicare alone, or is dually certified by

Medicare as a SNF and by Medicaid as a nursing facility (NF). For SNF residents,

consolidated billing requires all outpatient rehabilitation services be billed to Part B by

the SNF. If a resident has reached the financial limitation, and remains in the Medicare-

certified section of the SNF, no further payment will be made to the SNF or any other

entity. Therefore, SNF residents who are subject to consolidated billing may not obtain

services from an outpatient hospital after the cap has been exceeded.

Once the financial limitation has been reached, services furnished to SNF residents who

are in a non-Medicare certified section of the facility, i.e., one that is certified only by

Medicaid as a NF or that is not certified at all by either program, use bill type 23X. For

SNF residents in non-Medicare certified portions of the facility and SNF nonresidents

who go to the SNF for outpatient treatment (bill type 23X), medically necessary

outpatient therapy may be covered at an outpatient hospital facility after the financial

limitation has been exceeded when outpatient hospital therapy services are excluded from

the limitation.

B. Requirements - Professional Claims

Claims containing any of the “always therapy” codes must have one of the therapy

modifiers appended (GN, GO, GP). Contractors shall return claims for “always therapy”

codes when they do not contain appropriate therapy modifiers for the applicable HCPCS

codes. In addition, when any code on the list of therapy codes is submitted with specialty

codes “65” (physical therapist in private practice), “67” (occupational therapist in private

practice), or “15” (speech-language pathologist in private practice) they always represent

therapy services, because they are provided by therapists. Contractors shall return claims

for these services when they do not contain therapy modifiers for the applicable HCPCS

codes.

The contractor shall use the following remittance advice messages and associated codes

when rejecting/denying claims under this policy. This CARC/RARC combination is

compliant with CAQH CORE Business Scenario 2.

Group Code: CO

CARC: 4

RARC: N/A

MSN: N/A

The CMS identifies certain codes listed at:

http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage

as “sometimes therapy” services, regardless of the presence of a financial limitation.

Claims from physicians (all specialty codes) and nonphysician practitioners, including

specialty codes “50” (Nurse Practitioner), “89,” (Clinical Nurse Specialist), and “97,”

(Physician Assistant) may be processed without therapy modifiers when they are not

therapy services. On review of these claims, “sometimes therapy” services that are not

accompanied by a therapy modifier must be documented, reasonable and necessary, and

payable as physician or nonphysician practitioner services, and not services that the

contractor interprets as therapy services.

The CWF will capture the amount and apply it to the limitation whenever a service is

billed using the GN, GO, or GP modifier.

C. Contractor Action Based on CWF Trailer

Upon receipt of the CWF error code/trailer, contractors are responsible for assuring that

payment does not exceed the financial limitations, when the limits are in effect, except as

noted below.

In cases where a claim line partially exceeds the limit, the contractor must adjust the line

based on information contained in the CWF trailer. For example, where the MPFS

allowed amount is greater than the financial limitation available, always report the MPFS

allowed amount in the “Financial Limitation” field of the CWF record and include the

CWF override code. See example below for situations where the claim contains multiple

lines that exceed the limit.

EXAMPLE:

Services received to date are $15 under the limit. There is a $15 allowed amount

remaining that Medicare will cover before the cap is reached.

Incoming claim: Line 1 MPFS allowed amount is $50.

Line 2 MPFS allowed amount is $25.

Line 3, MPFS allowed amount is $30.

Based on this example, lines 1 and 3 are denied and line 2 is paid. The contractor reports

in the “Financial Limitation" field of the CWF record “$25.00 along with the CWF

override code. The contractor always applies the amount that would least exceed the

limit. Since institutional claims systems cannot split the payment on a line, CWF will

allow payment on the line that least exceeds the limit and deny other lines.

D. Additional Information for Contractors During the Time Financial Limits Are

in Effect With or Without Exceptions

Once the limit is reached, if a claim is submitted, CWF returns an error code stating the

financial limitation has been met. Over applied lines will be identified at the line level.

The outpatient rehabilitation therapy services that exceed the limit should be denied.

The contractor shall use the following remittance advice messages and associated codes

when rejecting/denying claims under this policy. This CARC/RARC combination is

compliant with CAQH CORE Business Scenario Three.

Group Code: CO or PR (as defined by section 10.5)

CARC: 119

RARC: N/A

MSN: 20.5

In situations where a beneficiary is close to reaching the financial limitation and a

particular claim might exceed the limitation, the provider/supplier should bill the usual

and customary charges for the services furnished even though such charges might exceed

the limit. The CWF will return an error code/trailer that will identify the line that

exceeds the limitation.

Because CWF applies the financial limitation according to the date when the claim was

received (when the date of service is within the effective date range for the limitation), it

is possible that the financial limitation will have been met before the date of service of a

given claim. Such claims will prompt the CWF error code and subsequent contractor

denial.

When the provider/supplier knows that the limit has been reached, and exceptions are

either not appropriate or not available, further billing should not occur. The

provider/supplier should inform the beneficiary of the limit and their option of receiving

further covered services from an outpatient hospital when outpatient hospital therapy

services are excluded from the limitation (unless consolidated billing rules prevent the

use of the outpatient hospital setting). If the beneficiary chooses to continue treatment at

a setting other than the outpatient hospital where medically necessary services may be

covered, the services may be billed at the rate the provider/supplier determines. Services

provided in a capped setting after the limitation has been reached are not Medicare

benefits and are not governed by Medicare policies.

If a beneficiary elects to receive services that exceed the cap limitation and a claim is

submitted for such services, the resulting determination is subject to the administrative

appeals process as described in subsection C. of section 10.3 and Pub. 100-04, Chapter

29.

10.5 - Notification for Beneficiaries Exceeding Financial Limitations

(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13)

A. Notice to Beneficiaries

Contractors will advise providers/suppliers to notify beneficiaries of the therapy financial

limitations at their first therapy encounter with the beneficiary. Prior to 2013, Medicare

instructed providers/suppliers to inform beneficiaries that beneficiaries were responsible

for 100 percent of the costs of therapy services above each respective therapy limit (cap),

unless this outpatient care was furnished directly or under arrangements by a hospital

when outpatient hospital therapy services were excluded from the limitation. The

American Taxpayer Relief Act (ATRA) of 2012 amended §1833(g)(5) of the Social

Security Act (the Act) providing limitation of liability protections (under §1879 of the

Act) to beneficiaries with respect to outpatient therapy services that exceed therapy cap

amounts, furnished on or after January 1, 2013. Thus, effective January 1, 2013,

assignment of liability has changed for therapy services exceeding the cap that don’t

qualify for a coverage exception. The provider/supplier is financially responsible when

Medicare denies payment for therapy services above the cap that don’t qualify for a

coverage exception unless a valid Advance Beneficiary Notice of Noncoverage (ABN),

Form CMS-R-131, was issued per CMS guidelines.

Providers were previously encouraged to use either a form of their own design or a

voluntary ABN when providing therapy above the cap where no exception was applied;

however, this instruction is no longer valid. When providing therapy services above the

cap that don’t qualify for the exceptions process, the provider/supplier must now issue a

mandatory ABN in order to transfer financial responsibility to the beneficiary. When the

ABN is used as a mandatory notice, providers must adhere to the ABN form instructions

and guidance published in Chapter 30, Section 50 of this manual. The ABN and

instructions can be found at: http://www.cms.gov/Medicare/Medicare-General-

Information/BNI/ABN.html.

When issuing the ABN for therapy in excess of therapy caps, the following language is

suggested for the “Reason Medicare May Not Pay” section: “Medicare won’t pay for

physical therapy and speech-language pathology services over (add the dollar amount of

the cap) in (add the year or the dates of service to which it applies) unless you qualify for

an exception to this cap amount. Your services don’t qualify for an exception. ” Providers

should use similar language for occupational therapy services when appropriate. A cost

estimate for the services should be included per the ABN form instructions. Therapy cost

estimates can be listed as a cost per service or as a projected total cost for a certain

amount of therapy provided over a specified time period.

ABN issuance remains mandatory before the cap is exceeded when services aren’t

expected to be covered by Medicare because they are not medically reasonable and

necessary. When the clinician determines that skilled services are not medically

necessary, the clinical goals have been met, or there is no longer potential for the

rehabilitation of health and/or function in a reasonable time, the beneficiary should be

informed. If the beneficiary will be getting services that don’t meet the medical necessity

requirements for Medicare payment, the ABN must be issued prior to delivering these

services. The ABN informs the beneficiary of his/her potential financial obligation to the

provider, allows him/her to choose whether or not to get the services, and provides

information regarding appeal rights.

When a provider/supplier expects that Medicare will deny payment on a claim for

therapy services because they are not medically reasonable and necessary, regardless of

whether or not therapy limits are met, the ABN must be issued before providing the

services in order to transfer financial responsibility to the beneficiary.

10.6 - Functional Reporting

(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19)

A. General

Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA)

amended Section 1833(g) of the Act to require a claims-based data collection system for

outpatient therapy services, including physical therapy (PT), occupational therapy (OT)

and speech-language pathology (SLP) services. 42 CFR 410.59, 410.60, 410.61, 410.62

and 410.105 implement this requirement. The system will collect data on beneficiary

function during the course of therapy services in order to better understand beneficiary

conditions, outcomes, and expenditures.

Beneficiary function information is reported using 42 nonpayable functional G-codes and

seven severity/complexity modifiers on claims for PT, OT, and SLP services. Functional

reporting on one functional limitation at a time is required periodically throughout an

entire PT, OT, or SLP therapy episode of care.

The nonpayable G-codes and severity modifiers provide information about the

beneficiary’s functional status at the outset of the therapy episode of care, including

projected goal status, at specified points during treatment, and at the time of discharge.

These G-codes, along with the associated modifiers, are required at specified intervals on

all claims for outpatient therapy services – not just those over the cap.

In the CY 2019 Physician Fee Schedule final rule, CMS-1693-F, after consideration of

stakeholders’ requests for burden reduction, a review of all of the MCTRJCA requirements,

and in light of the statutory amendments to section 1833(g) of the Act, via section 50202 of

Bipartisan Budget Act of 2018 to repeal the therapy caps, CMS concluded that continued

collection of functional reporting data through the same format would not yield additional

information to inform future analyses or to serve as a basis for reforms to the payment system

for therapy services. The rule ended the functional reporting requirements to reduce burden

of reporting for providers of therapy services and revised regulation text at 42 CFR 410.59,

410.60, 410.61, 410.62, 410.105, accordingly.

The instructions below apply only to dates of service when the reporting requirement was

effective, January 1, 2013 through December 31, 2018.

B. Application of Coding Requirements

This functional data reporting and collection system is effective for therapy services with

dates of service on and after January 1, 2013 and before January 1, 2019.

C. Services Affected

These requirements apply to all claims for services furnished under the Medicare Part B

outpatient therapy benefit and the PT, OT, and SLP services furnished under the CORF

benefit. They also apply to the therapy services furnished personally by and incident to

the service of a physician or a nonphysician practitioner (NPP), including a nurse

practitioner (NP), a certified nurse specialist (CNS), or a physician assistant (PA), as

applicable.

D. Providers and Practitioners Affected.

The functional reporting requirements apply to the therapy services furnished by the

following providers: hospitals, CAHs, SNFs, CORFs, rehabilitation agencies, and HHAs

(when the beneficiary is not under a home health plan of care). It applies to the following

practitioners: physical therapists, occupational therapists, and speech-language

pathologists in private practice (TPPs), physicians, and NPPs as noted above. The term

“clinician” is applied to these practitioners throughout this manual section. (See

definition section of Pub. 100-02, Chapter 15, section 220.)

E. Function-related G-codes

There are 42 functional G-codes, 14 sets of three codes each. Six of the G-code sets are

generally for PT and OT functional limitations and eight sets of G-codes are for SLP

functional limitations.

The following G-codes are for functional limitations typically seen in beneficiaries

receiving PT or OT services. The first four of these sets describe categories of functional

limitations and the final two sets describe “other” functional limitations, which are to be

used for functional limitations not described by one of the four categories.

NONPAYABLE G-CODES FOR FUNCTIONAL LIMITATIONS

Code

Long Descriptor

Short Descriptor

Mobility G-code Set

G8978

Mobility: walking & moving around functional

limitation, current status, at therapy episode

outset and at reporting intervals

Mobility current status

G8979

Mobility: walking & moving around functional

limitation, projected goal status, at therapy

episode outset, at reporting intervals, and at

discharge or to end reporting

Mobility goal status

G8980

Mobility: walking & moving around functional

limitation, discharge status, at discharge from

therapy or to end reporting

Mobility D/C status

Changing & Maintaining Body Position G-code Set

G8981

Changing & maintaining body position functional

limitation, current status, at therapy episode

outset and at reporting intervals

Body pos current

status

G8982

Changing & maintaining body position functional

limitation, projected goal status, at therapy

episode outset, at reporting intervals, and at

discharge or to end reporting

Body pos goal status

G8983

Changing & maintaining body position functional

limitation, discharge status, at discharge from

therapy or to end reporting

Body pos D/C status

Carrying, Moving & Handling Objects G-code Set

G8984

Carrying, moving & handling objects functional

limitation, current status, at therapy episode

outset and at reporting intervals

Carry current status

G8985

Carrying, moving & handling objects functional

limitation, projected goal status, at therapy

episode outset, at reporting intervals, and at

discharge or to end reporting

Carry goal status

G8986

Carrying, moving & handling objects functional

limitation, discharge status, at discharge from

therapy or to end reporting

Carry D/C status

Self Care G-code Set

G8987

Self care functional limitation, current status, at

therapy episode outset and at reporting intervals

Self care current status

G8988

Self care functional limitation, projected goal

status, at therapy episode outset, at reporting

intervals, and at discharge or to end reporting

Self care goal status

G8989

Self care functional limitation, discharge status, at

discharge from therapy or to end reporting

Self care D/C status

The following “other PT/OT” functional G-codes are used to report:

• a beneficiary’s functional limitation that is not defined by one of the above four

categories;

• a beneficiary whose therapy services are not intended to treat a functional

limitation;

• or a beneficiary’s functional limitation when an overall, composite or other score

from a functional assessment too is used and it does not clearly represent a

functional limitation defined by one of the above four code sets.

Code

Long Descriptor

Short Descriptor

Other PT/OT Primary G-code Set

G8990

Other physical or occupational therapy primary

functional limitation, current status, at therapy

episode outset and at reporting intervals

Other PT/OT current

status

Code

Long Descriptor

Short Descriptor

G8991

Other physical or occupational therapy primary

functional limitation, projected goal status, at

therapy episode outset, at reporting intervals, and

at discharge or to end reporting

Other PT/OT goal

status

G8992

Other physical or occupational therapy primary

functional limitation, discharge status, at

discharge from therapy or to end reporting

Other PT/OT D/C

status

Other PT/OT Subsequent G-code Set

G8993

Other physical or occupational therapy

subsequent functional limitation, current status, at

therapy episode outset and at reporting intervals

Sub PT/OT current

status

G8994

Other physical or occupational therapy

subsequent functional limitation, projected goal

status, at therapy episode outset, at reporting

intervals, and at discharge or to end reporting

Sub PT/OT goal status

G8995

Other physical or occupational subsequent

functional limitation, discharge from therapy or

end reporting.

Sub PT/OT D/C status

The following G-codes are for functional limitations typically seen in beneficiaries

receiving SLP services. Seven are for specific functional communication measures,

which are modeled after the National Outcomes Measurement System (NOMS), and one

is for any “other” measure not described by one of the other seven.

Code

Long Descriptor

Short Descriptor

Swallowing G-code Set

G8996

Swallowing functional limitation, current status,

at therapy episode outset and at reporting

intervals

Swallow current status

G8997

Swallowing functional limitation, projected goal

status, at therapy episode outset, at reporting

intervals, and at discharge or to end reporting

Swallow goal status

G8998

Swallowing functional limitation, discharge

status, at discharge from therapy or to end

reporting

Swallow D/C status

Motor Speech G-code Set

(Note: These codes are not sequentially numbered)

G8999

Motor speech functional limitation, current status,

at therapy episode outset and at reporting

intervals

Motor speech current

status

G9186

Motor speech functional limitation, projected goal

status at therapy episode outset, at reporting

intervals, and at discharge or to end reporting

Motor speech goal

status

Code

Long Descriptor

Short Descriptor

G9158

Motor speech functional limitation, discharge

status, at discharge from therapy or to end

reporting

Motor speech D/C

status

Spoken Language Comprehension G-code Set

G9159

Spoken language comprehension functional

limitation, current status, at therapy episode

outset and at reporting intervals

Lang comp current

status

G9160

Spoken language comprehension functional

limitation, projected goal status, at therapy

episode outset, at reporting intervals, and at

discharge or to end reporting

Lang comp goal status

G9161

Spoken language comprehension functional

limitation, discharge status, at discharge from

therapy or to end reporting

Lang comp D/C status

Spoken Language Expressive G-code Set

G9162

Spoken language expression functional limitation,

current status, at therapy episode outset and at

reporting intervals

Lang express current

status

G9163

Spoken language expression functional limitation,

projected goal status, at therapy episode outset, at

reporting intervals, and at discharge or to end

reporting

Lang press goal status

G9164

Spoken language expression functional limitation,

discharge status, at discharge from therapy or to

end reporting

Lang express D/C

status

Attention G-code Set

G9165

Attention functional limitation, current status, at

therapy episode outset and at reporting intervals

Atten current status

G9166

Attention functional limitation, projected goal

status, at therapy episode outset, at reporting

intervals, and at discharge or to end reporting

Atten goal status

G9167

Attention functional limitation, discharge status,

at discharge from therapy or to end reporting

Atten D/C status

Memory G-code Set

G9168

Memory functional limitation, current status, at

therapy episode outset and at reporting intervals

Memory current status

G9169

Memory functional limitation, projected goal

status, at therapy episode outset, at reporting

intervals, and at discharge or to end reporting

Memory goal status

G9170

Memory functional limitation, discharge status, at

discharge from therapy or to end reporting

Memory D/C status

Voice G-code Set

G9171

Voice functional limitation, current status, at

therapy episode outset and at reporting intervals

Voice current status

Code

Long Descriptor

Short Descriptor

G9172

Voice functional limitation, projected goal status,

at therapy episode outset, at reporting intervals,

and at discharge or to end reporting

Voice goal status

G9173

Voice functional limitation, discharge status, at

discharge from therapy or to end reporting

Voice D/C status

The following “other SLP” G-code set is used to report:

• on one of the other eight NOMS-defined functional measures not described by the

above code sets; or

• to report an overall, composite or other score from assessment tool that does not

clearly represent one of the above seven categorical SLP functional measures.

Code

Long Descriptor

Short Descriptor

Other Speech Language Pathology G-code Set

G9174

Other speech language pathology functional

limitation, current status, at therapy episode

outset and at reporting intervals

Speech lang current

status

G9175

Other speech language pathology functional

limitation, projected goal status, at therapy

episode outset, at reporting intervals, and at

discharge or to end reporting

Speech lang goal

status

G9176

Other speech language pathology functional

limitation, discharge status, at discharge from

therapy or to end reporting

Speech lang D/C

status

F. Severity/Complexity Modifiers

For each nonpayable functional G-code, one of the modifiers listed below must be used

to report the severity/complexity for that functional limitation.

Modifier

Impairment Limitation Restriction

0 percent impaired, limited or restricted

At least 1 percent but less than 20 percent impaired, limited or restricted

At least 20 percent but less than 40 percent impaired, limited or restricted

At least 40 percent but less than 60 percent impaired, limited or restricted

At least 60 percent but less than 80 percent impaired, limited or restricted

At least 80 percent but less than 100 percent impaired, limited or restricted

100 percent impaired, limited or restricted

The severity modifiers reflect the beneficiary’s percentage of functional impairment as

determined by the clinician furnishing the therapy services.

G. Required Reporting of Functional G-codes and Severity Modifiers

The functional G-codes and severity modifiers listed above are used in the required

reporting on therapy claims at certain specified points during therapy episodes of care.

Claims containing these functional G-codes must also contain another billable and

separately payable (non-bundled) service. Only one functional limitation shall be

reported at a given time for each related therapy plan of care (POC).

Functional reporting using the G-codes and corresponding severity modifiers is required

reporting on specified therapy claims. Specifically, they are required on claims:

• At the outset of a therapy episode of care (i.e., on the claim for the date of service

(DOS) of the initial therapy service);

• At least once every 10 treatment days, which corresponds with the progress

reporting period;

• When an evaluative procedure, including a re-evaluative one, ( HCPCS/CPT

codes 92521, 92522, 92523, 92524, 92597, 92607, 92608, 92610, 92611, 92612,

92614, 92616, 96105, 96125, 97161, 97162 ,97163, 97164, 97165, 97166, 97167,

97168) is furnished and billed;

• At the time of discharge from the therapy episode of care–(i.e., on the date

services related to the discharge [progress] report are furnished); and

• At the time reporting of a particular functional limitation is ended in cases where

the need for further therapy is necessary.

• At the time reporting is begun for a new or different functional limitation within

the same episode of care (i.e., after the reporting of the prior functional limitation

is ended)

Functional reporting is required on claims throughout the entire episode of care. When

the beneficiary has reached his or her goal or progress has been maximized on the

initially selected functional limitation, but the need for treatment continues, reporting is

required for a second functional limitation using another set of G-codes. In these

situations two or more functional limitations will be reported for a beneficiary during the

therapy episode of care. Thus, reporting on more than one functional limitation may be

required for some beneficiaries but not simultaneously.

When the beneficiary stops coming to therapy prior to discharge, the clinician should

report the functional information on the last claim. If the clinician is unaware that the

beneficiary is not returning for therapy until after the last claim is submitted, the clinician

cannot report the discharge status.

When functional reporting is required on a claim for therapy services, two G-codes will

generally be required.

Two exceptions exist:

1. Therapy services under more than one therapy POC-- Claims may contain more

than two nonpayable functional G-codes when in cases where a beneficiary

receives therapy services under multiple POCs (PT, OT, and/or SLP) from the

same therapy provider.

2. One-Time Therapy Visit-- When a beneficiary is seen and future therapy services

are either not medically indicated or are going to be furnished by another

provider, the clinician reports on the claim for the DOS of the visit, all three G-

codes in the appropriate code set (current status, goal status and discharge status),

along with corresponding severity modifiers.

Each reported functional G-code must also contain the following line of service

information:

• Functional severity modifier

• Therapy modifier indicating the related discipline/POC -- GP, GO or GN -- for

PT, OT, and SLP services, respectively

• Date of the related therapy service

• Nominal charge, e.g., a penny, for institutional claims submitted to the A/B

MACs (A). For professional claims, a zero charge is acceptable for the service

line. If provider billing software requires an amount for professional claims, a

nominal charge, e.g., a penny, may be included.

NOTE: The KX modifier is not required on the claim line for nonpayable G-codes, but

would be required with the procedure code for medically necessary therapy services

furnished once the beneficiary’s annual cap has been reached.

The following example demonstrates how the G-codes and modifiers are used. In this

example, the clinician determines that the beneficiary’s mobility restriction is the most

clinically relevant functional limitation and selects the Mobility G-code set (G8978 –

G8980) to represent the beneficiary’s functional limitation. The clinician also determines

the severity/complexity of the beneficiary’s functional limitation and selects the

appropriate modifier. In this example, the clinician determines that the beneficiary has a

75 percent mobility restriction for which the CL modifier is applicable. The clinician

expects that at the end of therapy the beneficiaries will have only a 15 percent mobility

restriction for which the CI modifier is applicable. When the beneficiary attains the

mobility goal, therapy continues to be medically necessary to address a functional

limitation for which there is no categorical G-code. The clinician reports this using

(G8990 – G8992).

At the outset of therapy-- On the DOS for which the initial evaluative procedure is

furnished or the initial treatment day of a therapy POC, the claim for the service will also

include two G-codes as shown below.

• G8978-CL to report the functional limitation (Mobility with current mobility

limitation of “at least 60 percent but less than 80 percent impaired, limited or

restricted”)

• G8979-CI to report the projected goal for a mobility restriction of “at least 1

percent but less than 20 percent impaired, limited or restricted.”

At the end of each progress reporting period-- On the claim for the DOS when the

services related to the progress report (which must be done at least once each 10

treatment days) are furnished, the clinician will report the same two G-codes but the

modifier for the current status may be different.

• G8978 with the appropriate modifier are reported to show the beneficiary’s

current status as of this DOS. So if the beneficiary has made no progress, this

claim will include G8978-CL. If the beneficiary made progress and now has a

mobility restriction of 65 percent CL would still be the appropriate modifier for

65 percent, and G8978-CL would be reported in this case. If the beneficiary now

has a mobility restriction of 45 percent, G8978-CK would be reported.

• G8979-CI would be reported to show the projected goal. This severity modifier

would not change unless the clinician adjusts the beneficiary’s goal.

This step is repeated as necessary and clinically appropriate, adjusting the current status

modifier used as the beneficiary progresses through therapy.

At the time the beneficiary is discharged from the therapy episode. The final claim for

therapy episode will include two G-codes.

• G8979-CI would be reported to show the projected goal. G8980-CI would be

reported if the beneficiary attained the 15 percent mobility goal. Alternatively, if

the beneficiary’s mobility restriction only reached 25 percent; G8980-CJ would

be reported.

To end reporting of one functional limitation-- As noted above, functional reporting is

required to continue throughout the entire episode of care. Accordingly, when further

therapy is medically necessary after the beneficiary attains the goal for the first reported

functional limitation, the clinician would end reporting of the first functional limitation

by using the same G-codes and modifiers that would be used at the time of discharge.

Using the mobility example, to end reporting of the mobility functional limitation,

G8979-CI and G8980-CI would be reported on the same DOS that coincides with end of

that progress reporting period.

To begin reporting of a second functional limitation. At the time reporting is begun for a

new and different functional limitation, within the same episode of care (i.e., after the

reporting of the prior functional limitation is ended). Reporting on the second functional

limitation, however, is not begun until the DOS of the next treatment day -- which is day

one of the new progress reporting period. When the next functional limitation to be

reported is NOT defined by one of the other three PT/OT categorical codes, the G-code

set (G8990 - G8992) for the “other PT/OT primary” functional limitation is used, rather

than the G-code set for the “other PT/OT subsequent” because it is the first reported

“other PT/OT” functional limitation. This reporting begins on the DOS of the first

treatment day following the mobility “discharge” reporting, which is counted as the

initial service for the “other PT/OT primary” functional limitation and the first treatment

day of the new progress reporting period. In this case, G8990 and G8991, along with the

corresponding modifiers, are reported on the claim for therapy services.

The table below illustrates when reporting is required using this example and what G-

codes would be used.

Example of Required Reporting

Key: Reporting Period (RP)

Begin RP #1 for Mobility

at Episode Outset

End RP#1for Mobility at

Progress Report

Mobility RP #2 Begins

Next Treatment Day

End RP #2 for Mobility

at Progress Report

Mobility RP #3 Begins

Next Treatment Day

D/C or End Reporting for

Mobility

Begin RP #1 for Other

PT/OT Primary

Mobility: Walking & Moving

Around

G8978 – Current Status

G 8979– Goal Status

G8980 – Discharge Status

Other PT/OT Primary

G8990 – Current Status

G8991 – Goal Status

G8992 – Discharge Status

No Functional Reporting

Required

X X

H. Required Tracking and Documentation of Functional G-codes and Severity

Modifiers

The clinician who furnishes the services must not only report the functional information

on the therapy claim, but, he/she must track and document the G-codes and severity

modifiers used for this reporting in the beneficiary’s medical record of therapy services.

For details related to the documentation requirements, refer to, Medicare Benefit Policy

Manual, Pub. 100-02, Chapter 15, section 220.4 - Functional Reporting. For coverage

rules related to MCTRJCA and therapy goals, refer to Pub. 100-02: a) for outpatient

therapy services, see Chapter 15, section 220.1.2 B and b) for instructions specific to PT,

OT, and SLP services in the CORF, see Chapter 12, section 10.

10.7 - Multiple Procedure Payment Reductions for Outpatient

Rehabilitation Services

(Rev. 3475, Issued: 03-04-16, Effective: 06-06-16, Implementation: 06-06-16)

Medicare applies a multiple procedure payment reduction (MPPR) to the practice

expense (PE) payment of select therapy services. The reduction applies to the HCPCS

codes contained on the list of “always therapy” services (see section 20), excluding A/B

MAC (B)-priced, bundled and add-on codes, regardless of the type of provider or

supplier that furnishes the services.

Medicare applies an MPPR to the PE payment when more than one unit or procedure is

provided to the same patient on the same day, i.e., the MPPR applies to multiple units as

well as multiple procedures. Many therapy services are time-based codes, i.e., multiple

units may be billed for a single procedure. The MPPR applies to all therapy services

furnished to a patient on the same day, regardless of whether the services are provided in

one therapy discipline or multiple disciplines, for example, physical therapy,

occupational therapy, or speech-language pathology.

Full payment is made for the unit or procedure with the highest PE payment.

For subsequent units and procedures with dates of service prior to April 1, 2013,

furnished to the same patient on the same day, full payment is made for work and

malpractice and 80 percent payment is made for the PE for services submitted on

professional claims (any claim submitted using the ASC X12 837 professional claim

format or the CMS-1500 paper claim form) and 75 percent payment is made for the PE

for services submitted on institutional claims (ASC X12 837 institutional claim format or

Form CMS-1450).

For subsequent units and procedures with dates of service on or after April 1, 2013,

furnished to the same patient on the same day, full payment is made for work and

malpractice and 50 percent payment is made for the PE for services submitted on either

professional or institutional claims.

To determine which services will receive the MPPR, contractors shall rank services

according to the applicable PE relative value units (RVU) and price the service with the

highest PE RVU at 100% and apply the appropriate MPPR to the remaining services.

When the highest PE RVU applies to more than one of the identified services, contractors

shall additionally sort and rank these services according to highest total fee schedule

amount, and price the service with the highest total fee schedule amount at 100% and

apply the appropriate MPPR to the remaining services.

The therapy payment amount that has been reduced by the MPPR is applied toward the

therapy caps described in section 10.2. As a result, the MPPR may increase the amount

of medically necessary therapy services a beneficiary may receive before exceeding the

caps. The reduced amount is also used to calculate the beneficiary’s coinsurance and

deductible amounts.

The contractor shall use the following remittance advice messages and associated codes

when adjusting payment under this policy. The CARC below is not included in the

CAQH CORE Business Scenarios.

Group Code: CO

CARC: 59

RARC: N/A

MSN: 30.1

20 - HCPCS Coding Requirement

(Rev. 1850, Issued: 11-13-09, Effective: 01-01-10, Implementation: 01-04-10)

A. Uniform Coding

Section 1834(k)(5) of the Act requires that all claims for outpatient rehabilitation therapy

services and all comprehensive outpatient rehabilitation facility (CORF) services be

reported using a uniform coding system. The current Healthcare Common Procedure

Coding System/Current Procedural Terminology is used for the reporting of these

services. The uniform coding requirement in the Act is specific to payment for all CORF

services and outpatient rehabilitation therapy services - including physical therapy,

occupational therapy, and speech-language pathology - that is provided and billed to

Medicare contractors. The Medicare physician fee schedule (MPFS) is used to make

payment for these therapy services at the non facility rate.

Effective for claims submitted on or after April 1, 1998, providers that had not previously

reported HCPCS/CPT for outpatient rehabilitation and CORF services began using

HCPCS to report these services. This requirement does not apply to outpatient

rehabilitation services provided by:

• Critical access hospitals, which are paid on a cost basis, not MPFS;

• RHCs, and FQHCs for which therapy is included in the all-inclusive rate; or

• Providers that do not furnish therapy services.

The following “providers of services” must bill the A/B MAC (A) for outpatient

rehabilitation services using HCPCS codes:

• Hospitals (to outpatients and inpatients who are not in a covered Part A stay);

• Skilled nursing facilities (SNFs) (to residents not in a covered Part A stay and to

nonresidents who receive outpatient rehabilitation services from the SNF);

• Home health agencies (HHAs) (to individuals who are not homebound or

otherwise are not receiving services under a home health plan of care (POC).

• Comprehensive outpatient rehabilitation facilities (CORFs); and

• Providers of outpatient physical therapy and speech-language pathology services

(OPTs), also known as rehabilitation agencies (previously termed outpatient

physical therapy facilities in this instruction).

Note 1. The requirements for hospitals and SNFs apply to inpatient Part B and outpatient

services only. Inpatient Part A services are bundled into the respective prospective

payment system payment; no separate payment is made.

Note 2. For HHAs, HCPCS/CPT coding for outpatient rehabilitation services is required

only when the HHA provides such service to individuals that are not homebound and,

therefore, not under a home health plan of care.

The following practitioners must bill the A/B MAC (B) for outpatient rehabilitation

therapy services using HCPCS/CPT codes:

• Physical therapists in private practice (PTPPs),

• Occupational therapists in private practice (OTPPs),

• Speech-language pathologists in private practice (SLPPs),

• Physicians, including MDs, DOs, podiatrists and optometrists, and

• Certain nonphysician practitioners (NPPs), acting within their State scope of

practice, e.g., nurse practitioners and clinical nurse specialists.

Providers billing to intermediaries shall report:

• The date the therapy plan of care was either established or last reviewed (see

§220.1.3B) in Occurrence Code 17, 29, or 30.

• The first day of treatment in Occurrence Code 35, 44, or 45.

B. Applicable Outpatient Rehabilitation HCPCS Codes

The CMS identifies the codes listed at:

http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage

as therapy services, regardless of the presence of a financial limitation. Therapy services

include only physical therapy, occupational therapy and speech-language pathology

services. Therapist means only a physical therapist, occupational therapist or speech-

language pathologist. Therapy modifiers are GP for physical therapy, GO for

occupational therapy, and GN for speech-language pathology.

When in effect, any financial limitation will also apply to services represented unless

otherwise noted on the therapy page on the CMS Web site.

C. Additional HCPCS Codes

Some HCPCS/CPT codes that are not on the list of therapy services should not be billed

with a modifier. For example, outpatient non-rehabilitation HCPCS codes G0237,

G0238, and G0239 should be billed without therapy modifiers. These HCPCS codes

describe services for the improvement of respiratory function and may represent either

“incident to” services or respiratory therapy services that may be appropriately billed in

the CORF setting. When the services described by these G-codes are provided by

physical therapists (PTs) or occupational therapists (OTs) treating respiratory conditions,

they are considered therapy services and must meet the other conditions for physical and

occupational therapy. The PT or OT would use the appropriate HCPCS/CPT code(s) in

the 97000 - 97799 series and the corresponding therapy modifier, GP or GO, must be

used.

Another example of codes that are not on the list of therapy services and should not be

billed with a therapy modifier includes the following HCPCS codes: 95860, 95861,

95863, 95864, 95867, 95869, 95870, 95900, 95903, 95904, and 95934. These services

represent diagnostic services - not therapy services; they must be appropriately billed and

shall not include therapy modifiers.

Other codes not on the therapy code list, and not paid under another fee schedule, are

appropriately billed with therapy modifiers when the services are furnished by therapists

or provided under a therapy plan of care and where the services are covered and

appropriately delivered (e.g., the therapist is qualified to provide the service). One

example of non-listed codes where a therapy modifier is indicated regards the provision

of services described in the CPT code series, 29000 through 29590, for the application of

casts and strapping. Some of these codes previously appeared on the therapy code list,

but were deleted because we determined that they represented services that are most often

performed outside a therapy plan of care. However, when these services are provided by

therapists or as an integral part of a therapy plan of care, the CPT code must be

accompanied with the appropriate therapy modifier.

NOTE: The above lists of HCPCS/CPT codes are intended to facilitate the contractor’s

ability to pay claims under the MPFS. It is not intended to be an exhaustive list of

covered services, imply applicability to provider settings, and does not assure coverage of

these services.

20.1 - Discipline Specific Outpatient Rehabilitation Modifiers - All

Claims

(Rev. 11129, Issued: 11-22-21, Effective: 01-01-22, Implementation: 01-03-22)

Modifiers are used to identify therapy services whether or not financial limitations are in

effect. When limitations are in effect, the CWF tracks the financial limitation based on

the presence of therapy modifiers. Providers/suppliers must continue to report one of

these modifiers for any therapy code on the list of applicable therapy codes except as

noted in §20 of this chapter. Consult §20 for the list of codes to which modifiers must be

applied. These modifiers do not allow a provider to deliver services that they are not

qualified and recognized by Medicare to perform.

The claim must include one of the following modifiers to distinguish the discipline of the

plan of care under which the service is delivered:

• GN Services delivered under an outpatient speech-language pathology plan of

care;

• GO Services delivered under an outpatient occupational therapy plan of care; or,

• GP Services delivered under an outpatient physical therapy plan of care.

This is applicable to all claims from physicians, nonphysician practitioners (NPPs),

PTPPs, OTPPs, SLPPs, CORFs, OPTs, hospitals, SNFs, and any others billing for

physical therapy, speech-language pathology or occupational therapy services as noted on

the applicable code list in §20 of this chapter.

Modifiers GN, GO, and GP refer only to services provided under plans of care for

physical therapy, occupational therapy and speech-language pathology services. They

should never be used with codes that are not on the list of applicable therapy services. For

example, respiratory therapy services, or nutrition therapy services shall not be

represented by therapy codes which require GN, GO, and GP modifiers.

Contractors edit institutional claims to ensure the following:

• that a GN, GO or GP modifier is present for all lines reporting revenue codes

042X, 043X, or 044X.

• that no more than one GN, GO or GP modifier is reported on the same service

line.

• that revenue codes and modifiers are reported only in the following combinations:

o Revenue code 42x (physical therapy) lines may only contain modifier GP

o Revenue code 43x (occupational therapy) lines may only contain modifier GO

o Revenue code 44x (speech-language pathology) lines may only contain

modifier GN.

• that discipline-specific evaluation and re-evaluation HCPCS codes are always

reported with the modifier for the associated discipline (e.g. modifier GP with a

HCPCS code for a physical therapy evaluation).

Contractors return to the provider institutional claims that do not meet one or more of

these conditions.

CMS has established two modifiers, CQ and CO, for services furnished in whole or in

part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs).

The modifiers are defined as follows:

• CQ modifier: Outpatient physical therapy services furnished in whole or in part

by a physical therapist assistant

• CO modifier: Outpatient occupational therapy services furnished in whole or in

part by an occupational therapy assistant

Effective for claims with dates of service on and after January 1, 2020, the CQ and CO

modifiers are required to be used, when applicable, for services furnished in whole or in

part by PTAs and OTAs on the claim line of the service alongside the respective GP or

GO therapy modifier, to identify those PTA and OTA services furnished under a PT or

OT plan of care.

For those practitioners submitting professional claims who are paid under the PFS, the

CQ/CO modifiers apply only to services of physical and occupational therapists in private

practice (PTPPs and OTPPs); and not to the therapy services furnished by or incident to

the services of physicians or nonphysician practitioners (NPPs) ‒ including nurse

practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) ‒

because PTAs and OTAs do not meet the qualifications and standards of physical or

occupational therapists, as required by §§ 410.60 and 410.59, respectively. However, the

CQ and CO modifiers do apply to claims from physician or NPP groups when a PTPP or

OTPP has reassigned their benefits to the group and their NPI appears as the rendering

provider of the therapy service(s) on the claim.

For providers submitting institutional claims and paid at PFS rates for their outpatient PT

and OT services, the CQ and CO modifiers apply to the following providers: outpatient

hospitals, rehabilitation agencies, skilled nursing facilities, home health agencies and

CORFs. However, the CQ and CO modifiers are not applicable to claims from critical

access hospitals because they are paid on a reasonable cost basis, or from other providers

for which payment for PT and OT services is not made under the PFS rates.

The CQ modifier must be paired to the GP therapy modifier and the CO modifier with the

GO therapy modifier. Claims not so paired will be rejected/returned as unprocessable.

For dates of service, on and after January 1, 2022, claims billed with a CQ or CO

modifier to indicate the services were furnished in whole or in part by a PTA or OTA are

paid at an amount equal to 85 percent of the otherwise applicable Part B payment that’s

based on the MPFS. The 15 percent reduction is taken last, e.g., after the MPPR (and

other reductions where applicable) and right before sequestration. This reduction is

taken from the paid amount, i.e., the actual amount paid not the MPFS allowed amount.

Regulations for the payment of therapy claims and the policy for assigning the therapy

assistant modifiers (CO and CQ) for services provided in whole or in part by OTAs and

PTAs are found at §§ 410.59(a)(4) and 410.60(a)(4) for outpatient occupational and

physical therapy services, respectively and at § 410.105(d) for CORF OT and PT

services.

20.2 - Reporting of Service Units With HCPCS

(Rev. 3670, Issued: 12-01-16, Effective: 01-01-17, Implementation: 01-03-17)

A. General

Effective with claims submitted on or after April 1, 1998, providers billing on the ASC

X12 837 institutional claim format or Form CMS-1450 were required to report the

number of units for outpatient rehabilitation services based on the procedure or service,

e.g., based on the HCPCS code reported instead of the revenue code. This was already in

effect for billing on the Form CMS-1500, and CORFs were required to report their full

range of CORF services on the institutional claim. These unit-reporting requirements

continue with the standards required for electronically submitting health care claims

under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) - the

currently adopted version of the ASC X12 837 transaction standards and implementation

guides. The Administrative Simplification Compliance Act mandates that claims be sent

to Medicare electronically unless certain exceptions are met.

B. Timed and Untimed Codes

When reporting service units for HCPCS codes where the procedure is not defined by a

specific timeframe (“untimed” HCPCS), the provider enters “1” in the field labeled units.

For timed codes, units are reported based on the number of times the procedure is

performed, as described in the HCPCS code definition.

EXAMPLE: A beneficiary received a speech-language pathology evaluation

represented by HCPCS “untimed” code 92521. Regardless of the number of minutes

spent providing this service only one unit of service is appropriately billed on the same

day.

Several CPT codes used for therapy modalities, procedures, and tests and measurements

specify that the direct (one on one) time spent in patient contact is 15 minutes. Providers

report these “timed” procedure codes for services delivered on any single calendar day

using CPT codes and the appropriate number of 15 minute units of service.

EXAMPLE: A beneficiary received a total of 60 minutes of occupational therapy, e.g.,

HCPCS “timed” code 97530 which is defined in 15 minute units, on a given date of

service. The provider would then report 4 units of 97530.

C. Counting Minutes for Timed Codes in 15 Minute Units

When only one service is provided in a day, providers should not bill for services

performed for less than 8 minutes. For any single timed CPT code in the same day

measured in 15 minute units, providers bill a single 15-minute unit for treatment greater

than or equal to 8 minutes through and including 22 minutes. If the duration of a single

modality or procedure in a day is greater than or equal to 23 minutes, through and

including 37 minutes, then 2 units should be billed. Time intervals for 1 through 8 units

are as follows:

Units Number of Minutes

1 unit: ≥ 8 minutes through 22 minutes

2 units: ≥ 23 minutes through 37 minutes

3 units: ≥ 38 minutes through 52 minutes

4 units: ≥ 53 minutes through 67 minutes

5 units: ≥ 68 minutes through 82 minutes

6 units: ≥ 83 minutes through 97 minutes

7 units: ≥ 98 minutes through 112 minutes

8 units: ≥ 113 minutes through 127 minutes

The pattern remains the same for treatment times in excess of 2 hours.

If a service represented by a 15 minute timed code is performed in a single day for at

least 15 minutes, that service shall be billed for at least one unit. If the service is

performed for at least 30 minutes, that service shall be billed for at least two units, etc. It

is not appropriate to count all minutes of treatment in a day toward the units for one code

if other services were performed for more than 15 minutes. See examples 2 and 3 below.

When more than one service represented by 15 minute timed codes is performed in a

single day, the total number of minutes of service (as noted on the chart above)

determines the number of timed units billed. See example 1 below.

If any 15 minute timed service that is performed for 7 minutes or less than 7 minutes on

the same day as another 15 minute timed service that was also performed for 7 minutes or

less and the total time of the two is 8 minutes or greater than 8 minutes, then bill one unit

for the service performed for the most minutes. This is correct because the total time is

greater than the minimum time for one unit. The same logic is applied when three or

more different services are provided for 7 minutes or less than 7 minutes. See example 5

below.

The expectation (based on the work values for these codes) is that a provider’s direct

patient contact time for each unit will average 15 minutes in length. If a provider has a

consistent practice of billing less than 15 minutes for a unit, these situations should be

highlighted for review.

If more than one 15 minute timed CPT code is billed during a single calendar day, then

the total number of timed units that can be billed is constrained by the total treatment

minutes for that day. See all examples below.

Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 220.3B,

Documentation Requirements for Therapy Services, indicates that the amount of time for

each specific intervention/modality provided to the patient is not required to be

documented in the Treatment Note. However, the total number of timed minutes must be

documented. These examples indicate how to count the appropriate number of units for

the total therapy minutes provided.

Example 1 –

24 minutes of neuromuscular reeducation, code 97112,

23 minutes of therapeutic exercise, code 97110,

Total timed code treatment time was 47 minutes.

See the chart above. The 47 minutes falls within the range for 3 units = 38 to 52 minutes.

Appropriate billing for 47 minutes is only 3 timed units. Each of the codes is performed

for more than 15 minutes, so each shall be billed for at least 1 unit. The correct coding is

2 units of code 97112 and one unit of code 97110, assigning more timed units to the

service that took the most time.

Example 2 –

20 minutes of neuromuscular reeducation (97112)

20 minutes therapeutic exercise (97110),

40 Total timed code minutes.

Appropriate billing for 40 minutes is 3 units. Each service was done at least 15 minutes

and should be billed for at least one unit, but the total allows 3 units. Since the time for

each service is the same, choose either code for 2 units and bill the other for 1 unit. Do

not bill 3 units for either one of the codes.

Example 3 –

33 minutes of therapeutic exercise (97110),

7 minutes of manual therapy (97140),

40 Total timed minutes

Appropriate billing for 40 minutes is for 3 units. Bill 2 units of 97110 and 1 unit of

97140. Count the first 30 minutes of 97110 as two full units. Compare the remaining

time for 97110 (33-30 = 3 minutes) to the time spent on 97140 (7 minutes) and bill the

larger, which is 97140.

Example 4 –

18 minutes of therapeutic exercise (97110),

13 minutes of manual therapy (97140),

10 minutes of gait training (97116),

8 minutes of ultrasound (97035),

49 Total timed minutes

Appropriate billing is for 3 units. Bill the procedures you spent the most time providing.

Bill 1 unit each of 97110, 97116, and 97140. You are unable to bill for the ultrasound

because the total time of timed units that can be billed is constrained by the total timed

code treatment minutes (i.e., you may not bill 4 units for less than 53 minutes regardless

of how many services were performed). You would still document the ultrasound in the

treatment notes.

Example 5 –

7 minutes of neuromuscular reeducation (97112)

7 minutes therapeutic exercise (97110)

7 minutes manual therapy (97140)

21 Total timed minutes

Appropriate billing is for one unit. The qualified professional (See definition in Pub.

100-02, chapter 15, section 220) shall select one appropriate CPT code (97112, 97110,

97140) to bill since each unit was performed for the same amount of time and only one

unit is allowed.

NOTE: The above schedule of times is intended to provide assistance in rounding time

into 15-minute increments. It does not imply that any minute until the eighth should be

excluded from the total count. The total minutes of active treatment counted for all 15

minute timed codes includes all direct treatment time for the timed codes. Total

treatment minutes - including minutes spent providing services represented by untimed

codes - are also documented. For documentation in the medical record of the services

provided see Pub. 100-02, chapter 15, section 220.3.

D. Specific Limits for HCPCS

The Deficit Reduction Act of 2005, section 5107 requires the implementation of

clinically appropriate code edits to eliminate improper payments for outpatient therapy

services. The following codes may be billed, when covered, only at or below the number

of units indicated on the chart per treatment day. When higher amounts of units are

billed than those indicated in the table below, the units on the claim line that exceed the

limit shall be denied as medically unnecessary (according to 1862(a)(1)(A)). Denied

claims may be appealed and an ABN is appropriate to notify the beneficiary of liability.

This chart does not include all of the codes identified as therapy codes; refer to section 20

of this chapter for further detail on these and other therapy codes. For example, therapy

codes called “always therapy” must always be accompanied by therapy modifiers

identifying the type of therapy plan of care under which the service is provided.

Use the chart in the following manner:

The codes that are allowed one unit for “Allowed Units” in the chart below may be billed

no more than once per provider, per discipline, per date of service, per patient.

The codes allowed 0 units in the column for “Allowed Units”, may not be billed under a

plan of care indicated by the discipline in that column. Some codes may be billed by one

discipline (e.g., PT) and not by others (e.g., OT or SLP).

When physicians/NPPs bill “always therapy” codes they must follow the policies of the

type of therapy they are providing e.g., utilize a plan of care, bill with the appropriate

therapy modifier (GP, GO, GN), bill the allowed units on the chart below for PT, OT or

SLP depending on the plan. A physician/NPP shall not bill an “always therapy” code

unless the service is provided under a therapy plan of care. Therefore, NA stands for

“Not Applicable” in the chart below.

When a “sometimes therapy” code is billed by a physician/NPP, but as a medical service,

and not under a therapy plan of care, the therapy modifier shall not be used, but the

number of units billed must not exceed the number of units indicated in the chart below

per patient, per provider/supplier, per day.

NOTE: As of April 1, 2017, the chart below uses the CPT Consumer Friendly Code

Descriptions which are intended only to assist the reader in identifying the service related

to the CPT/HCPCS code. The reader is reminded that these descriptions cannot be used

in place of the CPT long descriptions which officially define each of the services. The

table below no longer contains a column noting whether a code is “timed” or “untimed”

as this notation is not relevant to the number of units allowed per code on claims for the

listed therapy services. We note that the official long descriptors for the CPT codes can

be found in the latest CPT code book.

CPT/

HCPCS

Code

CPT Consumer Friendly

Code Descriptions and

Allowed

Units

Allowed

Units

SLP

Allowed

Units

Physician/

NPP Not

Claim Line Outlier/Edit

Details

Under

Therapy

POC

92521

Evaluation of speech

fluency

92522

Evaluation of speech

sound production

92523

Evaluation of speech

sound production with

evaluation of language

comprehension and

expression

92524

Behavioral and qualitative

analysis of voice and

resonance

92597

Evaluation for use and/or

fitting of voice prosthetic

device to supplement oral

speech

92607

Evaluation of patient with

prescription of speech-

generating and alternative

communication device

92611

Fluoroscopic and video

recorded motion

evaluation of swallowing

function

92612

Evaluation and recording

of swallowing using an

endoscope Evaluation and

recording of swallowing

using an endoscope

92614

Evaluation and recording

of voice box sensory

function using an

endoscope

92616

Evaluation and recording

of swallowing and voice

box sensory function using

an endoscope

95833

Manual muscle testing of

whole body

95834

Manual muscle testing of

whole body including

hands

96110

Developmental screening

96111

Developmental testing

97161

Evaluation of physical

therapy, typically 20

minutes

97162

Evaluation of physical

therapy, typically 30

minutes

97163

Evaluation of physical

therapy, typically 45

minutes

97164

Re-evaluation of physical

therapy, typically 20

minutes

97165

Evaluation of occupational

therapy, typically 30

minutes

97166

Evaluation of occupational

therapy, typically 45

minutes

97167

Evaluation of occupational

therapy, typically 60

minutes

97168

Re-evaluation of

occupational therapy

established plan of care,

typically 30 minutes

20.3 - Determining What Time Counts Towards 15-Minute Timed Codes - All

Claims

(Rev. 1, 10-01-03)

Providers report the code for the time actually spent in the delivery of the modality

requiring constant attendance and therapy services. Pre- and post-delivery services are

not to be counted in determining the treatment service time. In other words, the time

counted as “intra-service care” begins when the therapist or physician (or an assistant

under the supervision of a physician or therapist) is directly working with the patient to

deliver treatment services. The patient should already be in the treatment area (e.g., on

the treatment table or mat or in the gym) and prepared to begin treatment.

The time counted is the time the patient is treated. For example, if gait training in a

patient with a recent stroke requires both a therapist and an assistant, or even two

therapists, to manage in the parallel bars, each 15 minutes the patient is being treated can

count as only one unit of code 97116. The time the patient spends not being treated

because of the need for toileting or resting should not be billed. In addition, the time

spent waiting to use a piece of equipment or for other treatment to begin is not considered

treatment time.

20.4 - Coding Guidance for Certain CPT Codes - All Claims

(Rev. 3475, Issued: 03-04-16, Effective: 06-06-16, Implementation: 06-06-16)

The following provides guidance about the use of codes 96105, 97026, 97150, 97545,

97546, and G0128.

• CPT Codes 96105, 97545, and 97546.

Providers report code 96105, assessment of aphasia with interpretation and report in 1-

hour units. This code represents formal evaluation of aphasia with an instrument such as

the Boston Diagnostic Aphasia Examination. If this formal assessment is performed

during treatment, it is typically performed only once during treatment and its medical

necessity should be documented. If the test is repeated during treatment, the medical

necessity of the repeat administration of the test must also be documented. It is common

practice for regular assessment of a patient’s progress in therapy to be documented in the

chart, and this may be done using test items taken from the formal examinations. This is

considered to be part of the treatment and should not be billed as 96105 unless a full,

formal assessment is completed.

Other timed physical medicine codes are 97545 and 97546. The interval for code 97545

is 2 hours and for code 97546, 1 hour. These are specialized codes to be used in the

context of rehabilitating a worker to return to a job. The expectation is that the entire

time period specified in the codes 97545 or 97546 would be the treatment period, since a

shorter period of treatment could be coded with another code such as codes 97110,

97112, or 97537. (Codes 97545 and 97546 were developed for reporting services to

persons in the worker’s compensation program, thus CMS does not expect to see them

reported for Medicare patients except under very unusual circumstances. Further, CMS

would not expect to see code 97546 without also seeing code 97545 on the same claim.

Code 97546, when used, is used in conjunction with 97545.)

• CPT Code 97026

Effective for services performed on or after October 24, 2006, the Centers for Medicare

& Medicaid Services announce a NCD stating the use of infrared and/or near-infrared

light and/or heat, including monochromatic infrared energy (MIRE), is non-covered for

the treatment, including symptoms such as pain arising from these conditions, of diabetic

and/or non-diabetic peripheral sensory neuropathy, wounds and/or ulcers of the skin

and/or subcutaneous tissues in Medicare beneficiaries. Further coverage guidelines can

be found in the National Coverage Determination Manual (Pub. 100-03), section 270.6.

Contractors shall deny claims with CPT 97026 (infrared therapy incident to or as a

PT/OT benefit) and HCPCS E0221 or A4639, if the claim contains any of the following

diagnosis codes:

ICD-9-CM

250.60 - 250.63

354.4, 354.5, 354.9

355.1 - 355.4

355.6 - 355.9

356.0, 356.2-356.4, 356.8-356.9

357.0 - 357.7

674.10, 674.12, 674.14, 674.20, 674.22, 674.24

707.00 -707.07, 707.09-707.15, 707.19

870.0 - 879.9

880.00 - 887.7

890.0 - 897.7

998.31 - 998.32

ICD-10-CM

See Addendum A Chapter 5, Section 20.4 (at end of this chapter) for the list of ICD 10-

CM diagnosis codes that require denial with the above HCPCD codes.

The contractor shall use the following remittance advice messages and associated codes

when rejecting/denying claims under this policy. This CARC/RARC combination is

compliant with CAQH CORE Business Scenario Three.

Group Code: CO

CARC: 50

RARC: N/A

MSN: 21.11

Advanced Beneficiary Notice (ABN):

Physicians, physical therapists, occupational therapists, outpatient rehabilitation facilities

(ORFs), comprehensive outpatient rehabilitation facilities (CORFs), home health

agencies (HHA), and hospital outpatient departments are liable if the service is

performed, unless the beneficiary signs an ABN.

Similarly, DME suppliers and HHA are liable for the devices when they are supplied,

unless the beneficiary signs an ABN.

20.5 - CORF/OPT Edit for Billing Inappropriate Supplies

(Rev. 319, Issued: 10-22-04, Effective: 07-01-01, Implementation: 04-04-05)

Supplies furnished by CORFs/OPTs are considered part of the practice expense. Under

the Medicare Physician Fee Schedule (MPFS) these expenses are already taken into

account in the practice expense relative values. Therefore, CORFs/OPTs should not bill

for the supplies they furnish except for the splint and cast, level II HCPCS Q codes

associated with the level I HCPCS in the 29000 series.

The shared system maintainer will return to CORFs/OPTs any claims that they receive

that contain a supply revenue code 270 without the splint and cast Level II HCPCS Q

codes and the related Level I applicable HCPCS codes in the 29000 series.

The appropriate Level II HCPCS “Q” codes to be used are Q4001 thru Q4049.

The appropriate Level I HCPCS codes associated with the Level II HCPCS “Q” codes are

29000 thru 29085; 29105 thru 29131; and 29305 thru 29515.

30 - Special Claims Processing Rules for Outpatient Rehabilitation

Claims - Form CMS-1500

(Rev. 1, 10-01-03)

Rules for completing a Form CMS-1500 and electronic formats are in Chapter 26.

Instructions in §§10.1, 20.1, 20.2, 20.3 and 20.4 above also apply.

30.1 - Determining Payment Amounts

(Rev. 1, 10-01-03)

A/B MACs (B) use the MPFS to determine payment for outpatient rehabilitation services.

Payment rules are the same as those for other services paid on the MPFS.

Assignment is mandatory.

See chapter 23, for a description of the MPFS.

30.2 - Applicable A/B MAC (B) CWF Type of Service Codes

(Rev. 1, 10-01-03)

The A/B MAC (B) assigns the type of service code before submitting the claim record to

CWF.

U = Occupational therapy

W= Physical therapy

40 - Special Claims Processing Rules for Institutional Outpatient

Rehabilitation Claims

(Rev. 1921, Issued: 02-19-10, Effective: 04-01-10, Implementation: 04-05-10)

40.1 - Determining Payment Amounts – Institutional Claims

(Rev. 3367 Issued: 10-07-15, Effective: 01-01-16, Implementation: 01-04-16)

Institutional outpatient rehabilitation claims are paid under the Medicare Physician Fee

Schedule (MPFS), except for claims from CAHs and hospitals in Maryland. Medicare

contractors should see §100.2 for details on obtaining the correct fee amounts.

40.2 - Applicable Types of Bill

(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13)

The appropriate types of bill for submitting outpatient rehabilitation services are: 12X,

13X, 22X, 23X, 34X, 74X, 75X, and 85X.

40.3 - Applicable Revenue Codes

(Rev. 2044, Issued: 09-03-10, Effective: 09-30-10, Implementation: 09-30-10)

The appropriate revenue codes for reporting outpatient rehabilitation services are

0420 - Physical Therapy Services

0430 - Occupational Therapy Services

0440 – Speech-language pathology services

The general classification of revenue codes is all that is needed for billing. If, however,

providers choose to use more specific revenue code classifications, the A/B MAC (A)

should accept them. Reporting of services is not limited to specific revenue codes; e.g.,

services other than therapy may be included on the same claim.

Many therapy services may be provided by both physical and occupational therapists.

Other services may be delivered by either occupational therapists or speech-language

pathologists. Therefore, providers report outpatient rehabilitation HCPCS codes in

conjunction with the appropriate outpatient rehabilitation revenue code based on the type

of therapist who delivered the service, or, if a therapist does not deliver the service, then

on the type of therapy under the plan of care (POC) for which the service is delivered.

40.4 - Edit Requirements for Revenue Codes

(Rev. 1921, Issued: 02-19-10, Effective: 04-01-10, Implementation: 04-05-10)

Medicare contractors edit to assure the presence of a HCPCS code when revenue codes

0420, 0430, 0440, or 0470 are reported. However, Medicare contractors do not edit the

matching of revenue code to certain HCPCS codes or edit to limit provider reporting to

only those HCPCS listed in section 20.

40.5 - Line Item Date of Service Reporting

(Rev. 2044, Issued: 09-03-10, Effective: 09-30-10, Implementation: 09-30-10)

Providers are required to report line item dates of service per revenue code line for

outpatient rehabilitation services. CORFs are also required to report their full range of

CORF services by line item date of service. This means each service (revenue code)

provided must be repeated on a separate line item along with the specific date the service

was provided for every occurrence.

Contractors will return claims that span two or more dates if a line item date of service is

not entered for each HCPCS reported. Line item date of service reporting became

effective for claims with dates of service on or after October 1, 1998.

Services that do not require line item date of service reporting may be reported before or

after those services that require line item reporting.

40.6 - Non-covered Charge Reporting

(Rev. 1921, Issued: 02-19-10, Effective: 04-01-10, Implementation: 04-05-10)

Institutional outpatient therapy claims may report non-covered charges when appropriate

according to the instructions provided in of this manual. Outpatient therapies billed as

non-covered charges are not counted toward the financial limitation described above,

when that limitation is in effect, unless the charges are subject to review after they are

submitted and found to be covered by Medicare. Modifiers associated with non-covered

charges that are presented in Chapter 1, section 60 can be used on claim lines for therapy

services, in addition to the use of modifiers -GN, -GO and -GP.

40.7 - Billing for Biofeedback Training for the Treatment of Urinary

Incontinence

(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13)

Medicare covered biofeedback training for the treatment of urinary incontinence may be

provided by physical therapists in facility settings. For information regarding the

coverage of this service, see the Medicare National Coverage Determinations Manual,

Chapter 1, Section 30.1.1. Medicare pays for this service under the Medicare Physician

Fee Schedule.

Providers bill this service on one of the types of bill listed in section 40.2 using revenue

code 042X and one of the following HCPCS codes:

• 90901 - Biofeedback training by any modality

• 90911 - Biofeedback training, perineal muscles, anorectal or urethral sphincter,

including EMG and/or manometry

40.8 – Rebilling Therapy Services for Hospital Inpatients

(Rev. 2868, Issued: 02-06-14, Effective: 07-01-14, Implementation: 07-07-14)

If a beneficiary receives therapy services during an inpatient hospital stay which was

denied because the stay was not medically necessary, the therapy services may be rebilled

under Medicare Part B coverage. If the therapy would have been reasonable and

necessary as hospital outpatient services, and provided the beneficiary has Part B

entitlement, the services can be billed using Type of Bill 012x. All payment and billing

requirements for outpatient therapy (including therapy caps, functional reporting and

other instructions in this chapter) apply to these claims.

50 - CWF and PS&R Requirements - A/B MAC (A)

(Rev. 2044, Issued: 09-03-10, Effective: 09-30-10, Implementation: 09-30-10)

The A/B MAC (A) reports the procedure codes in the financial data section (field 65a-

65j) of the PS&R record. It includes revenue code, HCPCS, units, and covered charges

in the record. Where more than one HCPCS procedure is applicable to a single revenue

code, the provider reports each HCPCS and related charge on a separate line. The A/B

MAC (A) reports the payment amount before adjustment for beneficiary liability in field

65g “Rate” and the actual charge in field 65h “Covered Charges.” The PS&R system

includes outpatient rehabilitation, and CORF services listed in subsections E and F on a

separate report from cost based payments. See the PS&R guidelines for specific

information.

100 - Special Rules for Comprehensive Outpatient Rehabilitation

Facilities (CORFs)

(Rev. 1, 10-01-03)

100.1 - General

(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10,

ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of

ICD-10 ASC X12: 09-16-14)

The Omnibus Reconciliation Act of 1980 (Public Law 96-499, Section 933) defines

CORFs (Comprehensive Outpatient Rehabilitation Facilities) as a distinct type of

Medicare provider and adds CORF services as a benefit under Medicare Part B. The

Balance Budget Act (P.L.105-33) requires payment under a prospective system for all

CORF services.

See Chapter 1, for the policy on A/B MAC (A) designations governing CORFs.

See the Medicare Benefit Policy Manual, Chapter 12, for a description of covered CORF

services.

Physicians’ diagnostic and therapeutic services furnished to a CORF patient are not

considered CORF physician’s services. The physician must bill the area A/B MAC (B)

for these services. If they are covered, the A/B MAC (B) reimburses them via the MPFS.

However, other services are considered CORF services to be billed by the CORF to the

A/B MAC (A), and are also considered included in the fee amount under the MPFS.

These services include such services as administrative services provided by the physician

associated with the CORF, examinations for the purpose of establishing and reviewing

the plan of care, consultation with and medical supervision of nonphysician staff, team

conferences, case reviews, and other facility staff medical and facility administration

activities relating to the services described in Medicare Benefit Policy Manual, chapter

12. Related supplies are also included in the MPFS fee amount.

The CORFs bill Medicare with the ASC X12 837 institutional claim or Form CMS-1450

using HCPCS codes and Revenue Codes. Usually the zero level revenue code is used.

Payment is based on the HCPCS code and related MPFS amount.

Requirements in §§10 - 50 apply to CORF billing. In addition the following

requirements apply.

100.1.1 - Allowable Revenue Codes on CORF 75X Bill Types

(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13)

Effective October 1, 2012, the following revenue codes are allowable for reporting CORF

services on 75X bill types:

0270

0274

0279

029X

0412

0419

042X

0410

044X

0550

0559

043X

0636

0771

0911

0569

0942

NOTE: Billed revenue codes not listed in the above list will be returned to the provider

by Medicare systems. See Chapter 25, Completing and Processing the CMS-1450 Data

Set, for revenue code descriptions.

100.2 - Obtaining Fee Schedule Amounts

(Rev. 1, 10-01-03)

The CMS furnishes A/B MACs (A) with an annual therapy abstract file and a CORF

supplemental file through the Medicare Telecommunications System. The CMS notifies

A/B MACs (A) when new files are available. A/B MACs (A) are responsible for

informing CORFs of new fee schedule amounts.

Payment is calculated at 80 percent of the allowed charge after deductible is met. The

allowed charge is the lower of billed charges or the fee schedule amount. Unmet

deductible is subtracted from the allowed charge, and payment is calculated at 80 percent

of the result.

EXAMPLE:

$120 Provider charge;

$100 MPFS amount.

Payment is 80 percent of the lower of the actual charge or fee schedule amount,

which in this case is $80.00. ($100.00 (MPFS) X 80 percent.)

The remaining 20 percent or $20 is the patient s coinsurance liability.

These codes are updated as needed by CMS.

If the A/B MAC (A) receives a claim for a Medicare covered CORF service with dates of

service on or after July 1, 2000, that does not appear on its fee schedule abstract file, it

has two options for obtaining pricing information:

1. It is provided with a therapy abstract file or CORF supplemental file that contains

all therapy services and their related prices. This supplemental file contains

approximately a million records, and may be used as a resource to extract pricing

data as needed. The data in the supplemental file is in the same format as the

MPFS abstract file in exhibit 1, but the fields defining the fee and outpatient

hospital indicators are not populated, instead they are space-filled.

2. It can contact the local A/B MAC (B) to obtain the price. When requesting the

pricing data, it advises the A/B MAC (B) to provide the nonfacility fee from the

MPFS. The MPFS supplemental file of physician fee schedule services is

available for retrieval through CMS’ Mainframe Telecommunications System.

The A/B MAC (A) is notified yearly of the file retrieval names and dates by a

program memorandum or other communication.

100.3 - Proper Reporting of Nursing Services by CORFs - A/B MAC (A)

(Rev. 1459; Issued: 02-22-08; Effective: 07-01-08; Implementation: 07-07-08)

Nursing services performed in the CORF shall be billed utilizing the following HCPCS

code:

G0128 – Direct (Face to Face w/ patient) skilled nursing services of a registered nurse

provided in a CORF, each 10 minutes beyond the first 5 minutes.

In addition, HCPCS G0128 is billable with revenue codes 0550 and 0559 only.

100.4 - Outpatient Mental Health Treatment Limitation

(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13)

The Outpatient Mental Health Treatment Limitation (the limitation) is not applicable to

CORF services because CORFs do not provide services to treat mental, psychoneurotic

and personality disorders that are subject to the limitation in section 1833(c) of the Act.

For dates of service on or after October 1, 2012, HCPCS code G0409 is the only code

allowed for social work and psychological services furnished in a CORF. This service is

not subject to the limitation because it is not a psychiatric mental health treatment

service.

For additional information on the limitation, see Publication 100-01, Chapter 3, section

30 and Publication 100-02, Chapter 12, sections 50-50.5.

100.5 - Off-Site CORF Services

(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10,

ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of

ICD-10 ASC X12: 09-16-14)

The CORFs may provide physical therapy, speech-language pathology and occupational

therapy off the CORF’s premises in addition to the home evaluation. Services provided

offsite are billed separately and identified as “offsite” on the claim in remarks. The

charges for offsite visits include any additional charge for providing the services at a

place other than the CORF premises. There is no change in the payment method for

offsite services.

100.6 - Notifying Patient of Service Denial

(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10,

ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of

ICD-10 ASC X12: 09-16-14)

Services may be noncovered because they are statutorily excluded from coverage under

Medicare, or because they are not medically reasonable and necessary.

If a service is excluded by statute, the CORF may submit a claim for them to Medicare to

obtain a denial prior to billing another insurance carrier. It shows the charges as

noncovered, and includes Condition Code 21. It may bill the beneficiary for the excluded

services, and need not issue an advance beneficiary notice (ABN). However, when

providing therapy services under the financial limitations, the CORF should provide the

beneficiary with the Notice of Exclusion of Medicare Benefits (NEMB). The Medicare

Claims Processing Manual, Chapter 30, “Limitation on Liability,” discusses ABNs for

A/B MAC (A) processed claims for Part B services.

If, after reviewing the plan of care, the CORF determines that the services to be furnished

to the patient are not medically reasonable or necessary, it immediately provides the

beneficiary with an ABN. If the patient signs an ABN, the claim includes occurrence

code 32 “Date Beneficiary Notified of Intent to Bill (Procedures or Treatments)” along

with the date the ABN was signed.

If the beneficiary insists that a claim be submitted for payment, the CORF must indicate

on the bill (billed separately from bills with covered charges) that it is being submitted at

the beneficiary’s request. This is done by using condition code 20.

If during the course of the patient’s treatment the A/B MAC (A) advises the CORF that

covered care has ceased, the CORF must notify the beneficiary (or the beneficiary’s

representative) immediately.

NOTE: Information regarding the form locator numbers that correspond to these data

element names is found in Chapter 25.

100.7 - Payment of Drugs, Biologicals, and Supplies in a CORF

(Rev. 1459; Issued: 02-22-08; Effective: 07-01-08; Implementation: 07-07-08)

Drugs

Drugs and biologicals generally do not apply in a CORF setting. Therefore, contractors

are to advise their CORFs not to bill for them.

Supplies

The CORFs should not bill for the supplies they furnish when such supplies are part of

the practice expense for that service. Under the MPFS, nearly all of these expenses are

already taken into account in the practice expense relative values. However, CORFs may

bill separately for certain splint and cast supplies, represented by HCPCS codes Q4001

through Q4051, when furnishing a cast/strapping application service in the CPT code

series 29000 through 29750.

Vaccines

The CORFs should refer to Chapter 18, Preventive and Screening Services, for billing

guidance on influenza, pneumococcal pneumonia, and Hepatitis B vaccines and their

administration.

100.8 - Billing for DME, Prosthetic and Orthotic Devices, and Surgical Dressings

(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10,

ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of

ICD-10 ASC X12: 09-16-14)

The CORFs bill DME to the DME MAC with the ASC X12 professional claim format or

Form CMS-1500 except for claims for implanted DME, which are billed to the local A/B

MAC (B). If the CORF does not have a supplier billing number from the National

Supplier Clearinghouse (NSC), it may contact the NSC to secure one. If the local A/B

MAC (B) has issued the CORF a provider number for billing physician services, the

CORF may not use the same number when billing for DME.

100.10 - Group Therapy Services (Code 97150)

(Rev. 1145, Issued: 12-29-06, Effective: 01-01-07, Implementation: on or before 01-

29-07)

Policies for group therapy services for CORF are the same as group therapy services for

other Part B outpatient services. See Pub 100-02, chapter 15, section 230.

100.10.1 - Therapy Students

(Rev. 1145, Issued: 12-29-06, Effective: 01-01-07, Implementation: on or before 01-

29-07)

Policies for therapy students for CORF are the same as policies for therapy students for

other Part B outpatient services. See Pub. 100-02, chapter 15, section 230.

100.11 - Billing for Social Work and Psychological Services in a CORF

(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13)

The CORF providers shall only bill social work and psychological services with the

following HCPCS code:

G0409 – Social work and psychological services, directly relating to and/or the patient's

rehabilitation goals, each 15 minutes, face-to-face; individual (services provided

by a CORF-qualified social worker or psychologist in a CORF)

In addition, HCPCS code G0409 shall only be billed with revenue code 0569 or 0911.

100.12 - Billing for Respiratory Therapy Services in a CORF

(Rev. 1459; Issued: 02-22-08; Effective: 07-01-08; Implementation: 07-07-08)

The CORF providers shall only bill respiratory therapy services with revenue codes 0410,

0412 and 0419. See Chapter 25, Completing and Processing the CMS-1450 Data Set, for

revenue code descriptions.

Exhibit 1 - Physician Fee Schedule Abstract File

(Rev. 515, Issued: 04-01-05, Effective: 01-03-05, Implementation: 07-05-05)

This file contains nonfacility fee schedule payment amounts for the outpatient

rehabilitation, and CORF HCPCS codes listed in §20. These codes are identified in the

abstract file by a value of “R” in the fee indicator field. The file includes fee schedule

payment amounts by locality and is available via the CMS Mainframe

Telecommunications System (formerly referred to as the Network Data Mover).

Record Length:

Record Format:

Block size:

Character Code:

Sort Sequence:

6000

EBCDIC

A/B MAC (B), Locality HCPCS Code, Modifier

Data

Element Name COBOL

Location

Picture

Value

– HCPCS 1-5 X(05)

– Modifier 6-7 X(02)

– Filler 8-9 X(02)

-- Non-Facility Fee 10-16 9(05)V99

– Filler 17-23 X(07)

– Filler 24-30 X(07)

-- A/B MAC (B)

Number

31-35 X(05)

– Locality 36-37 X(02)

Identical to the

radiology/diagnostic fees

– Filler 38-40 X(03)

-- Fee Indicator 41-41 X(1)

“R”

- Rehab/Audiology/CORF

services

-- Outpatient

Hospital

indicator

42-42 X(1)

“0”

- Fee applicable in hospital

outpatient setting

“1”

- Fee not applicable in hospital

outpatient setting

– Filler 43-60 X(18)

Upon CMS notification, the contractor is responsible for retrieving this file and making

payment based on 80 percent of the lower of the actual charge or fee schedule amount

indicated on the file after the Part B deductible has been met. The CMS will notify

contractors of updates to the MPFS, file names and when the updated files will be

available for retrieval. Upon retrieval, contractors disseminate the fee schedules to their

providers. The file is also available on the CMS Web site in the Public Use Files (PUF)

area.

Addendum A - Chapter 5, Section 20.4 – Coding Guidance for Certain CPT

Codes – All Claims

(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10,

ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of

ICD-10 ASC X12: 09-16-14)

ICD-10-CM - Code and Description

A52.15 Late syphilitic neuropathy

E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy,

unspecified

E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy

E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy

E09.40 Drug or chemical induced diabetes mellitus with neurological complications

with diabetic neuropathy, unspecified

E09.41 Drug or chemical induced diabetes mellitus with neurological complications

with diabetic mononeuropathy

E09.42 Drug or chemical induced diabetes mellitus with neurological complications

with diabetic polyneuropathy

E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified

E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy

E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy

E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy

E10.44 Type 1 diabetes mellitus with diabetic amyotrophy

E10.49 Type 1 diabetes mellitus with other diabetic neurological complication

E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy

E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified

E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy

E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy

E11.44 Type 2 diabetes mellitus with diabetic amyotrophy

E11.49 Type 2 diabetes mellitus with other diabetic neurological complication

E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy

E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified

E13.41 Other specified diabetes mellitus with diabetic mononeuropathy

E13.42 Other specified diabetes mellitus with diabetic polyneuropathy

ICD-10-CM - Code and Description

E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy

E13.44 Other specified diabetes mellitus with diabetic amyotrophy

E13.49 Other specified diabetes mellitus with other diabetic neurological complication

E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy

G13.0 Paraneoplastic neuromyopathy and neuropathy

G13.1 Other systemic atrophy primarily affecting central nervous system in neoplastic

disease

G56.40 Causalgia of unspecified upper limb

G56.41 Causalgia of right upper limb

G56.42 Causalgia of left upper limb

G56.90 Unspecified mononeuropathy of unspecified upper limb

G56.91 Unspecified mononeuropathy of right upper limb

G56.92 Unspecified mononeuropathy of left upper limb

G57.10 Meralgia paresthetica, unspecified lower limb

G57.11 Meralgia paresthetica, right lower limb

G57.12 Meralgia paresthetica, left lower limb

G57.20 Lesion of femoral nerve, unspecified lower limb

G57.21 Lesion of femoral nerve, right lower limb

G57.22 Lesion of femoral nerve, left lower limb

G57.30 Lesion of lateral popliteal nerve, unspecified lower limb

G57.31 Lesion of lateral popliteal nerve, right lower limb

G57.32 Lesion of lateral popliteal nerve, left lower limb

G57.40 Lesion of medial popliteal nerve, unspecified lower limb

G57.41 Lesion of medial popliteal nerve, right lower limb

G57.42 Lesion of medial popliteal nerve, left lower limb

G57.60 Lesion of plantar nerve, unspecified lower limb

G57.61 Lesion of plantar nerve, right lower limb

G57.62 Lesion of plantar nerve, left lower limb

G57.70 Causalgia of unspecified lower limb

G57.71 Causalgia of right lower limb

G57.72 Causalgia of left lower limb

G57.80 Other specified mononeuropathies of unspecified lower limb

G57.81 Other specified mononeuropathies of right lower limb

G57.82 Other specified mononeuropathies of left lower limb

G57.90 Unspecified mononeuropathy of unspecified lower limb

ICD-10-CM - Code and Description

G57.91 Unspecified mononeuropathy of right lower limb

G57.92 Unspecified mononeuropathy of left lower limb

G58.7 Mononeuritis multiplex

G58.8 Other specified mononeuropathies

G58.9 Mononeuropathy, unspecified

G59 Mononeuropathy in diseases classified elsewhere

G60.0 Hereditary motor and sensory neuropathy

G60.1 Refsum's disease

G60.2 Neuropathy in association with hereditary ataxia

G60.3 Idiopathic progressive neuropathy

G60.8 Other hereditary and idiopathic neuropathies

G60.9 Hereditary and idiopathic neuropathy, unspecified

G61.0 Guillain-Barre syndrome

G61.1 Serum neuropathy

G62.0 Drug-induced polyneuropathy

G62.1 Alcoholic polyneuropathy

G62.2 Polyneuropathy due to other toxic agents

G62.82 Radiation-induced polyneuropathy

G63 Polyneuropathy in diseases classified elsewhere

G65.0 Sequelae of Guillain-Barré syndrome

G65.1 Sequelae of other inflammatory polyneuropathy

G65.2 Sequelae of toxic polyneuropathy

I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh

I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf

I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle

I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot

I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot

I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of

lower right leg

I70.239 Atherosclerosis of native arteries of right leg with ulceration of unspecified site

I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh

I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf

I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle

I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot

I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot

ICD-10-CM - Code and Description

I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of

lower left leg

I70.249 Atherosclerosis of native arteries of left leg with ulceration of unspecified site

I70.331 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with

ulceration of thigh

I70.332 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with

ulceration of calf

I70.333 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with

ulceration of ankle

I70.334 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with

ulceration of heel and midfoot

I70.335 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with

ulceration of other part of foot

I70.338 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with

ulceration of other part of lower leg

I70.339 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with

ulceration of unspecified site

I70.341 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with

ulceration of thigh

I70.342 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with

ulceration of calf

I70.343 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with

ulceration of ankle

I70.344 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with

ulceration of heel and midfoot

I70.345 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with

ulceration of other part of foot

I70.348 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with

ulceration of other part of lower leg

I70.349 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with

ulceration of unspecified site

I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with

ulceration of thigh

I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with

ulceration of calf

I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with

ulceration of ankle

I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with

ulceration of heel and midfoot

ICD-10-CM - Code and Description

I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with

ulceration of other part of foot

I70.438 Atherosclerosis of autologous vein bypass graft(s) of the right leg with

ulceration of other part of lower leg

I70.439 Atherosclerosis of autologous vein bypass graft(s) of the right leg with

ulceration of unspecified site

I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration

of thigh

I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration

of calf

I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration

of ankle

I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration

of heel and midfoot

I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration

of other part of foot

I70.448 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration

of other part of lower leg

I70.449 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration

of unspecified site

I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with

ulceration of thigh

I70.532 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with

ulceration of calf

I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with

ulceration of ankle

I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with

ulceration of heel and midfoot

I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with

ulceration of other part of foot

I70.538 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with

ulceration of other part of lower leg

I70.539 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with

ulceration of unspecified site

I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with

ulceration of thigh

I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with

ulceration of calf

ICD-10-CM - Code and Description

I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with

ulceration of ankle

I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with

ulceration of heel and midfoot

I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with

ulceration of other part of foot

I70.548 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with

ulceration of other part of lower leg

I70.549 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with

ulceration of unspecified site

I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration

of thigh

I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration

of calf

I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration

of ankle

I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration

of heel and midfoot

I70.635 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration

of other part of foot

I70.638 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration

of other part of lower leg

I70.639 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration

of unspecified site

I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of

thigh

I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of

calf

I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of

ankle

I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of

heel and midfoot

I70.645 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of

other part of foot

I70.648 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of

other part of lower leg

I70.649 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of

unspecified site

ICD-10-CM - Code and Description

I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration

of thigh

I70.732 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration

of calf

I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration

of ankle

I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration

of heel and midfoot

I70.735 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration

of other part of foot

I70.738 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration

of other part of lower leg

I70.739 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration

of unspecified site

I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of

thigh

I70.742 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of

calf

I70.743 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of

ankle

I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of

heel and midfoot

I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of

other part of foot

I70.748 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of

other part of lower leg

I70.749 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of

unspecified site

L89.000 Pressure ulcer of unspecified elbow, unstageable

L89.001 Pressure ulcer of unspecified elbow, stage 1

L89.002 Pressure ulcer of unspecified elbow, stage 2

L89.003 Pressure ulcer of unspecified elbow, stage 3

L89.004 Pressure ulcer of unspecified elbow, stage 4

L89.009 Pressure ulcer of unspecified elbow, unspecified stage

L89.010 Pressure ulcer of right elbow, unstageable

L89.011 Pressure ulcer of right elbow, stage 1

L89.012 Pressure ulcer of right elbow, stage 2

L89.013 Pressure ulcer of right elbow, stage 3

ICD-10-CM - Code and Description

L89.014 Pressure ulcer of right elbow, stage 4

L89.019 Pressure ulcer of right elbow, unspecified stage

L89.020 Pressure ulcer of left elbow, unstageable

L89.021 Pressure ulcer of left elbow, stage 1

L89.022 Pressure ulcer of left elbow, stage 2

L89.023 Pressure ulcer of left elbow, stage 3

L89.024 Pressure ulcer of left elbow, stage 4

L89.029 Pressure ulcer of left elbow, unspecified stage

L89.100 Pressure ulcer of unspecified part of back, unstageable

L89.101 Pressure ulcer of unspecified part of back, stage 1

L89.102 Pressure ulcer of unspecified part of back, stage 2

L89.103 Pressure ulcer of unspecified part of back, stage 3

L89.104 Pressure ulcer of unspecified part of back, stage 4

L89.109 Pressure ulcer of unspecified part of back, unspecified stage

L89.110 Pressure ulcer of right upper back, unstageable

L89.111 Pressure ulcer of right upper back, stage 1

L89.112 Pressure ulcer of right upper back, stage 2

L89.113 Pressure ulcer of right upper back, stage 3

L89.114 Pressure ulcer of right upper back, stage 4

L89.119 Pressure ulcer of right upper back, unspecified stage

L89.120 Pressure ulcer of left upper back, unstageable

L89.121 Pressure ulcer of left upper back, stage 1

L89.122 Pressure ulcer of left upper back, stage 2

L89.123 Pressure ulcer of left upper back, stage 3

L89.124 Pressure ulcer of left upper back, stage 4

L89.129 Pressure ulcer of left upper back, unspecified stage

L89.130 Pressure ulcer of right lower back, unstageable

L89.131 Pressure ulcer of right lower back, stage 1

L89.132 Pressure ulcer of right lower back, stage 2

L89.133 Pressure ulcer of right lower back, stage 3

L89.134 Pressure ulcer of right lower back, stage 4

L89.139 Pressure ulcer of right lower back, unspecified stage

L89.140 Pressure ulcer of left lower back, unstageable

L89.141 Pressure ulcer of left lower back, stage 1

ICD-10-CM - Code and Description

L89.142 Pressure ulcer of left lower back, stage 2

L89.143 Pressure ulcer of left lower back, stage 3

L89.144 Pressure ulcer of left lower back, stage 4

L89.149 Pressure ulcer of left lower back, unspecified stage

L89.150 Pressure ulcer of sacral region, unstageable

L89.151 Pressure ulcer of sacral region, stage 1

L89.152 Pressure ulcer of sacral region, stage 2

L89.153 Pressure ulcer of sacral region, stage 3

L89.154 Pressure ulcer of sacral region, stage 4

L89.159 Pressure ulcer of sacral region, unspecified stage

L89.200 Pressure ulcer of unspecified hip, unstageable

L89.201 Pressure ulcer of unspecified hip, stage 1

L89.202 Pressure ulcer of unspecified hip, stage 2

L89.203 Pressure ulcer of unspecified hip, stage 3

L89.204 Pressure ulcer of unspecified hip, stage 4

L89.209 Pressure ulcer of unspecified hip, unspecified stage

L89.210 Pressure ulcer of right hip, unstageable

L89.211 Pressure ulcer of right hip, stage 1

L89.212 Pressure ulcer of right hip, stage 2

L89.213 Pressure ulcer of right hip, stage 3

L89.214 Pressure ulcer of right hip, stage 4

L89.219 Pressure ulcer of right hip, unspecified stage

L89.220 Pressure ulcer of left hip, unstageable

L89.221 Pressure ulcer of left hip, stage 1

L89.222 Pressure ulcer of left hip, stage 2

L89.223 Pressure ulcer of left hip, stage 3

L89.224 Pressure ulcer of left hip, stage 4

L89.229 Pressure ulcer of left hip, unspecified stage

L89.300 Pressure ulcer of unspecified buttock, unstageable

L89.301 Pressure ulcer of unspecified buttock, stage 1

L89.302 Pressure ulcer of unspecified buttock, stage 2

L89.303 Pressure ulcer of unspecified buttock, stage 3

L89.304 Pressure ulcer of unspecified buttock, stage 4

L89.309 Pressure ulcer of unspecified buttock, unspecified stage

ICD-10-CM - Code and Description

L89.310 Pressure ulcer of right buttock, unstageable

L89.311 Pressure ulcer of right buttock, stage 1

L89.312 Pressure ulcer of right buttock, stage 2

L89.313 Pressure ulcer of right buttock, stage 3

L89.314 Pressure ulcer of right buttock, stage 4

L89.319 Pressure ulcer of right buttock, unspecified stage

L89.320 Pressure ulcer of left buttock, unstageable

L89.321 Pressure ulcer of left buttock, stage 1

L89.322 Pressure ulcer of left buttock, stage 2

L89.323 Pressure ulcer of left buttock, stage 3

L89.324 Pressure ulcer of left buttock, stage 4

L89.329 Pressure ulcer of left buttock, unspecified stage

L89.40 Pressure ulcer of contiguous site of back, buttock and hip, unspecified stage

L89.41 Pressure ulcer of contiguous site of back, buttock and hip, stage 1

L89.42 Pressure ulcer of contiguous site of back, buttock and hip, stage 2

L89.43 Pressure ulcer of contiguous site of back, buttock and hip, stage 3

L89.44 Pressure ulcer of contiguous site of back, buttock and hip, stage 4

L89.45 Pressure ulcer of contiguous site of back, buttock and hip, unstageable

L89.500 Pressure ulcer of unspecified ankle, unstageable

L89.501 Pressure ulcer of unspecified ankle, stage 1

L89.502 Pressure ulcer of unspecified ankle, stage 2

L89.503 Pressure ulcer of unspecified ankle, stage 3

L89.504 Pressure ulcer of unspecified ankle, stage 4

L89.509 Pressure ulcer of unspecified ankle, unspecified stage

L89.510 Pressure ulcer of right ankle, unstageable

L89.511 Pressure ulcer of right ankle, stage 1

L89.512 Pressure ulcer of right ankle, stage 2

L89.513 Pressure ulcer of right ankle, stage 3

L89.514 Pressure ulcer of right ankle, stage 4

L89.519 Pressure ulcer of right ankle, unspecified stage

L89.520 Pressure ulcer of left ankle, unstageable

L89.521 Pressure ulcer of left ankle, stage 1

L89.522 Pressure ulcer of left ankle, stage 2

L89.523 Pressure ulcer of left ankle, stage 3

ICD-10-CM - Code and Description

L89.524 Pressure ulcer of left ankle, stage 4

L89.529 Pressure ulcer of left ankle, unspecified stage

L89.600 Pressure ulcer of unspecified heel, unstageable

L89.601 Pressure ulcer of unspecified heel, stage 1

L89.602 Pressure ulcer of unspecified heel, stage 2

L89.603 Pressure ulcer of unspecified heel, stage 3

L89.604 Pressure ulcer of unspecified heel, stage 4

L89.609 Pressure ulcer of unspecified heel, unspecified stage

L89.610 Pressure ulcer of right heel, unstageable

L89.611 Pressure ulcer of right heel, stage 1

L89.612 Pressure ulcer of right heel, stage 2

L89.613 Pressure ulcer of right heel, stage 3

L89.614 Pressure ulcer of right heel, stage 4

L89.619 Pressure ulcer of right heel, unspecified stage

L89.620 Pressure ulcer of left heel, unstageable

L89.621 Pressure ulcer of left heel, stage 1

L89.622 Pressure ulcer of left heel, stage 2

L89.623 Pressure ulcer of left heel, stage 3

L89.624 Pressure ulcer of left heel, stage 4

L89.629 Pressure ulcer of left heel, unspecified stage

L89.810 Pressure ulcer of head, unstageable

L89.811 Pressure ulcer of head, stage 1

L89.812 Pressure ulcer of head, stage 2

L89.813 Pressure ulcer of head, stage 3

L89.814 Pressure ulcer of head, stage 4

L89.819 Pressure ulcer of head, unspecified stage

L89.890 Pressure ulcer of other site, unstageable

L89.891 Pressure ulcer of other site, stage 1

L89.892 Pressure ulcer of other site, stage 2

L89.893 Pressure ulcer of other site, stage 3

L89.894 Pressure ulcer of other site, stage 4

L89.899 Pressure ulcer of other site, unspecified stage

L89.90 Pressure ulcer of unspecified site, unspecified stage

L89.91 Pressure ulcer of unspecified site, stage 1

ICD-10-CM - Code and Description

L89.92 Pressure ulcer of unspecified site, stage 2

L89.93 Pressure ulcer of unspecified site, stage 3

L89.94 Pressure ulcer of unspecified site, stage 4

L89.95 Pressure ulcer of unspecified site, unstageable

L97.101 Non-pressure chronic ulcer of unspecified thigh limited to breakdown of skin

L97.102 Non-pressure chronic ulcer of unspecified thigh with fat layer exposed

L97.103 Non-pressure chronic ulcer of unspecified thigh with necrosis of muscle

L97.104 Non-pressure chronic ulcer of unspecified thigh with necrosis of bone

L97.109 Non-pressure chronic ulcer of unspecified thigh with unspecified severity

L97.111 Non-pressure chronic ulcer of right thigh limited to breakdown of skin

L97.112 Non-pressure chronic ulcer of right thigh with fat layer exposed

L97.113 Non-pressure chronic ulcer of right thigh with necrosis of muscle

L97.114 Non-pressure chronic ulcer of right thigh with necrosis of bone

L97.119 Non-pressure chronic ulcer of right thigh with unspecified severity

L97.121 Non-pressure chronic ulcer of left thigh limited to breakdown of skin

L97.122 Non-pressure chronic ulcer of left thigh with fat layer exposed

L97.123 Non-pressure chronic ulcer of left thigh with necrosis of muscle

L97.124 Non-pressure chronic ulcer of left thigh with necrosis of bone

L97.129 Non-pressure chronic ulcer of left thigh with unspecified severity

L97.201 Non-pressure chronic ulcer of unspecified calf limited to breakdown of skin

L97.202 Non-pressure chronic ulcer of unspecified calf with fat layer exposed

L97.203 Non-pressure chronic ulcer of unspecified calf with necrosis of muscle

L97.204 Non-pressure chronic ulcer of unspecified calf with necrosis of bone

L97.209 Non-pressure chronic ulcer of unspecified calf with unspecified severity

L97.211 Non-pressure chronic ulcer of right calf limited to breakdown of skin

L97.212 Non-pressure chronic ulcer of right calf with fat layer exposed

L97.213 Non-pressure chronic ulcer of right calf with necrosis of muscle

L97.214 Non-pressure chronic ulcer of right calf with necrosis of bone

L97.219 Non-pressure chronic ulcer of right calf with unspecified severity

L97.221 Non-pressure chronic ulcer of left calf limited to breakdown of skin

L97.222 Non-pressure chronic ulcer of left calf with fat layer exposed

L97.223 Non-pressure chronic ulcer of left calf with necrosis of muscle

L97.224 Non-pressure chronic ulcer of left calf with necrosis of bone

L97.229 Non-pressure chronic ulcer of left calf with unspecified severity

ICD-10-CM - Code and Description

L97.301 Non-pressure chronic ulcer of unspecified ankle limited to breakdown of skin

L97.302 Non-pressure chronic ulcer of unspecified ankle with fat layer exposed

L97.303 Non-pressure chronic ulcer of unspecified ankle with necrosis of muscle

L97.304 Non-pressure chronic ulcer of unspecified ankle with necrosis of bone

L97.309 Non-pressure chronic ulcer of unspecified ankle with unspecified severity

L97.311 Non-pressure chronic ulcer of right ankle limited to breakdown of skin

L97.312 Non-pressure chronic ulcer of right ankle with fat layer exposed

L97.313 Non-pressure chronic ulcer of right ankle with necrosis of muscle

L97.314 Non-pressure chronic ulcer of right ankle with necrosis of bone

L97.319 Non-pressure chronic ulcer of right ankle with unspecified severity

L97.321 Non-pressure chronic ulcer of left ankle limited to breakdown of skin

L97.322 Non-pressure chronic ulcer of left ankle with fat layer exposed

L97.323 Non-pressure chronic ulcer of left ankle with necrosis of muscle

L97.324 Non-pressure chronic ulcer of left ankle with necrosis of bone

L97.329 Non-pressure chronic ulcer of left ankle with unspecified severity

L97.401 Non-pressure chronic ulcer of unspecified heel and midfoot limited to

breakdown of skin

L97.402 Non-pressure chronic ulcer of unspecified heel and midfoot with fat layer

exposed

L97.403 Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of

muscle

L97.404 Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of

bone

L97.409 Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified

severity

L97.411 Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of

skin

L97.412 Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed

L97.413 Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle

L97.414 Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone

L97.419 Non-pressure chronic ulcer of right heel and midfoot with unspecified severity

L97.421 Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of

skin

L97.422 Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed

L97.423 Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle

L97.424 Non-pressure chronic ulcer of left heel and midfoot with necrosis of bone

ICD-10-CM - Code and Description

L97.429 Non-pressure chronic ulcer of left heel and midfoot with unspecified severity

L97.501 Non-pressure chronic ulcer of other part of unspecified foot limited to

breakdown of skin

L97.502 Non-pressure chronic ulcer of other part of unspecified foot with fat layer

exposed

L97.503 Non-pressure chronic ulcer of other part of unspecified foot with necrosis of

muscle

L97.504 Non-pressure chronic ulcer of other part of unspecified foot with necrosis of

bone

L97.509 Non-pressure chronic ulcer of other part of unspecified foot with unspecified

severity

L97.511 Non-pressure chronic ulcer of other part of right foot limited to breakdown of

skin

L97.512 Non-pressure chronic ulcer of other part of right foot with fat layer exposed

L97.513 Non-pressure chronic ulcer of other part of right foot with necrosis of muscle

L97.514 Non-pressure chronic ulcer of other part of right foot with necrosis of bone

L97.519 Non-pressure chronic ulcer of other part of right foot with unspecified severity

L97.521 Non-pressure chronic ulcer of other part of left foot limited to breakdown of

skin

L97.522 Non-pressure chronic ulcer of other part of left foot with fat layer exposed

L97.523 Non-pressure chronic ulcer of other part of left foot with necrosis of muscle

L97.524 Non-pressure chronic ulcer of other part of left foot with necrosis of bone

L97.529 Non-pressure chronic ulcer of other part of left foot with unspecified severity

L97.801 Non-pressure chronic ulcer of other part of unspecified lower leg limited to

breakdown of skin

L97.802 Non-pressure chronic ulcer of other part of unspecified lower leg with fat layer

exposed

L97.803 Non-pressure chronic ulcer of other part of unspecified lower leg with necrosis

of muscle

L97.804 Non-pressure chronic ulcer of other part of unspecified lower leg with necrosis

of bone

L97.809 Non-pressure chronic ulcer of other part of unspecified lower leg with

unspecified severity

L97.811 Non-pressure chronic ulcer of other part of right lower leg limited to

breakdown of skin

L97.812 Non-pressure chronic ulcer of other part of right lower leg with fat layer

exposed

ICD-10-CM - Code and Description

L97.813 Non-pressure chronic ulcer of other part of right lower leg with necrosis of

muscle

L97.814 Non-pressure chronic ulcer of other part of right lower leg with necrosis of

bone

L97.819 Non-pressure chronic ulcer of other part of right lower leg with unspecified

severity

L97.821 Non-pressure chronic ulcer of other part of left lower leg limited to breakdown

of skin

L97.822 Non-pressure chronic ulcer of other part of left lower leg with fat layer exposed

L97.823 Non-pressure chronic ulcer of other part of left lower leg with necrosis of

muscle

L97.824 Non-pressure chronic ulcer of other part of left lower leg with necrosis of bone

L97.829 Non-pressure chronic ulcer of other part of left lower leg with unspecified

severity

L97.901 Non-pressure chronic ulcer of unspecified part of unspecified lower leg limited

to breakdown of skin

L97.902 Non-pressure chronic ulcer of unspecified part of unspecified lower leg with fat

layer exposed

L97.903 Non-pressure chronic ulcer of unspecified part of unspecified lower leg with

necrosis of muscle

L97.904 Non-pressure chronic ulcer of unspecified part of unspecified lower leg with

necrosis of bone

L97.909 Non-pressure chronic ulcer of unspecified part of unspecified lower leg with

unspecified severity

L97.911 Non-pressure chronic ulcer of unspecified part of right lower leg limited to

breakdown of skin

L97.912 Non-pressure chronic ulcer of unspecified part of right lower leg with fat layer

exposed

L97.913 Non-pressure chronic ulcer of unspecified part of right lower leg with necrosis

of muscle

L97.914 Non-pressure chronic ulcer of unspecified part of right lower leg with necrosis

of bone

L97.919 Non-pressure chronic ulcer of unspecified part of right lower leg with

unspecified severity

L97.921 Non-pressure chronic ulcer of unspecified part of left lower leg limited to

breakdown of skin

L97.922 Non-pressure chronic ulcer of unspecified part of left lower leg with fat layer

exposed

ICD-10-CM - Code and Description

L97.923 Non-pressure chronic ulcer of unspecified part of left lower leg with necrosis of

muscle

L97.924 Non-pressure chronic ulcer of unspecified part of left lower leg with necrosis of

bone

L97.929 Non-pressure chronic ulcer of unspecified part of left lower leg with

unspecified severity

M05.50 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site

M05.511 Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder

M05.512 Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder

M05.519 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified shoulder

M05.521 Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow

M05.522 Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow

M05.529 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified elbow

M05.531 Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist

M05.532 Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist

M05.539 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified wrist

M05.541 Rheumatoid polyneuropathy with rheumatoid arthritis of right hand

M05.542 Rheumatoid polyneuropathy with rheumatoid arthritis of left hand

M05.549 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hand

M05.551 Rheumatoid polyneuropathy with rheumatoid arthritis of right hip

M05.552 Rheumatoid polyneuropathy with rheumatoid arthritis of left hip

M05.559 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hip

M05.561 Rheumatoid polyneuropathy with rheumatoid arthritis of right knee

M05.562 Rheumatoid polyneuropathy with rheumatoid arthritis of left knee

M05.569 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee

M05.571 Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot

M05.572 Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot

M05.579 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified ankle and

foot

M05.59 Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites

M34.83 Systemic sclerosis with polyneuropathy

O90.0 Disruption of cesarean delivery wound

O90.1 Disruption of perineal obstetric wound

S01.00XA Unspecified open wound of scalp, initial encounter

S01.01XA Laceration without foreign body of scalp, initial encounter

ICD-10-CM - Code and Description

S01.02XA Laceration with foreign body of scalp, initial encounter

S01.03XA Puncture wound without foreign body of scalp, initial encounter

S01.04XA Puncture wound with foreign body of scalp, initial encounter

S01.05XA Open bite of scalp, initial encounter

S01.101A Unspecified open wound of right eyelid and periocular area, initial encounter

S01.102A Unspecified open wound of left eyelid and periocular area, initial encounter

S01.109A Unspecified open wound of unspecified eyelid and periocular area, initial

encounter

S01.111A Laceration without foreign body of right eyelid and periocular area, initial

encounter

S01.112A Laceration without foreign body of left eyelid and periocular area, initial

encounter

S01.119A Laceration without foreign body of unspecified eyelid and periocular area,

initial encounter

S01.119A Laceration without foreign body of unspecified eyelid and periocular area,

initial encounter

S01.121A Laceration with foreign body of right eyelid and periocular area, initial

encounter

S01.122A Laceration with foreign body of left eyelid and periocular area, initial

encounter

S01.129A Laceration with foreign body of unspecified eyelid and periocular area, initial

encounter

S01.129A Laceration with foreign body of unspecified eyelid and periocular area, initial

encounter

S01.131A Puncture wound without foreign body of right eyelid and periocular area,

initial encounter

S01.132A Puncture wound without foreign body of left eyelid and periocular area, initial

encounter

S01.139A Puncture wound without foreign body of unspecified eyelid and periocular

area, initial encounter

S01.141A Puncture wound with foreign body of right eyelid and periocular area, initial

encounter

S01.142A Puncture wound with foreign body of left eyelid and periocular area, initial

encounter

S01.149A Puncture wound with foreign body of unspecified eyelid and periocular area,

initial encounter

S01.151A Open bite of right eyelid and periocular area, initial encounter

S01.152A Open bite of left eyelid and periocular area, initial encounter

ICD-10-CM - Code and Description

S01.159A Open bite of unspecified eyelid and periocular area, initial encounter

S01.20XA Unspecified open wound of nose, initial encounter

S01.21XA Laceration without foreign body of nose, initial encounter

S01.22XA Laceration with foreign body of nose, initial encounter

S01.23XA Puncture wound without foreign body of nose, initial encounter

S01.24XA Puncture wound with foreign body of nose, initial encounter

S01.25XA Open bite of nose, initial encounter

S01.301A Unspecified open wound of right ear, initial encounter

S01.302A Unspecified open wound of left ear, initial encounter

S01.309A Unspecified open wound of unspecified ear, initial encounter

S01.311A Laceration without foreign body of right ear, initial encounter

S01.312A Laceration without foreign body of left ear, initial encounter

S01.319A Laceration without foreign body of unspecified ear, initial encounter

S01.321A Laceration with foreign body of right ear, initial encounter

S01.322A Laceration with foreign body of left ear, initial encounter

S01.329A Laceration with foreign body of unspecified ear, initial encounter

S01.331A Puncture wound without foreign body of right ear, initial encounter

S01.332A Puncture wound without foreign body of left ear, initial encounter

S01.339A Puncture wound without foreign body of unspecified ear, initial encounter

S01.341A Puncture wound with foreign body of right ear, initial encounter

S01.342A Puncture wound with foreign body of left ear, initial encounter

S01.349A Puncture wound with foreign body of unspecified ear, initial encounter

S01.351A Open bite of right ear, initial encounter

S01.352A Open bite of left ear, initial encounter

S01.359A Open bite of unspecified ear, initial encounter

S01.401A Unspecified open wound of right cheek and temporomandibular area, initial

encounter

S01.402A Unspecified open wound of left cheek and temporomandibular area, initial

encounter

S01.409A Unspecified open wound of unspecified cheek and temporomandibular area,

initial encounter

S01.411A Laceration without foreign body of right cheek and temporomandibular area,

initial encounter

S01.412A Laceration without foreign body of left cheek and temporomandibular area,

initial encounter

ICD-10-CM - Code and Description

S01.419A Laceration without foreign body of unspecified cheek and temporomandibular

area, initial encounter

S01.421A Laceration with foreign body of right cheek and temporomandibular area,

initial encounter

S01.422A Laceration with foreign body of left cheek and temporomandibular area,

initial encounter

S01.429A Laceration with foreign body of unspecified cheek and temporomandibular

area, initial encounter

S01.431A Puncture wound without foreign body of right cheek and temporomandibular

area, initial encounter

S01.432A Puncture wound without foreign body of left cheek and temporomandibular

area, initial encounter

S01.439A Puncture wound without foreign body of unspecified cheek and

temporomandibular area, initial encounter

S01.441A Puncture wound with foreign body of right cheek and temporomandibular

area, initial encounter

S01.442A Puncture wound with foreign body of left cheek and temporomandibular area,

initial encounter

S01.449A Puncture wound with foreign body of unspecified cheek and

temporomandibular area, initial encounter

S01.451A Open bite of right cheek and temporomandibular area, initial encounter

S01.452A Open bite of left cheek and temporomandibular area, initial encounter

S01.459A Open bite of unspecified cheek and temporomandibular area, initial encounter

S01.501A Unspecified open wound of lip, initial encounter

S01.502A Unspecified open wound of oral cavity, initial encounter

S01.511A Laceration without foreign body of lip, initial encounter

S01.512A Laceration without foreign body of oral cavity, initial encounter

S01.521A Laceration with foreign body of lip, initial encounter

S01.522A Laceration with foreign body of oral cavity, initial encounter

S01.531A Puncture wound without foreign body of lip, initial encounter

S01.532A Puncture wound without foreign body of oral cavity, initial encounter

S01.541A Puncture wound with foreign body of lip, initial encounter

S01.542A Puncture wound with foreign body of oral cavity, initial encounter

S01.551A Open bite of lip, initial encounter

S01.552A Open bite of oral cavity, initial encounter

S01.80XA Unspecified open wound of other part of head, initial encounter

S01.81XA Laceration without foreign body of other part of head, initial encounter

ICD-10-CM - Code and Description

S01.82XA Laceration with foreign body of other part of head, initial encounter

S01.83XA Puncture wound without foreign body of other part of head, initial encounter

S01.84XA Puncture wound with foreign body of other part of head, initial encounter

S01.85XA Open bite of other part of head, initial encounter

S01.90XA Unspecified open wound of unspecified part of head, initial encounter

S01.91XA Laceration without foreign body of unspecified part of head, initial encounter

S01.92XA Laceration with foreign body of unspecified part of head, initial encounter

S01.93XA Puncture wound without foreign body of unspecified part of head, initial

encounter

S01.94XA Puncture wound with foreign body of unspecified part of head, initial

encounter

S01.95XA Open bite of unspecified part of head, initial encounter

S02.5XXA Fracture of tooth (traumatic), initial encounter for closed fracture

S02.5XXB Fracture of tooth (traumatic), initial encounter for open fracture

S03.2XXA Dislocation of tooth, initial encounter

S05.20XA Ocular laceration and rupture with prolapse or loss of intraocular tissue,

unspecified eye, initial encounter

S05.21XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, right

eye, initial encounter

S05.22XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, left

eye, initial encounter

S05.30XA Ocular laceration without prolapse or loss of intraocular tissue, unspecified

eye, initial encounter

S05.31XA Ocular laceration without prolapse or loss of intraocular tissue, right eye,

initial encounter

S05.32XA Ocular laceration without prolapse or loss of intraocular tissue, left eye,

initial encounter

S05.40XA Penetrating wound of orbit with or without foreign body, unspecified eye,

initial encounter

S05.41XA Penetrating wound of orbit with or without foreign body, right eye, initial

encounter

S05.42XA Penetrating wound of orbit with or without foreign body, left eye, initial

encounter

S05.50XA Penetrating wound with foreign body of unspecified eyeball, initial encounter

S05.51XA Penetrating wound with foreign body of right eyeball, initial encounter

S05.52XA Penetrating wound with foreign body of left eyeball, initial encounter

ICD-10-CM - Code and Description

S05.60XA Penetrating wound without foreign body of unspecified eyeball, initial

encounter

S05.61XA Penetrating wound without foreign body of right eyeball, initial encounter

S05.62XA Penetrating wound without foreign body of left eyeball, initial encounter

S05.70XA Avulsion of unspecified eye, initial encounter

S05.71XA Avulsion of right eye, initial encounter

S05.72XA Avulsion of left eye, initial encounter

S05.8X1A Other injuries of right eye and orbit, initial encounter

S05.8X2A Other injuries of left eye and orbit, initial encounter

S05.8X9A Other injuries of unspecified eye and orbit, initial encounter

S05.90XA Unspecified injury of unspecified eye and orbit, initial encounter

S05.91XA Unspecified injury of right eye and orbit, initial encounter

S05.92XA Unspecified injury of left eye and orbit, initial encounter

S08.0XXA Avulsion of scalp, initial encounter

S08.111A Complete traumatic amputation of right ear, initial encounter

S08.112A Complete traumatic amputation of left ear, initial encounter

S08.119A Complete traumatic amputation of unspecified ear, initial encounter

S08.121A Partial traumatic amputation of right ear, initial encounter

S08.122A Partial traumatic amputation of left ear, initial encounter

S08.129A Partial traumatic amputation of unspecified ear, initial encounter

S08.811A Complete traumatic amputation of nose, initial encounter

S08.812A Partial traumatic amputation of nose, initial encounter

S08.89XA Traumatic amputation of other parts of head, initial encounter

S09.12XA Laceration of muscle and tendon of head, initial encounter

S09.20XA Traumatic rupture of unspecified ear drum, initial encounter

S09.21XA Traumatic rupture of right ear drum, initial encounter

S09.22XA Traumatic rupture of left ear drum, initial encounter

S09.301A Unspecified injury of right middle and inner ear, initial encounter

S09.302A Unspecified injury of left middle and inner ear, initial encounter

S09.309A Unspecified injury of unspecified middle and inner ear, initial encounter

S09.311A Primary blast injury of right ear, initial encounter

S09.312A Primary blast injury of left ear, initial encounter

S09.313A Primary blast injury of ear, bilateral, initial encounter

S09.319A Primary blast injury of unspecified ear, initial encounter

S09.391A Other specified injury of right middle and inner ear, initial encounter

ICD-10-CM - Code and Description

S09.392A Other specified injury of left middle and inner ear, initial encounter

S09.399A Other specified injury of unspecified middle and inner ear, initial encounter

S09.8XXA Other specified injuries of head, initial encounter

S09.90XA Unspecified injury of head, initial encounter

S09.91XA Unspecified injury of ear, initial encounter

S09.93XA Unspecified injury of face, initial encounter

S11.011A Laceration without foreign body of larynx, initial encounter

S11.012A Laceration with foreign body of larynx, initial encounter

S11.013A Puncture wound without foreign body of larynx, initial encounter

S11.014A Puncture wound with foreign body of larynx, initial encounter

S11.015A Open bite of larynx, initial encounter

S11.019A Unspecified open wound of larynx, initial encounter

S11.021A Laceration without foreign body of trachea, initial encounter

S11.022A Laceration with foreign body of trachea, initial encounter

S11.023A Puncture wound without foreign body of trachea, initial encounter

S11.024A Puncture wound with foreign body of trachea, initial encounter

S11.025A Open bite of trachea, initial encounter

S11.029A Unspecified open wound of trachea, initial encounter

S11.031A Laceration without foreign body of vocal cord, initial encounter

S11.032A Laceration with foreign body of vocal cord, initial encounter

S11.033A Puncture wound without foreign body of vocal cord, initial encounter

S11.034A Puncture wound with foreign body of vocal cord, initial encounter

S11.035A Open bite of vocal cord, initial encounter

S11.039A Unspecified open wound of vocal cord, initial encounter

S11.10XA Unspecified open wound of thyroid gland, initial encounter

S11.11XA Laceration without foreign body of thyroid gland, initial encounter

S11.12XA Laceration with foreign body of thyroid gland, initial encounter

S11.13XA Puncture wound without foreign body of thyroid gland, initial encounter

S11.14XA Puncture wound with foreign body of thyroid gland, initial encounter

S11.15XA Open bite of thyroid gland, initial encounter

S11.20XA Unspecified open wound of pharynx and cervical esophagus, initial encounter

S11.21XA Laceration without foreign body of pharynx and cervical esophagus, initial

encounter

S11.22XA Laceration with foreign body of pharynx and cervical esophagus, initial

encounter

ICD-10-CM - Code and Description

S11.23XA Puncture wound without foreign body of pharynx and cervical esophagus,

initial encounter

S11.24XA Puncture wound with foreign body of pharynx and cervical esophagus, initial

encounter

S11.25XA Open bite of pharynx and cervical esophagus, initial encounter

S11.80XA Unspecified open wound of other specified part of neck, initial encounter

S11.81XA Laceration without foreign body of other specified part of neck, initial

encounter

S11.82XA Laceration with foreign body of other specified part of neck, initial encounter

S11.83XA Puncture wound without foreign body of other specified part of neck, initial

encounter

S11.84XA Puncture wound with foreign body of other specified part of neck, initial

encounter

S11.85XA Open bite of other specified part of neck, initial encounter

S11.89XA Other open wound of other specified part of neck, initial encounter

S11.90XA Unspecified open wound of unspecified part of neck, initial encounter

S11.91XA Laceration without foreign body of unspecified part of neck, initial encounter

S11.92XA Laceration with foreign body of unspecified part of neck, initial encounter

S11.93XA Puncture wound without foreign body of unspecified part of neck, initial

encounter

S11.94XA Puncture wound with foreign body of unspecified part of neck, initial

encounter

S11.95XA Open bite of unspecified part of neck, initial encounter

S16.2XXA Laceration of muscle, fascia and tendon at neck level, initial encounter

S21.001A Unspecified open wound of right breast, initial encounter

S21.002A Unspecified open wound of left breast, initial encounter

S21.009A Unspecified open wound of unspecified breast, initial encounter

S21.011A Laceration without foreign body of right breast, initial encounter

S21.012A Laceration without foreign body of left breast, initial encounter

S21.019A Laceration without foreign body of unspecified breast, initial encounter

S21.021A Laceration with foreign body of right breast, initial encounter

S21.022A Laceration with foreign body of left breast, initial encounter

S21.029A Laceration with foreign body of unspecified breast, initial encounter

S21.031A Puncture wound without foreign body of right breast, initial encounter

S21.032A Puncture wound without foreign body of left breast, initial encounter

S21.039A Puncture wound without foreign body of unspecified breast, initial encounter

ICD-10-CM - Code and Description

S21.041A Puncture wound with foreign body of right breast, initial encounter

S21.042A Puncture wound with foreign body of left breast, initial encounter

S21.049A Puncture wound with foreign body of unspecified breast, initial encounter

S21.051A Open bite of right breast, initial encounter

S21.052A Open bite of left breast, initial encounter

S21.059A Open bite of unspecified breast, initial encounter

S21.101A Unspecified open wound of right front wall of thorax without penetration into

thoracic cavity, initial encounter

S21.102A Unspecified open wound of left front wall of thorax without penetration into

thoracic cavity, initial encounter

S21.109A Unspecified open wound of unspecified front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.111A Laceration without foreign body of right front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.112A Laceration without foreign body of left front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.119A Laceration without foreign body of unspecified front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.121A Laceration with foreign body of right front wall of thorax without penetration

into thoracic cavity, initial encounter

S21.122A Laceration with foreign body of left front wall of thorax without penetration

into thoracic cavity, initial encounter

S21.129A Laceration with foreign body of unspecified front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.131A Puncture wound without foreign body of right front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.132A Puncture wound without foreign body of left front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.139A Puncture wound without foreign body of unspecified front wall of thorax

without penetration into thoracic cavity, initial encounter

S21.141A Puncture wound with foreign body of right front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.142A Puncture wound with foreign body of left front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.149A Puncture wound with foreign body of unspecified front wall of thorax without

penetration into thoracic cavity, initial encounter

S21.151A Open bite of right front wall of thorax without penetration into thoracic

cavity, initial encounter

ICD-10-CM - Code and Description

S21.152A Open bite of left front wall of thorax without penetration into thoracic cavity,

initial encounter

S21.159A Open bite of unspecified front wall of thorax without penetration into thoracic

cavity, initial encounter

S21.201A Unspecified open wound of right back wall of thorax without penetration into

thoracic cavity, initial encounter

S21.202A Unspecified open wound of left back wall of thorax without penetration into

thoracic cavity, initial encounter

S21.209A Unspecified open wound of unspecified back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.211A Laceration without foreign body of right back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.212A Laceration without foreign body of left back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.219A Laceration without foreign body of unspecified back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.221A Laceration with foreign body of right back wall of thorax without penetration

into thoracic cavity, initial encounter

S21.222A Laceration with foreign body of left back wall of thorax without penetration

into thoracic cavity, initial encounter

S21.229A Laceration with foreign body of unspecified back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.231A Puncture wound without foreign body of right back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.232A Puncture wound without foreign body of left back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.239A Puncture wound without foreign body of unspecified back wall of thorax

without penetration into thoracic cavity, initial encounter

S21.241A Puncture wound with foreign body of right back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.242A Puncture wound with foreign body of left back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.249A Puncture wound with foreign body of unspecified back wall of thorax without

penetration into thoracic cavity, initial encounter

S21.251A Open bite of right back wall of thorax without penetration into thoracic

cavity, initial encounter

S21.252A Open bite of left back wall of thorax without penetration into thoracic cavity,

initial encounter

ICD-10-CM - Code and Description

S21.259A Open bite of unspecified back wall of thorax without penetration into thoracic

cavity, initial encounter

S21.90XA Unspecified open wound of unspecified part of thorax, initial encounter

S21.91XA Laceration without foreign body of unspecified part of thorax, initial

encounter

S21.92XA Laceration with foreign body of unspecified part of thorax, initial encounter

S21.93XA Puncture wound without foreign body of unspecified part of thorax, initial

encounter

S21.94XA Puncture wound with foreign body of unspecified part of thorax, initial

encounter

S21.95XA Open bite of unspecified part of thorax, initial encounter

S28.1XXA Traumatic amputation (partial) of part of thorax, except breast, initial

encounter

S28.211A Complete traumatic amputation of right breast, initial encounter

S28.212A Complete traumatic amputation of left breast, initial encounter

S28.219A Complete traumatic amputation of unspecified breast, initial encounter

S28.221A Partial traumatic amputation of right breast, initial encounter

S28.222A Partial traumatic amputation of left breast, initial encounter

S28.229A Partial traumatic amputation of unspecified breast, initial encounter

S29.021A Laceration of muscle and tendon of front wall of thorax, initial encounter

S29.022A Laceration of muscle and tendon of back wall of thorax, initial encounter

S29.029A Laceration of muscle and tendon of unspecified wall of thorax, initial

encounter

S31.000A Unspecified open wound of lower back and pelvis without penetration into

retroperitoneum, initial encounter

S31.010A Laceration without foreign body of lower back and pelvis without penetration

into retroperitoneum, initial encounter

S31.020A Laceration with foreign body of lower back and pelvis without penetration

into retroperitoneum, initial encounter

S31.030A Puncture wound without foreign body of lower back and pelvis without

penetration into retroperitoneum, initial encounter

S31.040A Puncture wound with foreign body of lower back and pelvis without

penetration into retroperitoneum, initial encounter

S31.050A Open bite of lower back and pelvis without penetration into retroperitoneum,

initial encounter

S31.100A Unspecified open wound of abdominal wall, right upper quadrant without

penetration into peritoneal cavity, initial encounter

ICD-10-CM - Code and Description

S31.101A Unspecified open wound of abdominal wall, left upper quadrant without

penetration into peritoneal cavity, initial encounter

S31.102A Unspecified open wound of abdominal wall, epigastric region without

penetration into peritoneal cavity, initial encounter

S31.103A Unspecified open wound of abdominal wall, right lower quadrant without

penetration into peritoneal cavity, initial encounter

S31.104A Unspecified open wound of abdominal wall, left lower quadrant without

penetration into peritoneal cavity, initial encounter

S31.105A Unspecified open wound of abdominal wall, periumbilic region without

penetration into peritoneal cavity, initial encounter

S31.109A Unspecified open wound of abdominal wall, unspecified quadrant without

penetration into peritoneal cavity, initial encounter

S31.110A Laceration without foreign body of abdominal wall, right upper quadrant

without penetration into peritoneal cavity, initial encounter

S31.111A Laceration without foreign body of abdominal wall, left upper quadrant

without penetration into peritoneal cavity, initial encounter

S31.112A Laceration without foreign body of abdominal wall, epigastric region without

penetration into peritoneal cavity, initial encounter

S31.113A Laceration without foreign body of abdominal wall, right lower quadrant

without penetration into peritoneal cavity, initial encounter

S31.114A Laceration without foreign body of abdominal wall, left lower quadrant

without penetration into peritoneal cavity, initial encounter

S31.115A Laceration without foreign body of abdominal wall, periumbilic region

without penetration into peritoneal cavity, initial encounter

S31.119A Laceration without foreign body of abdominal wall, unspecified quadrant

without penetration into peritoneal cavity, initial encounter

S31.120A Laceration of abdominal wall with foreign body, right upper quadrant without

penetration into peritoneal cavity, initial encounter

S31.121A Laceration of abdominal wall with foreign body, left upper quadrant without

penetration into peritoneal cavity, initial encounter

S31.122A Laceration of abdominal wall with foreign body, epigastric region without

penetration into peritoneal cavity, initial encounter

S31.123A Laceration of abdominal wall with foreign body, right lower quadrant without

penetration into peritoneal cavity, initial encounter

S31.124A Laceration of abdominal wall with foreign body, left lower quadrant without

penetration into peritoneal cavity, initial encounter

S31.125A Laceration of abdominal wall with foreign body, periumbilic region without

penetration into peritoneal cavity, initial encounter

ICD-10-CM - Code and Description

S31.129A Laceration of abdominal wall with foreign body, unspecified quadrant without

penetration into peritoneal cavity, initial encounter

S31.130A Puncture wound of abdominal wall without foreign body, right upper

quadrant without penetration into peritoneal cavity, initial encounter

S31.131A Puncture wound of abdominal wall without foreign body, left upper quadrant

without penetration into peritoneal cavity, initial encounter

S31.132A Puncture wound of abdominal wall without foreign body, epigastric region

without penetration into peritoneal cavity, initial encounter

S31.133A Puncture wound of abdominal wall without foreign body, right lower

quadrant without penetration into peritoneal cavity, initial encounter

S31.134A Puncture wound of abdominal wall without foreign body, left lower quadrant

without penetration into peritoneal cavity, initial encounter

S31.135A Puncture wound of abdominal wall without foreign body, periumbilic region

without penetration into peritoneal cavity, initial encounter

S31.139A Puncture wound of abdominal wall without foreign body, unspecified

quadrant without penetration into peritoneal cavity, initial encounter

S31.140A Puncture wound of abdominal wall with foreign body, right upper quadrant

without penetration into peritoneal cavity, initial encounter

S31.141A Puncture wound of abdominal wall with foreign body, left upper quadrant

without penetration into peritoneal cavity, initial encounter

S31.142A Puncture wound of abdominal wall with foreign body, epigastric region

without penetration into peritoneal cavity, initial encounter

S31.143A Puncture wound of abdominal wall with foreign body, right lower quadrant

without penetration into peritoneal cavity, initial encounter

S31.144A Puncture wound of abdominal wall with foreign body, left lower quadrant

without penetration into peritoneal cavity, initial encounter

S31.145A Puncture wound of abdominal wall with foreign body, periumbilic region

without penetration into peritoneal cavity, initial encounter

S31.149A Puncture wound of abdominal wall with foreign body, unspecified quadrant

without penetration into peritoneal cavity, initial encounter

S31.150A Open bite of abdominal wall, right upper quadrant without penetration into

peritoneal cavity, initial encounter

S31.151A Open bite of abdominal wall, left upper quadrant without penetration into

peritoneal cavity, initial encounter

S31.152A Open bite of abdominal wall, epigastric region without penetration into

peritoneal cavity, initial encounter

S31.153A Open bite of abdominal wall, right lower quadrant without penetration into

peritoneal cavity, initial encounter

ICD-10-CM - Code and Description

S31.154A Open bite of abdominal wall, left lower quadrant without penetration into

peritoneal cavity, initial encounter

S31.155A Open bite of abdominal wall, periumbilic region without penetration into

peritoneal cavity, initial encounter

S31.159A Open bite of abdominal wall, unspecified quadrant without penetration into

peritoneal cavity, initial encounter

S31.20XA Unspecified open wound of penis, initial encounter

S31.21XA Laceration without foreign body of penis, initial encounter

S31.22XA Laceration with foreign body of penis, initial encounter

S31.23XA Puncture wound without foreign body of penis, initial encounter

S31.24XA Puncture wound with foreign body of penis, initial encounter

S31.25XA Open bite of penis, initial encounter

S31.30XA Unspecified open wound of scrotum and testes, initial encounter

S31.31XA Laceration without foreign body of scrotum and testes, initial encounter

S31.32XA Laceration with foreign body of scrotum and testes, initial encounter

S31.33XA Puncture wound without foreign body of scrotum and testes, initial encounter

S31.34XA Puncture wound with foreign body of scrotum and testes, initial encounter

S31.35XA Open bite of scrotum and testes, initial encounter

S31.40XA Unspecified open wound of vagina and vulva, initial encounter

S31.41XA Laceration without foreign body of vagina and vulva, initial encounter

S31.42XA Laceration with foreign body of vagina and vulva, initial encounter

S31.43XA Puncture wound without foreign body of vagina and vulva, initial encounter

S31.44XA Puncture wound with foreign body of vagina and vulva, initial encounter

S31.45XA Open bite of vagina and vulva, initial encounter

S31.501A Unspecified open wound of unspecified external genital organs, male, initial

encounter

S31.502A Unspecified open wound of unspecified external genital organs, female, initial

encounter

S31.511A Laceration without foreign body of unspecified external genital organs, male,

initial encounter

S31.512A Laceration without foreign body of unspecified external genital organs,

female, initial encounter

S31.521A Laceration with foreign body of unspecified external genital organs, male,

initial encounter

S31.522A Laceration with foreign body of unspecified external genital organs, female,

initial encounter

ICD-10-CM - Code and Description

S31.531A Puncture wound without foreign body of unspecified external genital organs,

male, initial encounter

S31.532A Puncture wound without foreign body of unspecified external genital organs,

female, initial encounter

S31.541A Puncture wound with foreign body of unspecified external genital organs,

male, initial encounter

S31.542A Puncture wound with foreign body of unspecified external genital organs,

female, initial encounter

S31.551A Open bite of unspecified external genital organs, male, initial encounter

S31.552A Open bite of unspecified external genital organs, female, initial encounter

S31.801A Laceration without foreign body of unspecified buttock, initial encounter

S31.802A Laceration with foreign body of unspecified buttock, initial encounter

S31.803A Puncture wound without foreign body of unspecified buttock, initial

encounter

S31.804A Puncture wound with foreign body of unspecified buttock, initial encounter

S31.805A Open bite of unspecified buttock, initial encounter

S31.809A Unspecified open wound of unspecified buttock, initial encounter

S31.811A Laceration without foreign body of right buttock, initial encounter

S31.812A Laceration with foreign body of right buttock, initial encounter

S31.813A Puncture wound without foreign body of right buttock, initial encounter

S31.814A Puncture wound with foreign body of right buttock, initial encounter

S31.815A Open bite of right buttock, initial encounter

S31.819A Unspecified open wound of right buttock, initial encounter

S31.821A Laceration without foreign body of left buttock, initial encounter

S31.822A Laceration with foreign body of left buttock, initial encounter

S31.823A Puncture wound without foreign body of left buttock, initial encounter

S31.824A Puncture wound with foreign body of left buttock, initial encounter

S31.825A Open bite of left buttock, initial encounter

S31.829A Unspecified open wound of left buttock, initial encounter

S31.831A Laceration without foreign body of anus, initial encounter

S31.832A Laceration with foreign body of anus, initial encounter

S31.833A Puncture wound without foreign body of anus, initial encounter

S31.834A Puncture wound with foreign body of anus, initial encounter

S31.835A Open bite of anus, initial encounter

S31.839A Unspecified open wound of anus, initial encounter

ICD-10-CM - Code and Description

S38.211A Complete traumatic amputation of female external genital organs, initial

encounter

S38.212A Partial traumatic amputation of female external genital organs, initial

encounter

S38.221A Complete traumatic amputation of penis, initial encounter

S38.222A Partial traumatic amputation of penis, initial encounter

S38.231A Complete traumatic amputation of scrotum and testis, initial encounter

S38.232A Partial traumatic amputation of scrotum and testis, initial encounter

S38.3XXA Transection (partial) of abdomen, initial encounter

S39.021A Laceration of muscle, fascia and tendon of abdomen, initial encounter

S39.022A Laceration of muscle, fascia and tendon of lower back, initial encounter

S39.023A Laceration of muscle, fascia and tendon of pelvis, initial encounter

S41.001A Unspecified open wound of right shoulder, initial encounter

S41.002A Unspecified open wound of left shoulder, initial encounter

S41.009A Unspecified open wound of unspecified shoulder, initial encounter

S41.011A Laceration without foreign body of right shoulder, initial encounter

S41.012A Laceration without foreign body of left shoulder, initial encounter

S41.019A Laceration without foreign body of unspecified shoulder, initial encounter

S41.021A Laceration with foreign body of right shoulder, initial encounter

S41.022A Laceration with foreign body of left shoulder, initial encounter

S41.029A Laceration with foreign body of unspecified shoulder, initial encounter

S41.031A Puncture wound without foreign body of right shoulder, initial encounter

S41.032A Puncture wound without foreign body of left shoulder, initial encounter

S41.039A Puncture wound without foreign body of unspecified shoulder, initial

encounter

S41.041A Puncture wound with foreign body of right shoulder, initial encounter

S41.042A Puncture wound with foreign body of left shoulder, initial encounter

S41.049A Puncture wound with foreign body of unspecified shoulder, initial encounter

S41.051A Open bite of right shoulder, initial encounter

S41.052A Open bite of left shoulder, initial encounter

S41.059A Open bite of unspecified shoulder, initial encounter

S41.101A Unspecified open wound of right upper arm, initial encounter

S41.102A Unspecified open wound of left upper arm, initial encounter

S41.109A Unspecified open wound of unspecified upper arm, initial encounter

S41.111A Laceration without foreign body of right upper arm, initial encounter

ICD-10-CM - Code and Description

S41.112A Laceration without foreign body of left upper arm, initial encounter

S41.119A Laceration without foreign body of unspecified upper arm, initial encounter

S41.121A Laceration with foreign body of right upper arm, initial encounter

S41.122A Laceration with foreign body of left upper arm, initial encounter

S41.129A Laceration with foreign body of unspecified upper arm, initial encounter

S41.131A Puncture wound without foreign body of right upper arm, initial encounter

S41.132A Puncture wound without foreign body of left upper arm, initial encounter

S41.139A Puncture wound without foreign body of unspecified upper arm, initial

encounter

S41.141A Puncture wound with foreign body of right upper arm, initial encounter

S41.142A Puncture wound with foreign body of left upper arm, initial encounter

S41.149A Puncture wound with foreign body of unspecified upper arm, initial encounter

S41.151A Open bite of right upper arm, initial encounter

S41.152A Open bite of left upper arm, initial encounter

S41.159A Open bite of unspecified upper arm, initial encounter

S46.021A Laceration of muscle(s) and tendon(s) of the rotator cuff of right shoulder,

initial encounter

S46.022A Laceration of muscle(s) and tendon(s) of the rotator cuff of left shoulder,

initial encounter

S46.029A Laceration of muscle(s) and tendon(s) of the rotator cuff of unspecified

shoulder, initial encounter

S46.121A Laceration of muscle, fascia and tendon of long head of biceps, right arm,

initial encounter

S46.122A Laceration of muscle, fascia and tendon of long head of biceps, left arm,

initial encounter

S46.129A Laceration of muscle, fascia and tendon of long head of biceps, unspecified

arm, initial encounter

S46.221A Laceration of muscle, fascia and tendon of other parts of biceps, right arm,

initial encounter

S46.222A Laceration of muscle, fascia and tendon of other parts of biceps, left arm,

initial encounter

S46.229A Laceration of muscle, fascia and tendon of other parts of biceps, unspecified

arm, initial encounter

S46.321A Laceration of muscle, fascia and tendon of triceps, right arm, initial encounter

S46.322A Laceration of muscle, fascia and tendon of triceps, left arm, initial encounter

S46.329A Laceration of muscle, fascia and tendon of triceps, unspecified arm, initial

encounter

ICD-10-CM - Code and Description

S46.821A Laceration of other muscles, fascia and tendons at shoulder and upper arm

level, right arm, initial encounter

S46.822A Laceration of other muscles, fascia and tendons at shoulder and upper arm

level, left arm, initial encounter

S46.829A Laceration of other muscles, fascia and tendons at shoulder and upper arm

level, unspecified arm, initial encounter

S46.921A Laceration of unspecified muscle, fascia and tendon at shoulder and upper

arm level, right arm, initial encounter

S46.922A Laceration of unspecified muscle, fascia and tendon at shoulder and upper

arm level, left arm, initial encounter

S46.929A Laceration of unspecified muscle, fascia and tendon at shoulder and upper

arm level, unspecified arm, initial encounter

S48.011A Complete traumatic amputation at right shoulder joint, initial encounter

S48.012A Complete traumatic amputation at left shoulder joint, initial encounter

S48.019A Complete traumatic amputation at unspecified shoulder joint, initial encounter

S48.021A Partial traumatic amputation at right shoulder joint, initial encounter

S48.022A Partial traumatic amputation at left shoulder joint, initial encounter

S48.029A Partial traumatic amputation at unspecified shoulder joint, initial encounter

S48.111A Complete traumatic amputation at level between right shoulder and elbow,

initial encounter

S48.112A Complete traumatic amputation at level between left shoulder and elbow,

initial encounter

S48.119A Complete traumatic amputation at level between unspecified shoulder and

elbow, initial encounter

S48.121A Partial traumatic amputation at level between right shoulder and elbow, initial

encounter

S48.122A Partial traumatic amputation at level between left shoulder and elbow, initial

encounter

S48.129A Partial traumatic amputation at level between unspecified shoulder and elbow,

initial encounter

S48.911A Complete traumatic amputation of right shoulder and upper arm, level

unspecified, initial encounter

S48.912A Complete traumatic amputation of left shoulder and upper arm, level

unspecified, initial encounter

S48.919A Complete traumatic amputation of unspecified shoulder and upper arm, level

unspecified, initial encounter

S48.921A Partial traumatic amputation of right shoulder and upper arm, level

unspecified, initial encounter

ICD-10-CM - Code and Description

S48.922A Partial traumatic amputation of left shoulder and upper arm, level unspecified,

initial encounter

S48.929A Partial traumatic amputation of unspecified shoulder and upper arm, level

unspecified, initial encounter

S51.001A Unspecified open wound of right elbow, initial encounter

S51.002A Unspecified open wound of left elbow, initial encounter

S51.009A Unspecified open wound of unspecified elbow, initial encounter

S51.011A Laceration without foreign body of right elbow, initial encounter

S51.012A Laceration without foreign body of left elbow, initial encounter

S51.019A Laceration without foreign body of unspecified elbow, initial encounter

S51.021A Laceration with foreign body of right elbow, initial encounter

S51.022A Laceration with foreign body of left elbow, initial encounter

S51.029A Laceration with foreign body of unspecified elbow, initial encounter

S51.031A Puncture wound without foreign body of right elbow, initial encounter

S51.032A Puncture wound without foreign body of left elbow, initial encounter

S51.039A Puncture wound without foreign body of unspecified elbow, initial encounter

S51.041A Puncture wound with foreign body of right elbow, initial encounter

S51.042A Puncture wound with foreign body of left elbow, initial encounter

S51.049A Puncture wound with foreign body of unspecified elbow, initial encounter

S51.051A Open bite, right elbow, initial encounter

S51.052A Open bite, left elbow, initial encounter

S51.059A Open bite, unspecified elbow, initial encounter

S51.801A Unspecified open wound of right forearm, initial encounter

S51.802A Unspecified open wound of left forearm, initial encounter

S51.809A Unspecified open wound of unspecified forearm, initial encounter

S51.811A Laceration without foreign body of right forearm, initial encounter

S51.812A Laceration without foreign body of left forearm, initial encounter

S51.819A Laceration without foreign body of unspecified forearm, initial encounter

S51.821A Laceration with foreign body of right forearm, initial encounter

S51.822A Laceration with foreign body of left forearm, initial encounter

S51.829A Laceration with foreign body of unspecified forearm, initial encounter

S51.831A Puncture wound without foreign body of right forearm, initial encounter

S51.832A Puncture wound without foreign body of left forearm, initial encounter

S51.839A Puncture wound without foreign body of unspecified forearm, initial

encounter

ICD-10-CM - Code and Description

S51.841A Puncture wound with foreign body of right forearm, initial encounter

S51.842A Puncture wound with foreign body of left forearm, initial encounter

S51.849A Puncture wound with foreign body of unspecified forearm, initial encounter

S51.851A Open bite of right forearm, initial encounter

S51.852A Open bite of left forearm, initial encounter

S51.859A Open bite of unspecified forearm, initial encounter

S56.021A Laceration of flexor muscle, fascia and tendon of right thumb at forearm

level, initial encounter

S56.022A Laceration of flexor muscle, fascia and tendon of left thumb at forearm level,

initial encounter

S56.029A Laceration of flexor muscle, fascia and tendon of unspecified thumb at

forearm level, initial encounter

S56.121A Laceration of flexor muscle, fascia and tendon of right index finger at forearm

level, initial encounter

S56.122A Laceration of flexor muscle, fascia and tendon of left index finger at forearm

level, initial encounter

S56.123A Laceration of flexor muscle, fascia and tendon of right middle finger at

forearm level, initial encounter

S56.124A Laceration of flexor muscle, fascia and tendon of left middle finger at forearm

level, initial encounter

S56.125A Laceration of flexor muscle, fascia and tendon of right ring finger at forearm

level, initial encounter

S56.126A Laceration of flexor muscle, fascia and tendon of left ring finger at forearm

level, initial encounter

S56.127A Laceration of flexor muscle, fascia and tendon of right little finger at forearm

level, initial encounter

S56.128A Laceration of flexor muscle, fascia and tendon of left little finger at forearm

level, initial encounter

S56.129A Laceration of flexor muscle, fascia and tendon of unspecified finger at

forearm level, initial encounter

S56.221A Laceration of other flexor muscle, fascia and tendon at forearm level, right

arm, initial encounter

S56.222A Laceration of other flexor muscle, fascia and tendon at forearm level, left arm,

initial encounter

S56.229A Laceration of other flexor muscle, fascia and tendon at forearm level,

unspecified arm, initial encounter

S56.321A Laceration of extensor or abductor muscles, fascia and tendons of right thumb

at forearm level, initial encounter

ICD-10-CM - Code and Description

S56.322A Laceration of extensor or abductor muscles, fascia and tendons of left thumb

at forearm level, initial encounter

S56.329A Laceration of extensor or abductor muscles, fascia and tendons of unspecified

thumb at forearm level, initial encounter

S56.421A Laceration of extensor muscle, fascia and tendon of right index finger at

forearm level, initial encounter

S56.422A Laceration of extensor muscle, fascia and tendon of left index finger at

forearm level, initial encounter

S56.423A Laceration of extensor muscle, fascia and tendon of right middle finger at

forearm level, initial encounter

S56.424A Laceration of extensor muscle, fascia and tendon of left middle finger at

forearm level, initial encounter

S56.425A Laceration of extensor muscle, fascia and tendon of right ring finger at

forearm level, initial encounter

S56.426A Laceration of extensor muscle, fascia and tendon of left ring finger at forearm

level, initial encounter

S56.427A Laceration of extensor muscle, fascia and tendon of right little finger at

forearm level, initial encounter

S56.428A Laceration of extensor muscle, fascia and tendon of left little finger at forearm

level, initial encounter

S56.429A Laceration of extensor muscle, fascia and tendon of unspecified finger at

forearm level, initial encounter

S56.521A Laceration of other extensor muscle, fascia and tendon at forearm level, right

arm, initial encounter

S56.522A Laceration of other extensor muscle, fascia and tendon at forearm level, left

arm, initial encounter

S56.529A Laceration of other extensor muscle, fascia and tendon at forearm level,

unspecified arm, initial encounter

S56.821A Laceration of other muscles, fascia and tendons at forearm level, right arm,

initial encounter

S56.822A Laceration of other muscles, fascia and tendons at forearm level, left arm,

initial encounter

S56.829A Laceration of other muscles, fascia and tendons at forearm level, unspecified

arm, initial encounter

S56.921A Laceration of unspecified muscles, fascia and tendons at forearm level, right

arm, initial encounter

S56.922A Laceration of unspecified muscles, fascia and tendons at forearm level, left

arm, initial encounter

ICD-10-CM - Code and Description

S56.929A Laceration of unspecified muscles, fascia and tendons at forearm level,

unspecified arm, initial encounter

S58.011A Complete traumatic amputation at elbow level, right arm, initial encounter

S58.012A Complete traumatic amputation at elbow level, left arm, initial encounter

S58.019A Complete traumatic amputation at elbow level, unspecified arm, initial

encounter

S58.021A Partial traumatic amputation at elbow level, right arm, initial encounter

S58.022A Partial traumatic amputation at elbow level, left arm, initial encounter

S58.029A Partial traumatic amputation at elbow level, unspecified arm, initial encounter

S58.111A Complete traumatic amputation at level between elbow and wrist, right arm,

initial encounter

S58.112A Complete traumatic amputation at level between elbow and wrist, left arm,

initial encounter

S58.119A Complete traumatic amputation at level between elbow and wrist, unspecified

arm, initial encounter

S58.121A Partial traumatic amputation at level between elbow and wrist, right arm,

initial encounter

S58.122A Partial traumatic amputation at level between elbow and wrist, left arm, initial

encounter

S58.129A Partial traumatic amputation at level between elbow and wrist, unspecified

arm, initial encounter

S58.911A Complete traumatic amputation of right forearm, level unspecified, initial

encounter

S58.912A Complete traumatic amputation of left forearm, level unspecified, initial

encounter

S58.919A Complete traumatic amputation of unspecified forearm, level unspecified,

initial encounter

S58.921A Partial traumatic amputation of right forearm, level unspecified, initial

encounter

S58.922A Partial traumatic amputation of left forearm, level unspecified, initial

encounter

S58.929A Partial traumatic amputation of unspecified forearm, level unspecified, initial

encounter

S61.001A Unspecified open wound of right thumb without damage to nail, initial

encounter

S61.002A Unspecified open wound of left thumb without damage to nail, initial

encounter

ICD-10-CM - Code and Description

S61.009A Unspecified open wound of unspecified thumb without damage to nail, initial

encounter

S61.011A Laceration without foreign body of right thumb without damage to nail, initial

encounter

S61.012A Laceration without foreign body of left thumb without damage to nail, initial

encounter

S61.019A Laceration without foreign body of unspecified thumb without damage to

nail, initial encounter

S61.021A Laceration with foreign body of right thumb without damage to nail, initial

encounter

S61.022A Laceration with foreign body of left thumb without damage to nail, initial

encounter

S61.029A Laceration with foreign body of unspecified thumb without damage to nail,

initial encounter

S61.031A Puncture wound without foreign body of right thumb without damage to nail,

initial encounter

S61.032A Puncture wound without foreign body of left thumb without damage to nail,

initial encounter

S61.039A Puncture wound without foreign body of unspecified thumb without damage

to nail, initial encounter

S61.041A Puncture wound with foreign body of right thumb without damage to nail,

initial encounter

S61.042A Puncture wound with foreign body of left thumb without damage to nail,

initial encounter

S61.049A Puncture wound with foreign body of unspecified thumb without damage to

nail, initial encounter

S61.051A Open bite of right thumb without damage to nail, initial encounter

S61.052A Open bite of left thumb without damage to nail, initial encounter

S61.059A Open bite of unspecified thumb without damage to nail, initial encounter

S61.101A Unspecified open wound of right thumb with damage to nail, initial encounter

S61.102A Unspecified open wound of left thumb with damage to nail, initial encounter

S61.109A Unspecified open wound of unspecified thumb with damage to nail, initial

encounter

S61.109A Unspecified open wound of unspecified thumb with damage to nail, initial

encounter

S61.111A Laceration without foreign body of right thumb with damage to nail, initial

encounter

ICD-10-CM - Code and Description

S61.112A Laceration without foreign body of left thumb with damage to nail, initial

encounter

S61.119A Laceration without foreign body of unspecified thumb with damage to nail,

initial encounter

S61.121A Laceration with foreign body of right thumb with damage to nail, initial

encounter

S61.122A Laceration with foreign body of left thumb with damage to nail, initial

encounter

S61.129A Laceration with foreign body of unspecified thumb with damage to nail,

initial encounter

S61.131A Puncture wound without foreign body of right thumb with damage to nail,

initial encounter

S61.132A Puncture wound without foreign body of left thumb with damage to nail,

initial encounter

S61.139A Puncture wound without foreign body of unspecified thumb with damage to

nail, initial encounter

S61.141A Puncture wound with foreign body of right thumb with damage to nail, initial

encounter

S61.142A Puncture wound with foreign body of left thumb with damage to nail, initial

encounter

S61.149A Puncture wound with foreign body of unspecified thumb with damage to nail,

initial encounter

S61.151A Open bite of right thumb with damage to nail, initial encounter

S61.152A Open bite of left thumb with damage to nail, initial encounter

S61.159A Open bite of unspecified thumb with damage to nail, initial encounter

S61.200A Unspecified open wound of right index finger without damage to nail, initial

encounter

S61.201A Unspecified open wound of left index finger without damage to nail, initial

encounter

S61.202A Unspecified open wound of right middle finger without damage to nail, initial

encounter

S61.203A Unspecified open wound of left middle finger without damage to nail, initial

encounter

S61.204A Unspecified open wound of right ring finger without damage to nail, initial

encounter

S61.205A Unspecified open wound of left ring finger without damage to nail, initial

encounter

S61.206A Unspecified open wound of right little finger without damage to nail, initial

encounter

ICD-10-CM - Code and Description

S61.207A Unspecified open wound of left little finger without damage to nail, initial

encounter

S61.208A Unspecified open wound of other finger without damage to nail, initial

encounter

S61.209A Unspecified open wound of unspecified finger without damage to nail, initial

encounter

S61.209A Unspecified open wound of unspecified finger without damage to nail, initial

encounter

S61.210A Laceration without foreign body of right index finger without damage to nail,

initial encounter

S61.211A Laceration without foreign body of left index finger without damage to nail,

initial encounter

S61.212A Laceration without foreign body of right middle finger without damage to

nail, initial encounter

S61.213A Laceration without foreign body of left middle finger without damage to nail,

initial encounter

S61.214A Laceration without foreign body of right ring finger without damage to nail,

initial encounter

S61.215A Laceration without foreign body of left ring finger without damage to nail,

initial encounter

S61.216A Laceration without foreign body of right little finger without damage to nail,

initial encounter

S61.217A Laceration without foreign body of left little finger without damage to nail,

initial encounter

S61.218A Laceration without foreign body of other finger without damage to nail, initial

encounter

S61.219A Laceration without foreign body of unspecified finger without damage to nail,

initial encounter

S61.220A Laceration with foreign body of right index finger without damage to nail,

initial encounter

S61.221A Laceration with foreign body of left index finger without damage to nail,

initial encounter

S61.222A Laceration with foreign body of right middle finger without damage to nail,

initial encounter

S61.223A Laceration with foreign body of left middle finger without damage to nail,

initial encounter

S61.224A Laceration with foreign body of right ring finger without damage to nail,

initial encounter

ICD-10-CM - Code and Description

S61.225A Laceration with foreign body of left ring finger without damage to nail, initial

encounter

S61.226A Laceration with foreign body of right little finger without damage to nail,

initial encounter

S61.227A Laceration with foreign body of left little finger without damage to nail, initial

encounter

S61.228A Laceration with foreign body of other finger without damage to nail, initial

encounter

S61.229A Laceration with foreign body of unspecified finger without damage to nail,

initial encounter

S61.230A Puncture wound without foreign body of right index finger without damage to

nail, initial encounter

S61.231A Puncture wound without foreign body of left index finger without damage to

nail, initial encounter

S61.232A Puncture wound without foreign body of right middle finger without damage

to nail, initial encounter

S61.233A Puncture wound without foreign body of left middle finger without damage to

nail, initial encounter

S61.234A Puncture wound without foreign body of right ring finger without damage to

nail, initial encounter

S61.235A Puncture wound without foreign body of left ring finger without damage to

nail, initial encounter

S61.236A Puncture wound without foreign body of right little finger without damage to

nail, initial encounter

S61.237A Puncture wound without foreign body of left little finger without damage to

nail, initial encounter

S61.238A Puncture wound without foreign body of other finger without damage to nail,

initial encounter

S61.239A Puncture wound without foreign body of unspecified finger without damage

to nail, initial encounter

S61.240A Puncture wound with foreign body of right index finger without damage to

nail, initial encounter

S61.241A Puncture wound with foreign body of left index finger without damage to

nail, initial encounter

S61.242A Puncture wound with foreign body of right middle finger without damage to

nail, initial encounter

S61.243A Puncture wound with foreign body of left middle finger without damage to

nail, initial encounter

ICD-10-CM - Code and Description

S61.244A Puncture wound with foreign body of right ring finger without damage to nail,

initial encounter

S61.245A Puncture wound with foreign body of left ring finger without damage to nail,

initial encounter

S61.246A Puncture wound with foreign body of right little finger without damage to

nail, initial encounter

S61.247A Puncture wound with foreign body of left little finger without damage to nail,

initial encounter

S61.248A Puncture wound with foreign body of other finger without damage to nail,

initial encounter

S61.249A Puncture wound with foreign body of unspecified finger without damage to

nail, initial encounter

S61.250A Open bite of right index finger without damage to nail, initial encounter

S61.251A Open bite of left index finger without damage to nail, initial encounter

S61.252A Open bite of right middle finger without damage to nail, initial encounter

S61.253A Open bite of left middle finger without damage to nail, initial encounter

S61.254A Open bite of right ring finger without damage to nail, initial encounter

S61.255A Open bite of left ring finger without damage to nail, initial encounter

S61.256A Open bite of right little finger without damage to nail, initial encounter

S61.257A Open bite of left little finger without damage to nail, initial encounter

S61.258A Open bite of other finger without damage to nail, initial encounter

S61.259A Open bite of unspecified finger without damage to nail, initial encounter

S61.300A Unspecified open wound of right index finger with damage to nail, initial

encounter

S61.301A Unspecified open wound of left index finger with damage to nail, initial

encounter

S61.302A Unspecified open wound of right middle finger with damage to nail, initial

encounter

S61.303A Unspecified open wound of left middle finger with damage to nail, initial

encounter

S61.304A Unspecified open wound of right ring finger with damage to nail, initial

encounter

S61.305A Unspecified open wound of left ring finger with damage to nail, initial

encounter

S61.306A Unspecified open wound of right little finger with damage to nail, initial

encounter

S61.307A Unspecified open wound of left little finger with damage to nail, initial

encounter

ICD-10-CM - Code and Description

S61.308A Unspecified open wound of other finger with damage to nail, initial encounter

S61.309A Unspecified open wound of unspecified finger with damage to nail, initial

encounter

S61.310A Laceration without foreign body of right index finger with damage to nail,

initial encounter

S61.311A Laceration without foreign body of left index finger with damage to nail,

initial encounter

S61.312A Laceration without foreign body of right middle finger with damage to nail,

initial encounter

S61.313A Laceration without foreign body of left middle finger with damage to nail,

initial encounter

S61.314A Laceration without foreign body of right ring finger with damage to nail,

initial encounter

S61.315A Laceration without foreign body of left ring finger with damage to nail, initial

encounter

S61.316A Laceration without foreign body of right little finger with damage to nail,

initial encounter

S61.317A Laceration without foreign body of left little finger with damage to nail, initial

encounter

S61.318A Laceration without foreign body of other finger with damage to nail, initial

encounter

S61.319A Laceration without foreign body of unspecified finger with damage to nail,

initial encounter

S61.320A Laceration with foreign body of right index finger with damage to nail, initial

encounter

S61.321A Laceration with foreign body of left index finger with damage to nail, initial

encounter

S61.322A Laceration with foreign body of right middle finger with damage to nail,

initial encounter

S61.323A Laceration with foreign body of left middle finger with damage to nail, initial

encounter

S61.324A Laceration with foreign body of right ring finger with damage to nail, initial

encounter

S61.325A Laceration with foreign body of left ring finger with damage to nail, initial

encounter

S61.326A Laceration with foreign body of right little finger with damage to nail, initial

encounter

S61.327A Laceration with foreign body of left little finger with damage to nail, initial

encounter

ICD-10-CM - Code and Description

S61.328A Laceration with foreign body of other finger with damage to nail, initial

encounter

S61.329A Laceration with foreign body of unspecified finger with damage to nail, initial

encounter

S61.330A Puncture wound without foreign body of right index finger with damage to

nail, initial encounter

S61.331A Puncture wound without foreign body of left index finger with damage to

nail, initial encounter

S61.340A Puncture wound with foreign body of right index finger with damage to nail,

initial encounter

S61.341A Puncture wound with foreign body of left index finger with damage to nail,

initial encounter

S61.342A Puncture wound with foreign body of right middle finger with damage to nail,

initial encounter

S61.343A Puncture wound with foreign body of left middle finger with damage to nail,

initial encounter

S61.344A Puncture wound with foreign body of right ring finger with damage to nail,

initial encounter

S61.345A Puncture wound with foreign body of left ring finger with damage to nail,

initial encounter

S61.346A Puncture wound with foreign body of right little finger with damage to nail,

initial encounter

S61.347A Puncture wound with foreign body of left little finger with damage to nail,

initial encounter

S61.348A Puncture wound with foreign body of other finger with damage to nail, initial

encounter

S61.349A Puncture wound with foreign body of unspecified finger with damage to nail,

initial encounter

S61.401A Unspecified open wound of right hand, initial encounter

S61.402A Unspecified open wound of left hand, initial encounter

S61.409A Unspecified open wound of unspecified hand, initial encounter

S61.411A Laceration without foreign body of right hand, initial encounter

S61.412A Laceration without foreign body of left hand, initial encounter

S61.419A Laceration without foreign body of unspecified hand, initial encounter

S61.421A Laceration with foreign body of right hand, initial encounter

S61.422A Laceration with foreign body of left hand, initial encounter

S61.429A Laceration with foreign body of unspecified hand, initial encounter

S61.431A Puncture wound without foreign body of right hand, initial encounter

ICD-10-CM - Code and Description

S61.432A Puncture wound without foreign body of left hand, initial encounter

S61.439A Puncture wound without foreign body of unspecified hand, initial encounter

S61.441A Puncture wound with foreign body of right hand, initial encounter

S61.442A Puncture wound with foreign body of left hand, initial encounter

S61.449A Puncture wound with foreign body of unspecified hand, initial encounter

S61.451A Open bite of right hand, initial encounter

S61.452A Open bite of left hand, initial encounter

S61.459A Open bite of unspecified hand, initial encounter

S61.501A Unspecified open wound of right wrist, initial encounter

S61.502A Unspecified open wound of left wrist, initial encounter

S61.509A Unspecified open wound of unspecified wrist, initial encounter

S61.511A Laceration without foreign body of right wrist, initial encounter

S61.512A Laceration without foreign body of left wrist, initial encounter

S61.519A Laceration without foreign body of unspecified wrist, initial encounter

S61.521A Laceration with foreign body of right wrist, initial encounter

S61.522A Laceration with foreign body of left wrist, initial encounter

S61.529A Laceration with foreign body of unspecified wrist, initial encounter

S61.531A Puncture wound without foreign body of right wrist, initial encounter

S61.532A Puncture wound without foreign body of left wrist, initial encounter

S61.539A Puncture wound without foreign body of unspecified wrist, initial encounter

S61.541A Puncture wound with foreign body of right wrist, initial encounter

S61.542A Puncture wound with foreign body of left wrist, initial encounter

S61.549A Puncture wound with foreign body of unspecified wrist, initial encounter

S61.551A Open bite of right wrist, initial encounter

S61.552A Open bite of left wrist, initial encounter

S61.559A Open bite of unspecified wrist, initial encounter

S66.021A Laceration of long flexor muscle, fascia and tendon of right thumb at wrist

and hand level, initial encounter

S66.022A Laceration of long flexor muscle, fascia and tendon of left thumb at wrist and

hand level, initial encounter

S66.029A Laceration of long flexor muscle, fascia and tendon of unspecified thumb at

wrist and hand level, initial encounter

S66.120A Laceration of flexor muscle, fascia and tendon of right index finger at wrist

and hand level, initial encounter

ICD-10-CM - Code and Description

S66.121A Laceration of flexor muscle, fascia and tendon of left index finger at wrist and

hand level, initial encounter

S66.122A Laceration of flexor muscle, fascia and tendon of right middle finger at wrist

and hand level, initial encounter

S66.123A Laceration of flexor muscle, fascia and tendon of left middle finger at wrist

and hand level, initial encounter

S66.124A Laceration of flexor muscle, fascia and tendon of right ring finger at wrist and

hand level, initial encounter

S66.125A Laceration of flexor muscle, fascia and tendon of left ring finger at wrist and

hand level, initial encounter

S66.126A Laceration of flexor muscle, fascia and tendon of right little finger at wrist

and hand level, initial encounter

S66.127A Laceration of flexor muscle, fascia and tendon of left little finger at wrist and

hand level, initial encounter

S66.128A Laceration of flexor muscle, fascia and tendon of other finger at wrist and

hand level, initial encounter

S66.129A Laceration of flexor muscle, fascia and tendon of unspecified finger at wrist

and hand level, initial encounter

S66.221A Laceration of extensor muscle, fascia and tendon of right thumb at wrist and

hand level, initial encounter

S66.222A Laceration of extensor muscle, fascia and tendon of left thumb at wrist and

hand level, initial encounter

S66.229A Laceration of extensor muscle, fascia and tendon of unspecified thumb at

wrist and hand level, initial encounter

S66.320A Laceration of extensor muscle, fascia and tendon of right index finger at wrist

and hand level, initial encounter

S66.321A Laceration of extensor muscle, fascia and tendon of left index finger at wrist

and hand level, initial encounter

S66.322A Laceration of extensor muscle, fascia and tendon of right middle finger at

wrist and hand level, initial encounter

S66.323A Laceration of extensor muscle, fascia and tendon of left middle finger at wrist

and hand level, initial encounter

S66.324A Laceration of extensor muscle, fascia and tendon of right ring finger at wrist

and hand level, initial encounter

S66.325A Laceration of extensor muscle, fascia and tendon of left ring finger at wrist

and hand level, initial encounter

S66.326A Laceration of extensor muscle, fascia and tendon of right little finger at wrist

and hand level, initial encounter

ICD-10-CM - Code and Description

S66.327A Laceration of extensor muscle, fascia and tendon of left little finger at wrist

and hand level, initial encounter

S66.328A Laceration of extensor muscle, fascia and tendon of other finger at wrist and

hand level, initial encounter

S66.329A Laceration of extensor muscle, fascia and tendon of unspecified finger at wrist

and hand level, initial encounter

S66.421A Laceration of intrinsic muscle, fascia and tendon of right thumb at wrist and

hand level, initial encounter

S66.422A Laceration of intrinsic muscle, fascia and tendon of left thumb at wrist and

hand level, initial encounter

S66.429A Laceration of intrinsic muscle, fascia and tendon of unspecified thumb at

wrist and hand level, initial encounter

S66.520A Laceration of intrinsic muscle, fascia and tendon of right index finger at wrist

and hand level, initial encounter

S66.521A Laceration of intrinsic muscle, fascia and tendon of left index finger at wrist

and hand level, initial encounter

S66.522A Laceration of intrinsic muscle, fascia and tendon of right middle finger at

wrist and hand level, initial encounter

S66.523A Laceration of intrinsic muscle, fascia and tendon of left middle finger at wrist

and hand level, initial encounter

S66.524A Laceration of intrinsic muscle, fascia and tendon of right ring finger at wrist

and hand level, initial encounter

S66.525A Laceration of intrinsic muscle, fascia and tendon of left ring finger at wrist

and hand level, initial encounter

S66.526A Laceration of intrinsic muscle, fascia and tendon of right little finger at wrist

and hand level, initial encounter

S66.527A Laceration of intrinsic muscle, fascia and tendon of left little finger at wrist

and hand level, initial encounter

S66.528A Laceration of intrinsic muscle, fascia and tendon of other finger at wrist and

hand level, initial encounter

S66.529A Laceration of intrinsic muscle, fascia and tendon of unspecified finger at wrist

and hand level, initial encounter

S66.821A Laceration of other specified muscles, fascia and tendons at wrist and hand

level, right hand, initial encounter

S66.822A Laceration of other specified muscles, fascia and tendons at wrist and hand

level, left hand, initial encounter

S66.829A Laceration of other specified muscles, fascia and tendons at wrist and hand

level, unspecified hand, initial encounter

ICD-10-CM - Code and Description

S66.921A Laceration of unspecified muscle, fascia and tendon at wrist and hand level,

right hand, initial encounter

S66.922A Laceration of unspecified muscle, fascia and tendon at wrist and hand level,

left hand, initial encounter

S66.929A Laceration of unspecified muscle, fascia and tendon at wrist and hand level,

unspecified hand, initial encounter

S68.011A Complete traumatic metacarpophalangeal amputation of right thumb, initial

encounter

S68.012A Complete traumatic metacarpophalangeal amputation of left thumb, initial

encounter

S68.019A Complete traumatic metacarpophalangeal amputation of unspecified thumb,

initial encounter

S68.021A Partial traumatic metacarpophalangeal amputation of right thumb, initial

encounter

S68.022A Partial traumatic metacarpophalangeal amputation of left thumb, initial

encounter

S68.029A Partial traumatic metacarpophalangeal amputation of unspecified thumb,

initial encounter

S68.110A Complete traumatic metacarpophalangeal amputation of right index finger,

initial encounter

S68.111A Complete traumatic metacarpophalangeal amputation of left index finger,

initial encounter

S68.112A Complete traumatic metacarpophalangeal amputation of right middle finger,

initial encounter

S68.113A Complete traumatic metacarpophalangeal amputation of left middle finger,

initial encounter

S68.114A Complete traumatic metacarpophalangeal amputation of right ring finger,

initial encounter

S68.115A Complete traumatic metacarpophalangeal amputation of left ring finger,

initial encounter

S68.116A Complete traumatic metacarpophalangeal amputation of right little finger,

initial encounter

S68.117A Complete traumatic metacarpophalangeal amputation of left little finger,

initial encounter

S68.118A Complete traumatic metacarpophalangeal amputation of other finger, initial

encounter

S68.119A Complete traumatic metacarpophalangeal amputation of unspecified finger,

initial encounter

ICD-10-CM - Code and Description

S68.120A Partial traumatic metacarpophalangeal amputation of right index finger, initial

encounter

S68.121A Partial traumatic metacarpophalangeal amputation of left index finger, initial

encounter

S68.122A Partial traumatic metacarpophalangeal amputation of right middle finger,

initial encounter

S68.123A Partial traumatic metacarpophalangeal amputation of left middle finger, initial

encounter

S68.124A Partial traumatic metacarpophalangeal amputation of right ring finger, initial

encounter

S68.125A Partial traumatic metacarpophalangeal amputation of left ring finger, initial

encounter

S68.126A Partial traumatic metacarpophalangeal amputation of right little finger, initial

encounter

S68.127A Partial traumatic metacarpophalangeal amputation of left little finger, initial

encounter

S68.128A Partial traumatic metacarpophalangeal amputation of other finger, initial

encounter

S68.129A Partial traumatic metacarpophalangeal amputation of unspecified finger,

initial encounter

S68.411A Complete traumatic amputation of right hand at wrist level, initial encounter

S68.412A Complete traumatic amputation of left hand at wrist level, initial encounter

S68.419A Complete traumatic amputation of unspecified hand at wrist level, initial

encounter

S68.421A Partial traumatic amputation of right hand at wrist level, initial encounter

S68.422A Partial traumatic amputation of left hand at wrist level, initial encounter

S68.429A Partial traumatic amputation of unspecified hand at wrist level, initial

encounter

S68.511A Complete traumatic transphalangeal amputation of right thumb, initial

encounter

S68.512A Complete traumatic transphalangeal amputation of left thumb, initial

encounter

S68.519A Complete traumatic transphalangeal amputation of unspecified thumb, initial

encounter

S68.521A Partial traumatic transphalangeal amputation of right thumb, initial encounter

S68.522A Partial traumatic transphalangeal amputation of left thumb, initial encounter

S68.529A Partial traumatic transphalangeal amputation of unspecified thumb, initial

encounter

ICD-10-CM - Code and Description

S68.610A Complete traumatic transphalangeal amputation of right index finger, initial

encounter

S68.611A Complete traumatic transphalangeal amputation of left index finger, initial

encounter

S68.612A Complete traumatic transphalangeal amputation of right middle finger, initial

encounter

S68.613A Complete traumatic transphalangeal amputation of left middle finger, initial

encounter

S68.614A Complete traumatic transphalangeal amputation of right ring finger, initial

encounter

S68.615A Complete traumatic transphalangeal amputation of left ring finger, initial

encounter

S68.616A Complete traumatic transphalangeal amputation of right little finger, initial

encounter

S68.617A Complete traumatic transphalangeal amputation of left little finger, initial

encounter

S68.618A Complete traumatic transphalangeal amputation of other finger, initial

encounter

S68.619A Complete traumatic transphalangeal amputation of unspecified finger, initial

encounter

S68.620A Partial traumatic transphalangeal amputation of right index finger, initial

encounter

S68.621A Partial traumatic transphalangeal amputation of left index finger, initial

encounter

S68.622A Partial traumatic transphalangeal amputation of right middle finger, initial

encounter

S68.623A Partial traumatic transphalangeal amputation of left middle finger, initial

encounter

S68.624A Partial traumatic transphalangeal amputation of right ring finger, initial

encounter

S68.625A Partial traumatic transphalangeal amputation of left ring finger, initial

encounter

S68.626A Partial traumatic transphalangeal amputation of right little finger, initial

encounter

S68.627A Partial traumatic transphalangeal amputation of left little finger, initial

encounter

S68.628A Partial traumatic transphalangeal amputation of other finger, initial encounter

S68.629A Partial traumatic transphalangeal amputation of unspecified finger, initial

encounter

ICD-10-CM - Code and Description

S68.711A Complete traumatic transmetacarpal amputation of right hand, initial

encounter

S68.712A Complete traumatic transmetacarpal amputation of left hand, initial encounter

S68.719A Complete traumatic transmetacarpal amputation of unspecified hand, initial

encounter

S68.721A Partial traumatic transmetacarpal amputation of right hand, initial encounter

S68.722A Partial traumatic transmetacarpal amputation of left hand, initial encounter

S68.729A Partial traumatic transmetacarpal amputation of unspecified hand, initial

encounter

S71.001A Unspecified open wound, right hip, initial encounter

S71.002A Unspecified open wound, left hip, initial encounter

S71.009A Unspecified open wound, unspecified hip, initial encounter

S71.011A Laceration without foreign body, right hip, initial encounter

S71.012A Laceration without foreign body, left hip, initial encounter

S71.019A Laceration without foreign body, unspecified hip, initial encounter

S71.021A Laceration with foreign body, right hip, initial encounter

S71.022A Laceration with foreign body, left hip, initial encounter

S71.029A Laceration with foreign body, unspecified hip, initial encounter

S71.031A Puncture wound without foreign body, right hip, initial encounter

S71.032A Puncture wound without foreign body, left hip, initial encounter

S71.039A Puncture wound without foreign body, unspecified hip, initial encounter

S71.041A Puncture wound with foreign body, right hip, initial encounter

S71.042A Puncture wound with foreign body, left hip, initial encounter

S71.049A Puncture wound with foreign body, unspecified hip, initial encounter

S71.051A Open bite, right hip, initial encounter

S71.052A Open bite, left hip, initial encounter

S71.059A Open bite, unspecified hip, initial encounter

S71.101A Unspecified open wound, right thigh, initial encounter

S71.102A Unspecified open wound, left thigh, initial encounter

S71.109A Unspecified open wound, unspecified thigh, initial encounter

S71.111A Laceration without foreign body, right thigh, initial encounter

S71.112A Laceration without foreign body, left thigh, initial encounter

S71.119A Laceration without foreign body, unspecified thigh, initial encounter

S71.121A Laceration with foreign body, right thigh, initial encounter

S71.122A Laceration with foreign body, left thigh, initial encounter

ICD-10-CM - Code and Description

S71.129A Laceration with foreign body, unspecified thigh, initial encounter

S71.131A Puncture wound without foreign body, right thigh, initial encounter

S71.132A Puncture wound without foreign body, left thigh, initial encounter

S71.139A Puncture wound without foreign body, unspecified thigh, initial encounter

S71.141A Puncture wound with foreign body, right thigh, initial encounter

S71.142A Puncture wound with foreign body, left thigh, initial encounter

S71.149A Puncture wound with foreign body, unspecified thigh, initial encounter

S71.151A Open bite, right thigh, initial encounter

S71.152A Open bite, left thigh, initial encounter

S71.159A Open bite, unspecified thigh, initial encounter

S76.021A Laceration of muscle, fascia and tendon of right hip, initial encounter

S76.022A Laceration of muscle, fascia and tendon of left hip, initial encounter

S76.029A Laceration of muscle, fascia and tendon of unspecified hip, initial encounter

S76.121A Laceration of right quadriceps muscle, fascia and tendon, initial encounter

S76.122A Laceration of left quadriceps muscle, fascia and tendon, initial encounter

S76.129A Laceration of unspecified quadriceps muscle, fascia and tendon, initial

encounter

S76.221A Laceration of adductor muscle, fascia and tendon of right thigh, initial

encounter

S76.222A Laceration of adductor muscle, fascia and tendon of left thigh, initial

encounter

S76.229A Laceration of adductor muscle, fascia and tendon of unspecified thigh, initial

encounter

S76.321A Laceration of muscle, fascia and tendon of the posterior muscle group at thigh

level, right thigh, initial encounter

S76.322A Laceration of muscle, fascia and tendon of the posterior muscle group at thigh

level, left thigh, initial encounter

S76.329A Laceration of muscle, fascia and tendon of the posterior muscle group at thigh

level, unspecified thigh, initial encounter

S76.821A Laceration of other specified muscles, fascia and tendons at thigh level, right

thigh, initial encounter

S76.822A Laceration of other specified muscles, fascia and tendons at thigh level, left

thigh, initial encounter

S76.829A Laceration of other specified muscles, fascia and tendons at thigh level,

unspecified thigh, initial encounter

S76.921A Laceration of unspecified muscles, fascia and tendons at thigh level, right

thigh, initial encounter

ICD-10-CM - Code and Description

S76.922A Laceration of unspecified muscles, fascia and tendons at thigh level, left

thigh, initial encounter

S76.929A Laceration of unspecified muscles, fascia and tendons at thigh level,

unspecified thigh, initial encounter

S78.011A Complete traumatic amputation at right hip joint, initial encounter

S78.012A Complete traumatic amputation at left hip joint, initial encounter

S78.019A Complete traumatic amputation at unspecified hip joint, initial encounter

S78.021A Partial traumatic amputation at right hip joint, initial encounter

S78.022A Partial traumatic amputation at left hip joint, initial encounter

S78.029A Partial traumatic amputation at unspecified hip joint, initial encounter

S78.111A Complete traumatic amputation at level between right hip and knee, initial

encounter

S78.112A Complete traumatic amputation at level between left hip and knee, initial

encounter

S78.119A Complete traumatic amputation at level between unspecified hip and knee,

initial encounter

S78.121A Partial traumatic amputation at level between right hip and knee, initial

encounter

S78.122A Partial traumatic amputation at level between left hip and knee, initial

encounter

S78.129A Partial traumatic amputation at level between unspecified hip and knee, initial

encounter

S78.911A Complete traumatic amputation of right hip and thigh, level unspecified,

initial encounter

S78.912A Complete traumatic amputation of left hip and thigh, level unspecified, initial

encounter

S78.919A Complete traumatic amputation of unspecified hip and thigh, level

unspecified, initial encounter

S78.921A Partial traumatic amputation of right hip and thigh, level unspecified, initial

encounter

S78.922A Partial traumatic amputation of left hip and thigh, level unspecified, initial

encounter

S78.929A Partial traumatic amputation of unspecified hip and thigh, level unspecified,

initial encounter

S81.001A Unspecified open wound, right knee, initial encounter

S81.002A Unspecified open wound, left knee, initial encounter

S81.009A Unspecified open wound, unspecified knee, initial encounter

S81.011A Laceration without foreign body, right knee, initial encounter

ICD-10-CM - Code and Description

S81.012A Laceration without foreign body, left knee, initial encounter

S81.019A Laceration without foreign body, unspecified knee, initial encounter

S81.021A Laceration with foreign body, right knee, initial encounter

S81.022A Laceration with foreign body, left knee, initial encounter

S81.029A Laceration with foreign body, unspecified knee, initial encounter

S81.031A Puncture wound without foreign body, right knee, initial encounter

S81.032A Puncture wound without foreign body, left knee, initial encounter

S81.039A Puncture wound without foreign body, unspecified knee, initial encounter

S81.041A Puncture wound with foreign body, right knee, initial encounter

S81.042A Puncture wound with foreign body, left knee, initial encounter

S81.049A Puncture wound with foreign body, unspecified knee, initial encounter

S81.051A Open bite, right knee, initial encounter

S81.052A Open bite, left knee, initial encounter

S81.059A Open bite, unspecified knee, initial encounter

S81.801A Unspecified open wound, right lower leg, initial encounter

S81.802A Unspecified open wound, left lower leg, initial encounter

S81.809A Unspecified open wound, unspecified lower leg, initial encounter

S81.811A Laceration without foreign body, right lower leg, initial encounter

S81.812A Laceration without foreign body, left lower leg, initial encounter

S81.819A Laceration without foreign body, unspecified lower leg, initial encounter

S81.821A Laceration with foreign body, right lower leg, initial encounter

S81.822A Laceration with foreign body, left lower leg, initial encounter

S81.829A Laceration with foreign body, unspecified lower leg, initial encounter

S81.831A Puncture wound without foreign body, right lower leg, initial encounter

S81.832A Puncture wound without foreign body, left lower leg, initial encounter

S81.839A Puncture wound without foreign body, unspecified lower leg, initial encounter

S81.841A Puncture wound with foreign body, right lower leg, initial encounter

S81.842A Puncture wound with foreign body, left lower leg, initial encounter

S81.849A Puncture wound with foreign body, unspecified lower leg, initial encounter

S81.851A Open bite, right lower leg, initial encounter

S81.852A Open bite, left lower leg, initial encounter

S81.859A Open bite, unspecified lower leg, initial encounter

S86.021A Laceration of right Achilles tendon, initial encounter

S86.022A Laceration of left Achilles tendon, initial encounter

ICD-10-CM - Code and Description

S86.029A Laceration of unspecified Achilles tendon, initial encounter

S86.121A Laceration of other muscle(s) and tendon(s) of posterior muscle group at

lower leg level, right leg, initial encounter

S86.122A Laceration of other muscle(s) and tendon(s) of posterior muscle group at

lower leg level, left leg, initial encounter

S86.129A Laceration of other muscle(s) and tendon(s) of posterior muscle group at

lower leg level, unspecified leg, initial encounter

S86.221A Laceration of muscle(s) and tendon(s) of anterior muscle group at lower leg

level, right leg, initial encounter

S86.222A Laceration of muscle(s) and tendon(s) of anterior muscle group at lower leg

level, left leg, initial encounter

S86.229A Laceration of muscle(s) and tendon(s) of anterior muscle group at lower leg

level, unspecified leg, initial encounter

S86.321A Laceration of muscle(s) and tendon(s) of peroneal muscle group at lower leg

level, right leg, initial encounter

S86.322A Laceration of muscle(s) and tendon(s) of peroneal muscle group at lower leg

level, left leg, initial encounter

S86.329A Laceration of muscle(s) and tendon(s) of peroneal muscle group at lower leg

level, unspecified leg, initial encounter

S86.821A Laceration of other muscle(s) and tendon(s) at lower leg level, right leg, initial

encounter

S86.822A Laceration of other muscle(s) and tendon(s) at lower leg level, left leg, initial

encounter

S86.829A Laceration of other muscle(s) and tendon(s) at lower leg level, unspecified

leg, initial encounter

S86.921A Laceration of unspecified muscle(s) and tendon(s) at lower leg level, right leg,

initial encounter

S86.922A Laceration of unspecified muscle(s) and tendon(s) at lower leg level, left leg,

initial encounter

S86.929A Laceration of unspecified muscle(s) and tendon(s) at lower leg level,

unspecified leg, initial encounter

S88.011A Complete traumatic amputation at knee level, right lower leg, initial encounter

S88.012A Complete traumatic amputation at knee level, left lower leg, initial encounter

S88.019A Complete traumatic amputation at knee level, unspecified lower leg, initial

encounter

S88.021A Partial traumatic amputation at knee level, right lower leg, initial encounter

S88.022A Partial traumatic amputation at knee level, left lower leg, initial encounter

ICD-10-CM - Code and Description

S88.029A Partial traumatic amputation at knee level, unspecified lower leg, initial

encounter

S88.111A Complete traumatic amputation at level between knee and ankle, right lower

leg, initial encounter

S88.112A Complete traumatic amputation at level between knee and ankle, left lower

leg, initial encounter

S88.119A Complete traumatic amputation at level between knee and ankle, unspecified

lower leg, initial encounter

S88.121A Partial traumatic amputation at level between knee and ankle, right lower leg,

initial encounter

S88.122A Partial traumatic amputation at level between knee and ankle, left lower leg,

initial encounter

S88.129A Partial traumatic amputation at level between knee and ankle, unspecified

lower leg, initial encounter

S88.911A Complete traumatic amputation of right lower leg, level unspecified, initial

encounter

S88.912A Complete traumatic amputation of left lower leg, level unspecified, initial

encounter

S88.919A Complete traumatic amputation of unspecified lower leg, level unspecified,

initial encounter

S88.921A Partial traumatic amputation of right lower leg, level unspecified, initial

encounter

S88.922A Partial traumatic amputation of left lower leg, level unspecified, initial

encounter

S88.929A Partial traumatic amputation of unspecified lower leg, level unspecified,

initial encounter

S91.001A Unspecified open wound, right ankle, initial encounter

S91.002A Unspecified open wound, left ankle, initial encounter

S91.009A Unspecified open wound, unspecified ankle, initial encounter

S91.011A Laceration without foreign body, right ankle, initial encounter

S91.012A Laceration without foreign body, left ankle, initial encounter

S91.019A Laceration without foreign body, unspecified ankle, initial encounter

S91.021A Laceration with foreign body, right ankle, initial encounter

S91.022A Laceration with foreign body, left ankle, initial encounter

S91.029A Laceration with foreign body, unspecified ankle, initial encounter

S91.031A Puncture wound without foreign body, right ankle, initial encounter

S91.032A Puncture wound without foreign body, left ankle, initial encounter

ICD-10-CM - Code and Description

S91.039A Puncture wound without foreign body, unspecified ankle, initial encounter

S91.041A Puncture wound with foreign body, right ankle, initial encounter

S91.042A Puncture wound with foreign body, left ankle, initial encounter

S91.049A Puncture wound with foreign body, unspecified ankle, initial encounter

S91.051A Open bite, right ankle, initial encounter

S91.052A Open bite, left ankle, initial encounter

S91.059A Open bite, unspecified ankle, initial encounter

S91.101A Unspecified open wound of right great toe without damage to nail, initial

encounter

S91.102A Unspecified open wound of left great toe without damage to nail, initial

encounter

S91.103A Unspecified open wound of unspecified great toe without damage to nail,

initial encounter

S91.104A Unspecified open wound of right lesser toe(s) without damage to nail, initial

encounter

S91.105A Unspecified open wound of left lesser toe(s) without damage to nail, initial

encounter

S91.106A Unspecified open wound of unspecified lesser toe(s) without damage to nail,

initial encounter

S91.109A Unspecified open wound of unspecified toe(s) without damage to nail, initial

encounter

S91.111A Laceration without foreign body of right great toe without damage to nail,

initial encounter

S91.112A Laceration without foreign body of left great toe without damage to nail,

initial encounter

S91.113A Laceration without foreign body of unspecified great toe without damage to

nail, initial encounter

S91.114A Laceration without foreign body of right lesser toe(s) without damage to nail,

initial encounter

S91.115A Laceration without foreign body of left lesser toe(s) without damage to nail,

initial encounter

S91.116A Laceration without foreign body of unspecified lesser toe(s) without damage

to nail, initial encounter

S91.119A Laceration without foreign body of unspecified toe without damage to nail,

initial encounter

S91.121A Laceration with foreign body of right great toe without damage to nail, initial

encounter

ICD-10-CM - Code and Description

S91.122A Laceration with foreign body of left great toe without damage to nail, initial

encounter

S91.123A Laceration with foreign body of unspecified great toe without damage to nail,

initial encounter

S91.124A Laceration with foreign body of right lesser toe(s) without damage to nail,

initial encounter

S91.125A Laceration with foreign body of left lesser toe(s) without damage to nail,

initial encounter

S91.126A Laceration with foreign body of unspecified lesser toe(s) without damage to

nail, initial encounter

S91.129A Laceration with foreign body of unspecified toe(s) without damage to nail,

initial encounter

S91.131A Puncture wound without foreign body of right great toe without damage to

nail, initial encounter

S91.132A Puncture wound without foreign body of left great toe without damage to nail,

initial encounter

S91.133A Puncture wound without foreign body of unspecified great toe without

damage to nail, initial encounter

S91.134A Puncture wound without foreign body of right lesser toe(s) without damage to

nail, initial encounter

S91.135A Puncture wound without foreign body of left lesser toe(s) without damage to

nail, initial encounter

S91.136A Puncture wound without foreign body of unspecified lesser toe(s) without

damage to nail, initial encounter

S91.139A Puncture wound without foreign body of unspecified toe(s) without damage

to nail, initial encounter

S91.141A Puncture wound with foreign body of right great toe without damage to nail,

initial encounter

S91.142A Puncture wound with foreign body of left great toe without damage to nail,

initial encounter

S91.143A Puncture wound with foreign body of unspecified great toe without damage to

nail, initial encounter

S91.144A Puncture wound with foreign body of right lesser toe(s) without damage to

nail, initial encounter

S91.145A Puncture wound with foreign body of left lesser toe(s) without damage to nail,

initial encounter

S91.146A Puncture wound with foreign body of unspecified lesser toe(s) without

damage to nail, initial encounter

ICD-10-CM - Code and Description

S91.149A Puncture wound with foreign body of unspecified toe(s) without damage to

nail, initial encounter

S91.151A Open bite of right great toe without damage to nail, initial encounter

S91.152A Open bite of left great toe without damage to nail, initial encounter

S91.153A Open bite of unspecified great toe without damage to nail, initial encounter

S91.154A Open bite of right lesser toe(s) without damage to nail, initial encounter

S91.155A Open bite of left lesser toe(s) without damage to nail, initial encounter

S91.156A Open bite of unspecified lesser toe(s) without damage to nail, initial encounter

S91.159A Open bite of unspecified toe(s) without damage to nail, initial encounter

S91.201A Unspecified open wound of right great toe with damage to nail, initial

encounter

S91.202A Unspecified open wound of left great toe with damage to nail, initial

encounter

S91.203A Unspecified open wound of unspecified great toe with damage to nail, initial

encounter

S91.204A Unspecified open wound of right lesser toe(s) with damage to nail, initial

encounter

S91.205A Unspecified open wound of left lesser toe(s) with damage to nail, initial

encounter

S91.206A Unspecified open wound of unspecified lesser toe(s) with damage to nail,

initial encounter

S91.209A Unspecified open wound of unspecified toe(s) with damage to nail, initial

encounter

S91.211A Laceration without foreign body of right great toe with damage to nail, initial

encounter

S91.212A Laceration without foreign body of left great toe with damage to nail, initial

encounter

S91.213A Laceration without foreign body of unspecified great toe with damage to nail,

initial encounter

S91.214A Laceration without foreign body of right lesser toe(s) with damage to nail,

initial encounter

S91.215A Laceration without foreign body of left lesser toe(s) with damage to nail,

initial encounter

S91.216A Laceration without foreign body of unspecified lesser toe(s) with damage to

nail, initial encounter

S91.219A Laceration without foreign body of unspecified toe(s) with damage to nail,

initial encounter

ICD-10-CM - Code and Description

S91.221A Laceration with foreign body of right great toe with damage to nail, initial

encounter

S91.222A Laceration with foreign body of left great toe with damage to nail, initial

encounter

S91.223A Laceration with foreign body of unspecified great toe with damage to nail,

initial encounter

S91.224A Laceration with foreign body of right lesser toe(s) with damage to nail, initial

encounter

S91.225A Laceration with foreign body of left lesser toe(s) with damage to nail, initial

encounter

S91.226A Laceration with foreign body of unspecified lesser toe(s) with damage to nail,

initial encounter

S91.229A Laceration with foreign body of unspecified toe(s) with damage to nail, initial

encounter

S91.231A Puncture wound without foreign body of right great toe with damage to nail,

initial encounter

S91.232A Puncture wound without foreign body of left great toe with damage to nail,

initial encounter

S91.233A Puncture wound without foreign body of unspecified great toe with damage to

nail, initial encounter

S91.234A Puncture wound without foreign body of right lesser toe(s) with damage to

nail, initial encounter

S91.235A Puncture wound without foreign body of left lesser toe(s) with damage to nail,

initial encounter

S91.236A Puncture wound without foreign body of unspecified lesser toe(s) with

damage to nail, initial encounter

S91.239A Puncture wound without foreign body of unspecified toe(s) with damage to

nail, initial encounter

S91.241A Puncture wound with foreign body of right great toe with damage to nail,

initial encounter

S91.242A Puncture wound with foreign body of left great toe with damage to nail, initial

encounter

S91.243A Puncture wound with foreign body of unspecified great toe with damage to

nail, initial encounter

S91.244A Puncture wound with foreign body of right lesser toe(s) with damage to nail,

initial encounter

S91.245A Puncture wound with foreign body of left lesser toe(s) with damage to nail,

initial encounter

ICD-10-CM - Code and Description

S91.246A Puncture wound with foreign body of unspecified lesser toe(s) with damage to

nail, initial encounter

S91.249A Puncture wound with foreign body of unspecified toe(s) with damage to nail,

initial encounter

S91.251A Open bite of right great toe with damage to nail, initial encounter

S91.252A Open bite of left great toe with damage to nail, initial encounter

S91.253A Open bite of unspecified great toe with damage to nail, initial encounter

S91.254A Open bite of right lesser toe(s) with damage to nail, initial encounter

S91.255A Open bite of left lesser toe(s) with damage to nail, initial encounter

S91.256A Open bite of unspecified lesser toe(s) with damage to nail, initial encounter

S91.259A Open bite of unspecified toe(s) with damage to nail, initial encounter

S91.301A Unspecified open wound, right foot, initial encounter

S91.302A Unspecified open wound, left foot, initial encounter

S91.309A Unspecified open wound, unspecified foot, initial encounter

S91.311A Laceration without foreign body, right foot, initial encounter

S91.312A Laceration without foreign body, left foot, initial encounter

S91.319A Laceration without foreign body, unspecified foot, initial encounter

S91.321A Laceration with foreign body, right foot, initial encounter

S91.322A Laceration with foreign body, left foot, initial encounter

S91.329A Laceration with foreign body, unspecified foot, initial encounter

S91.331A Puncture wound without foreign body, right foot, initial encounter

S91.332A Puncture wound without foreign body, left foot, initial encounter

S91.339A Puncture wound without foreign body, unspecified foot, initial encounter

S91.341A Puncture wound with foreign body, right foot, initial encounter

S91.342A Puncture wound with foreign body, left foot, initial encounter

S91.349A Puncture wound with foreign body, unspecified foot, initial encounter

S91.351A Open bite, right foot, initial encounter

S91.352A Open bite, left foot, initial encounter

S91.359A Open bite, unspecified foot, initial encounter

S96.021A Laceration of muscle and tendon of long flexor muscle of toe at ankle and

foot level, right foot, initial encounter

S96.022A Laceration of muscle and tendon of long flexor muscle of toe at ankle and

foot level, left foot, initial encounter

S96.029A Laceration of muscle and tendon of long flexor muscle of toe at ankle and

foot level, unspecified foot, initial encounter

ICD-10-CM - Code and Description

S96.121A Laceration of muscle and tendon of long extensor muscle of toe at ankle and

foot level, right foot, initial encounter

S96.122A Laceration of muscle and tendon of long extensor muscle of toe at ankle and

foot level, left foot, initial encounter

S96.129A Laceration of muscle and tendon of long extensor muscle of toe at ankle and

foot level, unspecified foot, initial encounter

S96.221A Laceration of intrinsic muscle and tendon at ankle and foot level, right foot,

initial encounter

S96.222A Laceration of intrinsic muscle and tendon at ankle and foot level, left foot,

initial encounter

S96.229A Laceration of intrinsic muscle and tendon at ankle and foot level, unspecified

foot, initial encounter

S96.821A Laceration of other specified muscles and tendons at ankle and foot level,

right foot, initial encounter

S96.822A Laceration of other specified muscles and tendons at ankle and foot level, left

foot, initial encounter

S96.829A Laceration of other specified muscles and tendons at ankle and foot level,

unspecified foot, initial encounter

S96.921A Laceration of unspecified muscle and tendon at ankle and foot level, right

foot, initial encounter

S96.922A Laceration of unspecified muscle and tendon at ankle and foot level, left foot,

initial encounter

S96.929A Laceration of unspecified muscle and tendon at ankle and foot level,

unspecified foot, initial encounter

S98.011A Complete traumatic amputation of right foot at ankle level, initial encounter

S98.012A Complete traumatic amputation of left foot at ankle level, initial encounter

S98.019A Complete traumatic amputation of unspecified foot at ankle level, initial

encounter

S98.021A Partial traumatic amputation of right foot at ankle level, initial encounter

S98.022A Partial traumatic amputation of left foot at ankle level, initial encounter

S98.029A Partial traumatic amputation of unspecified foot at ankle level, initial

encounter

S98.111A Complete traumatic amputation of right great toe, initial encounter

S98.112A Complete traumatic amputation of left great toe, initial encounter

S98.119A Complete traumatic amputation of unspecified great toe, initial encounter

S98.121A Partial traumatic amputation of right great toe, initial encounter

S98.122A Partial traumatic amputation of left great toe, initial encounter

S98.129A Partial traumatic amputation of unspecified great toe, initial encounter

ICD-10-CM - Code and Description

S98.131A Complete traumatic amputation of one right lesser toe, initial encounter

S98.132A Complete traumatic amputation of one left lesser toe, initial encounter

S98.139A Complete traumatic amputation of one unspecified lesser toe, initial encounter

S98.141A Partial traumatic amputation of one right lesser toe, initial encounter

S98.142A Partial traumatic amputation of one left lesser toe, initial encounter

S98.149A Partial traumatic amputation of one unspecified lesser toe, initial encounter

S98.211A Complete traumatic amputation of two or more right lesser toes, initial

encounter

S98.212A Complete traumatic amputation of two or more left lesser toes, initial

encounter

S98.219A Complete traumatic amputation of two or more unspecified lesser toes, initial

encounter

S98.221A Partial traumatic amputation of two or more right lesser toes, initial encounter

S98.222A Partial traumatic amputation of two or more left lesser toes, initial encounter

S98.229A Partial traumatic amputation of two or more unspecified lesser toes, initial

encounter

S98.311A Complete traumatic amputation of right midfoot, initial encounter

S98.312A Complete traumatic amputation of left midfoot, initial encounter

S98.319A Complete traumatic amputation of unspecified midfoot, initial encounter

S98.321A Partial traumatic amputation of right midfoot, initial encounter

S98.322A Partial traumatic amputation of left midfoot, initial encounter

S98.329A Partial traumatic amputation of unspecified midfoot, initial encounter

S98.911A Complete traumatic amputation of right foot, level unspecified, initial

encounter

S98.912A Complete traumatic amputation of left foot, level unspecified, initial

encounter

S98.919A Complete traumatic amputation of unspecified foot, level unspecified, initial

encounter

S98.921A Partial traumatic amputation of right foot, level unspecified, initial encounter

S98.922A Partial traumatic amputation of left foot, level unspecified, initial encounter

S98.929A Partial traumatic amputation of unspecified foot, level unspecified, initial

encounter

T81.31XA Disruption of external operation (surgical) wound, not elsewhere classified,

initial encounter

T81.32XA Disruption of internal operation (surgical) wound, not elsewhere classified,

initial encounter

Transmittals Issued for this Chapter

Rev # Issue Date

Subject Impl Date CR#

R11129CP

11/22/2021

Reduced Payment for Physical Therapy and

Occupational Therapy Services Furnished In

Whole or In Part by a Physical Therapist

Assistant (PTA) or Occupational Therapy

Assistant (OTA)

01/03/2022 12397

08/13/2021

Reduced Payment for Physical Therapy and

Occupational Therapy Services Furnished In

Whole or In Part by a Physical Therapist

Assistant (PTA) or Occupational Therapy

Assistant (OTA)

SENSITIVE/CONTROVERSIAL-

Rescinded and replaced by Transmittal 11129

01/03/2022 12397

R4440CP 11/01/2019

New Modifiers to Identify Occupational

Therapy (OT) and Physical Therapy (PT)

Services Provided by a Therapy Assistant- No

Longer Sensitive/Controversial

01/06/2020 11362

09/01/2019

New Modifiers to Identify Occupational

Therapy (OT) and Physical Therapy (PT)

Services Provided by a Therapy Assistant

SENSITIVE/CONTROVERSIAL-

Rescinded and replaced by Transmittal 4440

01/06/2020 11362

R4214CP 01/25/2019

Updates to Reflect Removal of Functional

Reporting Requirements and Therapy

Provisions of the Bipartisan Budget Act of

2018

02/26/2019 11120

R3995CP 03/09/2018

Correction to Pub. 100-04, Chapter 5

06/11/2018 10509

R3936CP 12/21/2017

Updated Editing of Always Therapy Services -

MCS

01/02/2018 10176

R3863CP 09/15/2017

Updated Editing of Always Therapy Services

– MCS- Rescinded and replaced by

Transmittal 3936

01/02/2018 10176

Rev # Issue Date

Subject Impl Date CR#

R3814CP 07/27/2017

Updated Editing of Always Therapy Services

– MCS - Rescinded and replaced by

Transmittal 3863

01/02/2018 10176

R3670CP 12/01/2016

Update to Editing of Therapy Services to

Reflect Coding Changes

04/03/2017 9698

R3634CP 10/27/2016

Update to Editing of Therapy Services to

Reflect Coding Changes – Rescinded and

replaced by Transmittal 3670

04/03/2017 9698

R3475CP 03/04/2016

Updates to Pub. 100-04, Chapters 4 and 5 to

Correct Remittance Advice Messages

06/06/2016 9424

R3454CP 02/04/2016

Correction to Applying Therapy Caps to

Maryland Hospitals and Billing Requirement

for Rehabilitation Agencies and

Comprehensive Outpatient Rehabilitation

Facilities (CORFs)

07/05/2016 9489

R3367CP 10/07/2015

Applying Therapy Caps to Maryland Hospitals

01/04/2016 9223

R3309CP 08/06/2015

Applying Therapy Caps to Maryland Hospitals

– Rescinded and replaced by Transmittal 3367

01/04/2016 9223

R3220CP 03/16/2015

Update to Pub. 100-04, Chapters 5 and 6 to

Provide Language-Only Changes for Updating

ICD-10, ASC X12, and Medicare

Administrative Contractor (MAC)

Implementation

09/16/2014 8524

R3028CP 08/15/2014

Update to Pub. 100-04, Chapters 5 and 6 to

Provide Language-Only Changes for Updating

ICD-10, ASC X12, and Medicare

Administrative Contractor (MAC)

Implementation – Rescinded and replaced by

Transmittal 3220

09/16/2014 8524

R2899CP 03/07/2014

Pub 100-04, Language Only Update for

Chapters Five and Six for Conversion to ICD-

10/01/2014 8524

Rev # Issue Date

Subject Impl Date CR#

10 - Rescinded and replaced by Transmittal

3028

R2868CP 02/06/2014

Therapy Modifier Consistency Edits 07/07/2014 8556

R2859CP 01/17/2014

Applying the Therapy Caps to Critical Access

Hospitals

01/31/2014 8426

R2844CP 12/27/2013

2014 Annual Update to the Therapy Code List 01/06/2014 8482

R2809CP 11/06/2013

2014 Annual Update to the Therapy Code List

– Rescinded and replaced by Transmittal 2844

01/06/2014 8482

R2783CP 09/10/2013

Corrections to the Medicare Claims Processing

Manual

09/17/2013 8343

R2736CP 06/28/2013

Billing Social Work and Psychological

Services in Comprehensive Outpatient

Rehabilitation Facilities (CORFs)

10/07/2013 8257

R2725CP 06/14/2013

Corrections to the Medicare Claims Processing

Manual – Rescinded and replaced by

Transmittal 2783

09/17/2013 8343

R2690CP 05/03/2013

Billing Social Work and Psychological

Services in Comprehensive Outpatient

Rehabilitation Facilities (CORFs) – Rescinded

and replaced by Transmittal 2736

10/07/2013 8257

R2622CP 12/21/2012

Implementing the Claims-Based Data

Collection Requirement for Outpatient

Therapy Services -- Section 3005(g) of the

Middle Class Tax Relief and Jobs Creation Act

(MCTRJCA) of 2012

01/07/2013 8005

R2615CP 12/14/2012

Revisions of the Financial Limitation for

Outpatient Therapy Services-Section 3005 of

the Middle Class Tax Relief and Job Creation

Act of 2012

10/01/2012 7785

Rev # Issue Date

Subject Impl Date CR#

R2603CP 11/30/2012

Implementing the Claims-Based Data

Collection Requirement for Outpatient

Therapy Services -- Section 3005(g) of the

Middle Clas

s Tax Relief and Jobs Creation Act

(MCTRJCA) of 2012 – Rescinded and

replaced by Transmittal 2622

01/07/2013 8005

R2537CP 08/31/2012

Expiration of 2012

Therapy Cap Revisions and

User-Controlled Mechanism to Identify

Legislative Effective Dates

01/07/2013 7881

R2532CP 08/24/2012

Implementing the Claims-Based Data

Collection Requirement for Outpatient

Therapy Services -- Section 3005(g) of the

Middle Class Tax Relief and Jobs Creation Act

(MCTRJCA) of 2012 – Rescinded and

replaced by Transmittal 2603

01/07/2013 8005

R2457CP 04/27/2012

Revisions of the Financial Limitation for

Outpatient Therapy Services-Section 3005 of

the Middle Class Tax Relief and Job Creation

Act of 2012 – Rescinded and replaced by

Transmittal 2615

10/01/2012 7785

R2328CP 10/27/2011

Claim Adjustment Reason Code (CARC) Used

for Therapy Claims Subject to the Multiple

Procedure Payment Reduction

04/02/2012 7564

R2160CP 02/18/2011

Correction to Manual References in Chapter 5,

Section 20.2

05/19/2011 7315

R2121CP 12/17/2010

Reporting of Service Units With HCPCS 03/21/2011 7247

R2091CP 11/12/2010

Correct Reporting of Modifiers and Revenue

Codes on Claims for Therapy Services

04/04/2011 7170

R2073CP 10/22/2010

Therapy Cap Values for Calendar Year (CY)

2011

01/03/2011 7107

Rev # Issue Date

Subject Impl Date CR#

R2055CP 09/17/2010

Therapy Cap Values for Calendar Year (CY)

2011 – Rescinded and replaced by Transmittal

2073

01/03/2011 7107

R2044CP 09/03/2010

Revisions and Re-issuance of Audiology

Policies

09/30/2010 6447

R2007CP 07/23/2007

Revisions and Re-issuance of Audiology

Policies – Rescinded and replaced by

Transmittal 2044

08/11/2010 6447

R1985CP 06/11/2010

Clarifications and Updates of Therapy

Services Policies

07/11/2010 6980

R1975CP 05/28/2010

Revisions and Re-issuance of Audiology

Policies - Rescinded and replaced by

Transmittal 2007

07/28/2010 6447

R1951CP 04/27/2010

Removal of the Provider Reporting

Requirement for Total Number of Therapy

Visits Using Value Codes 50-53

10/04/2010 6899

R1921CP 02/19/2010

Billing for Services Related to Voluntary Uses

of Advanced Beneficiary Notices of

Noncoverage (ABNs)

04/05/2010 6563

R1894CP 01/15/2010

Billing for Services Related to Voluntary Uses

of Advanced Beneficiary Notices of

Noncoverage (ABNs) – Rescinded and

replaced by Transmittal 1921

04/05/2010 6563

R1876CP 12/18/2009

Coverage of Kidney Disease Patient Education

Services

04/05/2010 6557

R1860CP 11/20/2009

Therapy Cap Values for Calendar Year (CY)

2010

01/04/2010 6660

R1851CP 11/13/2009

Therapy Cap Values for Calendar Year (CY)

2010 – Rescinded and replaced by Transmittal

1860

01/04/2010 6660

Rev # Issue Date

Subject Impl Date CR#

R1850CP 11/13/2009

2010 Annual Update to the Therapy Code List 01/04/2010 6719

R1843CP 10/30/2009

Outpatient Mental Health Treatment

Limitation

01/04/2010 6686

R1840CP 10/29/2009

Billing for Services Related to Voluntary Uses

of Advanced Beneficiary Notices of

Noncoverage (ABNs) – Rescinded and

replaced by Transmittal 1894

04/05/2010 6563

R1733CP 05/08/2009

Manual Clarification for Skilled Nursing

Facility (SNF) and Therapy Billing

04/27/2009 6407

R1717CP 04/24/2009

Speech-Language Pathology Practice Payment

Policy

07/06/2009 6381

R1706CP 03/27/2009

Manual Clarification for Skilled Nursing

Facility (SNF) and Therapy Billing –

Rescinded and replaced by Transmittal 1733

04/27/2009 6407

R1678CP 02/13/2009

Outpatient Therapy Caps With Exceptions in

CY 2009

04/06/2009 6321

R1631CP 11/07/2008

Extension of Therapy Cap Exception Process 12/08/2008 6222

R1593CP 09/12/2008

Smoking and Tobacco Use Cessation

Counseling Billing Update for Comprehensive

Outpatient Rehabilitation Facilities (CORFs)

and Outpatient Physical Therapy Providers

(OPTs)

12/12/2008 6163

R1472CP 03/06/2008

Update of Institutional Claims References 04/07/2008 5893

R1459CP 02/22/2008

Comprehensive Outpatient Rehabilitation

Facility (CORF) Billing Requirement Updates

for Fiscal Year (FY) 2008

07/07/2008 5898

R1421CP 01/25/2008

Update of Institutional Claims References -

Rescinded and Replaced by Transmittal 1472

04/07/2008 5893

Rev # Issue Date

Subject Impl Date CR#

R1414CP 01/17/2008

Outpatient Therapy Caps Without KX

Modifier Exceptions Start January 1, 2008

01/07/2008 5871

R1407CP 01/10/2008

Outpatient Therapy Caps Without KX

Modifier Exceptions Start January 1, 2008 –

Replaced by Transmittal 1414

01/07/2008 5871

R1377CP 11/23/2007

2008 Annual Update to the Therapy Code List 01/07/2008 5810

R1183CP 02/09/2007

Infrared Therapy Devices 01/16/2007 5421

R1145CP 12/29/2006

Outpatient Therapy Cap Exceptions Process

for Calendar Year (CY) 2007

01/29/2007 5478

R1127CP 12/15/2006

Infrared Therapy Devices – Replaced by

Transmittal 1183

01/16/2007 5421

R1106CP 11/09/2006

Outpatient Therapy Cap Clarifications 12/09/2006 5271

R1019CP 08/03/2006

Outpatient Therapy - Additional DRA

Mandated Service Edits

01/02/2007 5253

R1016CP 07/28/2006

Outpatient Therapy - Additional DRA

Mandated Service Edit

01/02/2007 5253

R1000CP 07/19/2006

Common Working File (CWF) to the

Medicare Beneficiary Database (MBD) Data

Exchange Changes

10/02/2006 4300

R980CP 06/14/2006

Changes Conforming to CR 3648 Instructions

for Therapy Services - Replaces Rev. 941

10/02/2006 4014

R941CP 05/05/2006

Changes Conforming to CR 3648 Instructions

for Therapy Services

10/02/2006 4014

R908CP 04/21/2006

Common Working File (CWF) to the

Medicare Beneficiary Database (MBD) Data

Exchange Changes

10/02/2006 4300

Rev # Issue Date

Subject Impl Date CR#

R855CP 02/15/2006

Therapy Caps Exception Process 3/13/2006 4364

R853CP 02/13/2006

Therapy Caps Exception Process 3/13/2006 4364

R805CP 01/06/2006

Annual Update to the Therapy Code List 02/06/2006 4226

R771CP 12/02/2005

Revisions to Pub.100-04, Medicare Claims

Processing Manual in Preparation for the

National Provider Identifier

01/03/2006 4181

R759CP 11/18/2005

Therapy Caps to be Effective January 1, 2006 01/03/2006 4115

R515CP 04/01/2005

Update to 100-04 and Therapy Code Lists 07/05/2005 3647

R463CP 02/04/2005

Update to 100-04 and Therapy Code Lists 07/05/2005 3647

R319CP 10/22/2004

CORF/OPT Edit for Billing Inappropriate

Supplies

04/04/2005 3468

R042CP 12/08/2003

The Financial Limitation on Therapy Services 12/08/2003 3005

R030CP 11/14/2003

The Financial Limitation on Therapy Services 01/05/2004 2973

R001CP 10/01/2003

Initial Publication of Manual NA NA