(1) Fees for services provided by occupational therapists and physical therapists are payable only for the procedure codes listed below, and unless otherwise specified are payable according to the unit values listed in the RVP.
(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 services to those that 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) Except as provided by (6), the conversion factor used depends on the date the service was rendered:
(a) Effective July 1, 2002, the conversion factor for services performed by a licensed occupational therapist, or a licensed physical therapist within their scope of practice, is set at $4.25.
(b) Beginning January 1, 2003, the conversion factor will be adjusted in the manner specified by ARM 24.29.1536.
(4) Only the following codes found in the RVP may be billed for services provided by occupational therapists and physical therapists:
(a) All physical medicine and rehabilitation codes, except 97770 through 97781, may be billed. Code 97799 may be billed only for providing the following services and requires a separate written report describing the service provided when billing for this code:
(i) face-to-face conferences with payor representative(s) to update the status of a patient upon request of the payor;
(ii) a report associated with nonphysician conferences required by the payor; or
(iii) completion of a job description or job analysis form requested by the payor.
(b) Special services, procedures, and report codes 99070 and 99080 Nt bw billed. A separate written report must be submitted describing the service provided when billing for these codes.
(5) The explanations, protocols, comments, and directions for use contained in both the CPT manual and the RVP are to be applied to the procedure codes contained in this rule.
(6) Effective July 1, 2002, code 97750 is payable at $26.50 per 15-minute unit for a maximum of 24 15-minute increments of service per day. Beginning January 1, 2003, and each year annually thereafter, the amount payable per 15-minute unit for code 97750 shall increase by the percentage increase in the state's annual average weekly wage. If for any year the state's average weekly wage does not increase, the rate will be held at the existing level until there is a net increase in the state's average weekly wage.
(7) When physical or occupational therapists are billing code 97033 (iontophoresis), medication charges and electrode charges must each be billed separately for each visit using CPT code 99070.
(8) When occupational therapists or physical therapists are performing orthotics fitting and training (code 97504) or checking for orthotic/prosthetic use (code 97703), supplies and materials provided may be billed separately for each visit using CPT code 99070.