(1) Services rendered by occupational therapists and physical therapists from April 1, 1993 through June 30, 2002 are payable only for the procedure codes listed in (7) of this rule. None of the procedure codes, descriptions, or unit values in Relative Values for Physicians apply to occupational therapy and physical therapy services.

(2) Nothing in this rule is to be construed so as to broaden the scope of a provider's practice. Each provider is to limit their services to those which can be performed within the limits and restrictions of the provider's professional licensure. Providers may only charge for services performed that are consistent with the scope of their practice and licensure.

(3) The conversion factor used depends on the date the service was rendered:

(a) Effective April 1, 1993, the conversion factor for occupational therapists and physical therapists is $5.87.

(b) Effective January 1, 1994, and each year annually thereafter, the conversion factor will increase in the manner specified by ARM 24.29.1536.

(4) Occupational and physical therapists must obtain prior authorization for any of the following procedures:

(a) 97544, work hardening;

(b) 97546, work conditioning;

(c) 97750, off-site therapy;

(d) 97751, off-site equipment;

(e) 97764, job site visit; or

(f) 97770, physical capacity evaluation.

(5) The unit value for each procedure listed in (7) includes the value for the associated office visit.

(6) Where the fee for a procedure depends on the time spent by the provider, the time spent on the completion of reports is already included within the procedure code unless otherwise noted.

(7) The following special procedure codes, with the associated description and unit values, are recognized for physical medicine services:

 

	Procedure Code	Description	Unit Value
(a)	97010	treatment to one area; hot or cold packs	2.0
	97012	traction, mechanical	2.0
	97014	electrical stimulation (unattended)	2.0
	97016	vasopneumatic devices	2.0
	97018	paraffin bath	2.0
(b)	97020	microwave	2.0
	97022	whirlpool	2.0
	97024	diathermy	2.0
	97026	infrared	2.0
	97028	ultraviolet	2.0
(c)	97039	unlisted modality, equivalent in level of service to 97010-97028 (specify)	2.0
(d)	97050	treatment to one area involving two or more procedures from series 97010-97039	2.4
(e)	97110	treatment to one area, each visit; therapeutic exercises (teaching and supervision of exercises which will improve or enhance strength, range of motion, flexibility, and endurance, including passive, isotonic [concentric and eccentric], isometric, relaxation, posture, and endurance training)	5.6
	97112	neuromuscular reeducation (incorporating the concepts of motor control and motor learning to improve movement, balance, proprioceptive sense, kinesthetic sense, and perceptual motor skills [for example, neuromuscular treatment approaches, facilitation procedures, closed kinetic chain activities, developmental approaches, and sensory integration approaches])	5.6
	97114	functional activities (teaching of skills which will improve or enhance an individual's ability to perform functional activities [for example, bed mobility, transfers, gait, lifting, use of adaptive devices, joint protection and cognitive re-education] which are goal directed and task specific)	5.6
	97116	gait training (specific instructions in the proper patterns and components of walking and/or running; can be applied along a continuum from crutch training for very simple gait deviations to the application and instruction in complicated gait techniques for very complex gait dysfunctions)	5.6
	97118	electrical stimulation (manual)	5.6
(f)	97120	iontophoresis	5.6
	97121	phonophoresis	5.6
	97122	traction, manual	5.6
	97124	massage	5.6
	97126	contrast baths	5.6
	97128	ultrasound	5.6
(g)	97130	soft tissue mobilization	5.6
	97132	joint mobilization	5.6
	97133	rehabilitation taping	5.6
	97134	spray/stretch	5.6
	97136	postural drain	5.6
	97139	unlisted procedure, equivalent in level of service to 97110-97136 (specify)	5.6
(h)	97200	treatment involving one or more procedures from group A below, and at least one procedure also in group B	6.8
		Group A                                 Group B 97010-97039                        97118-97139 97118-97139                        97260 (minutes n/a) 97260 (minutes n/a)             97261 (minutes n/a) 97261 (minutes n/a)
(i)	97220	hubbard tank; each visit	7.2
(j)	97240	individual pool therapy or hubbard tank with therapeutic exercises; each visit (practitioner-supervised exercises and activities performed in a pool to enhance flexibility, coordination, strength, and/or cardiovascular capacity where buoyancy and/or decreased weight bearing are indicated)	8.8
	97241	group pool therapy or hubbard tank with therapeutic exercises, per person supervised; each visit	4.4
(k)	97260	manipulation (cervical, thoracic, lumbosacral, sacroiliac, hand, wrist) (separate procedure); one area	5.6
	97261	each additional area	2.6
(l)	97301	treatment involving one or more procedures from group A below, and at least one procedure also in group B	9.5
		Group A                           Group B 97110                               97118-97139 97112                               97260 (minutes n/a) 97114                               97261 (minutes n/a) 97116
(m)	97500	orthotics training (dynamic bracing splinting), upper extremities; each visit	6.6
(n)	97520	prosthetic training; each visit	6.6
(o)	97530	kinetic activities to increase coordination, strength and/or range of motion, one area (any two extremities or trunk); each visit (mechanized/computerized therapeutic exercise or activity to rehabilitate joint/muscle function using, for example, isokinetic, isotonic, isoinertial and/or isometric equipment)	7.4
(p)	97540	training in activities of daily living (self care skills and/or daily life management skills); each visit	6.6
	97544	work hardening; each one hour [an individualized therapist-supervised, work-oriented treatment process involving the worker in simulated or actual work tasks which are structured and graded to progressively increase physical tolerances, adaptability, pacing, knowledge of task performance, body-mechanics, efficiency, endurance, and productivity to return-to-work goals. To be conducted only when a job has been identified for the worker to return to and specific job demands have been identified through a job analysis.] Other services are billable separately from work hardening.	8.5
	97546	work conditioning; each one hour [an individualized, therapist-established and -supervised therapeutic exercise program which may include aerobic conditioning, education, limited work tasks and simulation, and progressive resistive functional exercises.]	8.5
(q)	97705	orthotic/prosthetic evaluation--deleted; to report use evaluation procedure code applicable to profession of provider
	97708	activities of daily living evaluation--deleted; to report use evaluation procedure code applicable to profession of provider
(r)	97719	face-to-face conference by therapist with payor representative(s) to update status of patient, upon request of payor or payor's authorized representative (content must be documented)	BR
(s)	97720	extremity testing for strength, dexterity, or stamina--deleted; to report use evaluation procedure code applicable to profession of provider
(t)	97750	physical or occupational therapy provided outside usual location of practice	12.0
	97751	physical or occupational therapy equipment and personnel provided outside usual location of practice	12.0
	97752	muscle testing with torque curves during isometric and isokinetic exercise, mechanized or computerized evaluations with printout (includes representation in graph form of muscle-joint measurements of velocity, acceleration, power, range of motion, endurance, and work)	9.0
(u)	97762	computerized movement analysis testing-- kinematic and/or kinetic (includes computerized measurement and analysis of functional human movement and the forces [velocity, acceleration, displacement, and muscle and joint reaction] involved in movement; can include interfacing or individual measurement of electromyogram muscle activity and/or force plate analysis [three-dimensional analysis of ground reaction forces during weight-bearing activities and movements])	9.0
	97764	job site visit, each 60 minutes (includes report)	12.0
(v)	97770	physical capacity evaluation, each 60 minutes, up to six hours (includes report) [Objective, directly observed measurement of a worker's ability to perform a variety of physical tasks combined with statements of abilities by worker and evaluator. Includes 97772 if requested along with physical capacity evaluation by insurer. Also called "physical tolerance screening", "functional capacity evaluation", "functional capacity assessment", or "work tolerance screening".]	14.0
(w)	97799	unlisted physical medicine service	BR
(x)	97800	New patient; routine level of service (one body part or localized area in otherwise generally healthy patient with few or no pre-existing conditions; service includes abbreviated history, clarifying tests, diagnosis, and limited treatment plan)	6.7
	97801	intermediate level of service (one or more body parts, areas, or systems affected in patient with significant but not complicated history or lengthy but not extended condition duration; service includes intermediate history, intermediate examination with up to three clarifying tests, diagnosis, and appropriate treatment plan)	9.9
	97802	complex level of service (two or more body parts, areas, or systems affected, complicated history, extended condition duration, severe injury, or complicating or precautionary circumstances; service includes extensive history, comprehensive examination with four or more clarifying tests, diagnosis, and comprehensive treatment plan)	13.0
(y)	97810	Established patient; routine level of level of service (see 97800)	4.0
	97811	intermediate level of service (see 97801)	6.7
	97812	complex level of service (see 97802)	9.9
(z)	97880	physical medicine supplies and durable medical equipment (including but not limited to corsets, heel lifts, lumbar rolls, ankle wraps, taping supplies, TENS electrodes, knee immobilizer or other braces, cervical collars, Thera-Band, surgical tubing, and prescription medicines)	BR
(aa)	98951	Report associated with nonphysician conference, required by payor	3.4
(ab)	99085	Completion of job description or job analysis forms; initial 30 minutes	4.2
	99086	each additional 15 minutes	2.1