Immunization Injections 90700 - 90749
Therapy CPT code list
Listing of the following codes does not imply that services are covered or applicable to all provider settings.
Underlined codes are “always therapy” services, regardless of who performs them. These codes always require therapy modifiers (GP, GO, GN).
+ These HCPCS/CPT codes sometimes represent therapy services. However, these codes always represent therapy services and require the use of a therapy modifier when performed by therapists. There are some circumstances when these codes will not be considered representative of therapy services and therapy limits (when they are in effect) will not apply. Codes marked + are not therapy services when:
• It is not appropriate to bill the service under a therapy plan of care, and
• They are billed by practitioners/providers of services who are not therapists, i.e., physicians, clinical nurse specialists, nurse practitioners and psychologists; or they are billed to fiscal intermediaries by hospitals for outpatient services which are performed by non-therapists.
While the “+” designates that a particular HCPCS/CPT code will not of itself always indicate that a therapy service was rendered, these codes always represent therapy services when rendered by therapists or by practitioners who are not therapists in situations where the service provided is integral to an outpatient rehabilitation therapy plan of care.
For these situations, these codes must always have a therapy modifier. For example, when the service is rendered by either a doctor of medicine or a nurse practitioner (acting within the scope of his or her license when performing such service), with the goal of rehabilitation, a modifier is required. When there is doubt about whether a service should be part of a therapy plan of care, WPS Medicare shall make that determination.
The underlined HCPCS codes on the above list do not have a + sign because they are considered “always therapy” codes and always require a therapy modifier. Therapy services, whether represented by “always therapy” codes, or + codes in the above list performed as outpatient rehabilitation therapy services, must follow all the policies for therapy services (e.g., Pub. 100-04, chapter 5; Pub. 100-02, chapters 12 and 15).
64550+ 95834+ 97032 97597+
90901+ 95851+ 97033 97598+
92506 95852+ 97034 97602+
92507 95992+ 97035 97605+
92508 96105+ 97036 97606+
92526 96110+ 97039 97550
92597 96111+ 97110 97755
92605 96125 97112 97760
92606 97001 97113 97761
92607 97002 97116 97762
92608 97003 97124 977799
92609 97004 97139 G0281
92610+ 97010 97140 G0283
92611+ 97012 97150 G0329
92612+ 97016 97530 0019T+
92614+ 97018 97532 0029T+
92616+ 97022 97533 0183T+
95831+ 97024 97535
95832+ 97026 97537
95833+ 97028 97542
Surgery CPT code list
Surgery - CPT code
10021 10022 General 2
10040 19499 Integumentary System 372
20000 29999 Musculoskeletal System 1525
30000 32999 Respiratory System 271
33010 37799 Cardiovascular System 543
38100 38999 Hemic and Lymphatic Systems 49
39000 39599 Mediastinum and Diaphragm 18
40490 49999 Digestive System 763
50010 53899 Urinary System 302
54000 55899 Male Genital System 143
55970 55980 Intersex Surgery 2
56405 58999 Female Genital System 180
59000 59899 Maternity Care and Delivery 59
60000 60699 Endocrine System 30
61000 64999 Nervous System 449
65091 68899 Eye and Ocular Adnexa 267
69000 69979 Auditory System 97
69990 69990 Operating Microscope 1
Therapeutic/ Diagnostic Infusions ( excludes chemo) 90780 - 90781
Therapeutic or Diagnostic Injections 90782 - 90799
Psychiatry 90801 - 90899
Biofeedback 90901 - 90911
Dialysis 90918 - 90999
Gastroenterology 91000 - 91299
Ophthalmology 92002 - 92499
Special Otorhinolaryngologic Services 92502 - 92599
Cardiovascular 92950 - 93799
Non-Invasive Vascular Diagnostic Studies 93875 - 93990
Pulmonary 94010 - 94799
Allergy and Clinical Immunology 95004 - 95199
Endocrinology 95250
Therapeutic or Diagnostic Injections 90782 - 90799
Psychiatry 90801 - 90899
Biofeedback 90901 - 90911
Dialysis 90918 - 90999
Gastroenterology 91000 - 91299
Ophthalmology 92002 - 92499
Special Otorhinolaryngologic Services 92502 - 92599
Cardiovascular 92950 - 93799
Non-Invasive Vascular Diagnostic Studies 93875 - 93990
Pulmonary 94010 - 94799
Allergy and Clinical Immunology 95004 - 95199
Endocrinology 95250
Neurology and Neuromuscular Procedures 95805 - 96004
Central Nervous System Assessments/Tests 96100 - 96117
Health and Behavior Assessment/Intervention 96150 - 96155
Chemotherapy Administration 96400 - 96549
Photodynamic Therapy 96567 - 96571
Special Dermatological Procedures 96900 - 96999
Physical Medicine and Rehabilitation 97001 - 97799
Medical Nutrition Therapy 97802 - 97804
Osteopathic Manipulative Treatment 98925 - 98929
Chiropractic Manipulative Treatment 98940 - 98943
Special Services Procedures and Reports 99000 - 99091
Qualifying Circumstances for Anesthesia 99100 - 99140
Sedation With or Without Analgesia 99141 - 99142
Other Services and procedures 99170 - 99199
Home Health Procedures/Services 99500 - 99539
Home Infusion Procedures 99551 - 99569
Central Nervous System Assessments/Tests 96100 - 96117
Health and Behavior Assessment/Intervention 96150 - 96155
Chemotherapy Administration 96400 - 96549
Photodynamic Therapy 96567 - 96571
Special Dermatological Procedures 96900 - 96999
Physical Medicine and Rehabilitation 97001 - 97799
Medical Nutrition Therapy 97802 - 97804
Osteopathic Manipulative Treatment 98925 - 98929
Chiropractic Manipulative Treatment 98940 - 98943
Special Services Procedures and Reports 99000 - 99091
Qualifying Circumstances for Anesthesia 99100 - 99140
Sedation With or Without Analgesia 99141 - 99142
Other Services and procedures 99170 - 99199
Home Health Procedures/Services 99500 - 99539
Home Infusion Procedures 99551 - 99569
Listing of the following codes does not imply that services are covered or applicable to all provider settings.
Underlined codes are “always therapy” services, regardless of who performs them. These codes always require therapy modifiers (GP, GO, GN).
+ These HCPCS/CPT codes sometimes represent therapy services. However, these codes always represent therapy services and require the use of a therapy modifier when performed by therapists. There are some circumstances when these codes will not be considered representative of therapy services and therapy limits (when they are in effect) will not apply. Codes marked + are not therapy services when:
• It is not appropriate to bill the service under a therapy plan of care, and
• They are billed by practitioners/providers of services who are not therapists, i.e., physicians, clinical nurse specialists, nurse practitioners and psychologists; or they are billed to fiscal intermediaries by hospitals for outpatient services which are performed by non-therapists.
While the “+” designates that a particular HCPCS/CPT code will not of itself always indicate that a therapy service was rendered, these codes always represent therapy services when rendered by therapists or by practitioners who are not therapists in situations where the service provided is integral to an outpatient rehabilitation therapy plan of care.
For these situations, these codes must always have a therapy modifier. For example, when the service is rendered by either a doctor of medicine or a nurse practitioner (acting within the scope of his or her license when performing such service), with the goal of rehabilitation, a modifier is required. When there is doubt about whether a service should be part of a therapy plan of care, WPS Medicare shall make that determination.
The underlined HCPCS codes on the above list do not have a + sign because they are considered “always therapy” codes and always require a therapy modifier. Therapy services, whether represented by “always therapy” codes, or + codes in the above list performed as outpatient rehabilitation therapy services, must follow all the policies for therapy services (e.g., Pub. 100-04, chapter 5; Pub. 100-02, chapters 12 and 15).
64550+ 95834+ 97032 97597+
90901+ 95851+ 97033 97598+
92506 95852+ 97034 97602+
92507 95992+ 97035 97605+
92508 96105+ 97036 97606+
92526 96110+ 97039 97550
92597 96111+ 97110 97755
92605 96125 97112 97760
92606 97001 97113 97761
92607 97002 97116 97762
92608 97003 97124 977799
92609 97004 97139 G0281
92610+ 97010 97140 G0283
92611+ 97012 97150 G0329
92612+ 97016 97530 0019T+
92614+ 97018 97532 0029T+
92616+ 97022 97533 0183T+
95831+ 97024 97535
95832+ 97026 97537
95833+ 97028 97542
Surgery CPT code list
Surgery - CPT code
10021 10022 General 2
10040 19499 Integumentary System 372
20000 29999 Musculoskeletal System 1525
30000 32999 Respiratory System 271
33010 37799 Cardiovascular System 543
38100 38999 Hemic and Lymphatic Systems 49
39000 39599 Mediastinum and Diaphragm 18
40490 49999 Digestive System 763
50010 53899 Urinary System 302
54000 55899 Male Genital System 143
55970 55980 Intersex Surgery 2
56405 58999 Female Genital System 180
59000 59899 Maternity Care and Delivery 59
60000 60699 Endocrine System 30
61000 64999 Nervous System 449
65091 68899 Eye and Ocular Adnexa 267
69000 69979 Auditory System 97
69990 69990 Operating Microscope 1
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