Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

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Title XVIII of the Social Security Act, §1835(a)(2)(A) addresses procedure for payment of claims of providers of services.

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Please Note: For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types.

Some articles contain a large number of codes. If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. Sometimes, a large group can make scrolling thru a document unwieldy. You can collapse such groups by clicking on the group header to make navigation easier. However, please note that once a group is collapsed, the browser Find function will not find codes in that group.

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For the most part, codes are no longer included in the LCD (policy). You will find them in the Billing & Coding Articles. Try using the MCD Search to find what you're looking for. Enter the code you're looking for in the "Enter keyword, code, or document ID" box. The list of results will include documents which contain the code you entered.

Coding Guidelines1. Outcome and Information Set (OASIS) data should support the medical necessity of the services documented in the medical records. For therapy services the OASIS M2200 should be filled out completely. An updated and completed OASIS for the billing period should be in the patient's medical records and made available to the Medicare Administrative Contractor (MAC) upon request. 2. HCPCS code G0152 (services of occupational therapist in home health setting, each 15 minutes) is the only required HCPCS code in home health. All others are for informational purposes only.3. It is usually not reasonable and necessary to have more than 1 form of heat treatment (paraffin bath, contrast baths) for a single condition per day. Therefore, documentation of the medical necessity of multiple heating modalities on the same date of service must be in the patient's medical records and made available to the MAC upon request.4. CPT® code 97140 (Manual Therapy Techniques) includes different treatment techniques. The patient's medical records should indicate which modalities were performed and this documentation made available to the MAC upon request.5. ICD-10 codes for Migraines (G43.XX codes) are included in this billing and coding article for patients that require training in how to reduce pain during basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs) by training in adaptive techniques, instruction in use of adaptive equipment and positioning. This can usually be done in 3-4 sessions.6. An Occupational Therapist can only recertify a patient under a plan of care if:

This page displays your requested Article. The document is broken into multiple sections. You can use the Contents side panel to help navigate the various sections. Articles are a type of document published by the Medicare Administrative Contractors (MACs). Articles often contain coding or other guidelines and may or may not be in support of a Local Coverage Determination (LCD).

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CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, §160.2 Treatment of Motor Function Disorders with Electric Nerve Stimulation and §160.15 Electrotherapy for Treatment of Facial Nerve Palsy (Bell’s Palsy)

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted G11.1, G71.2, T86.848 and R51.M05.7A, M05.8A, M06.0A, M06.8A, M08.0A, M08.2A, M08.4A, M08.9A, M19.09, M19.19, M19.29, M24.19, M24.29, M24.39, M24.49, M24.59, M24.69, M24.89, M25.39, M25.59, M25.69, M80.0AXA, M80.0AXD, M80.0AXG, M80.0AXK, M80.0AXP, M80.0AXS, M80.8AXA, M80.8AXD, M80.8AXG, M80.8AXK, M80.8AXP, M80.8AXS, S20.213A, S20.213D, S20.213S, S20.214A, S20.214D, S20.214S, S20.223A, S20.223D, S20.224A, S20.224D, S20.224S, S20.303A, S20.303D, S20.303S, S20.304A, S20.304D, S20.304S, S20.313A, S20.313D, S20.313S, S20.314A, S20.314D, S20.314S, S20.343A, S20.343D, S20.343S, S20.344A, S20.344D, S20.344S, S20.353A, S20.353D, S20.353S, S20.354A, S20.354D, S20.354S, S20.373A, S20.373D, S20.373S, S20.374A, S20.374D, S20.374S, G11.10, G11.11, G11.19, G71.20, G71.21, G71.220, G71.228 and G71.29. This revision is due to the Annual ICD-10 Code Update and is effective on October 1, 2020.

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Colorectal Sacral nerve lead or leads, inserted for the management of faecal incontinence in a patient with faecal incontinence refractory to conservative non- ...

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Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted D48.1 and added G31.80, G31.86, M80.0B1A, M80.0B1D, M80.0B1G, M80.0B1K, M80.0B1P, M80.0B1S, M80.0B2A, M80.0B2D, M80.0B2G, M80.0B2K, M80.0B2P, M80.0B2S, M80.0B9A, M80.0B9D, M80.0B9G, M80.0B9K, M80.0B9P, M80.0B9S, M80.8B1A, M80.8B1D, M80.8B1G, M80.8B1K, M80.8B1P, M80.8B1S, M80.8B2A, M80.8B2D, M80.8B2G, M80.8B2K, M80.8B2P, M80.8B2S, M80.8B9A, M80.8B9D, M80.8B9G, M80.8B9K, M80.8B9P, M80.8B9S, G43.E01, G43.E09, G43.E11 and G43.E19. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/01/23.

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Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted M51.36, M51.37 and T81.32XS and added F50.810, F50.811, F50.812, F50.813, F50.814, F50.819, F50.83, F50.84, M51.360, M51.361, M51.362, M51.369, M51.370, M51.371, M51.372, M51.379, M62.85, M65.90, M65.911, M65.912, M65.919, M65.921, M65.922, M65.929, M65.931, M65.932, M65.939, M65.941, M65.942, M65.949, M65.951, M65.952, M65.959, M65.961, M65.962, M65.969, M65.971, M65.972, M65.979, M65.98, M65.99, R41.85, T81.320A, T81.320D, T81.320S, T81.321A, T81.321D, T81.321S, T81.328A, T81.328D, T81.328S, T81.329A, T81.329D and T81.329S. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/24.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, AMA Plaza, 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of FAR 52.227-14 (December 2007) and/or subject to the restricted rights provisions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Home Health Occupational Therapy L34560.

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Under CMS National Coverage Policy added the following regulations and related verbiage: Title XVIII of the Social Security Act (SSA) §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim; 42 CFR §484.2 Home Health Services; CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §160.2 Treatment of Motor Function Disorders with Electric Nerve Stimulation and §160.15 Electrotherapy for Treatment of Facial Nerve Palsy (Bell’s Palsy), and CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 7, §40.2.4 Application of the General Principles to Occupational Therapy. Section headings were updated for regulations. Typographical errors were corrected throughout the article. This revision will become effective 10/1/21.

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS disclaims responsibility for any liability attributable to end user use of the CPT. CMS will not be liable for any claims attributable to any errors, omissions, or other inaccuracies in the information or material contained on this page. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

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Articles which directly support an LCD are known as “LCD Reference Articles”. The referenced LCD may be cited in the Article Text field and may also be linked to in the Related Documents field. Examples may include but are not limited to Response to Comments and some Billing and Coding Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article. Articles identified as “Not an LCD Reference Article” are articles that do not directly support a Local Coverage Determination (LCD). They do not include a citation of an LCD. An example would include, but is not limited to, the Self-Administered Drug (SAD) Exclusion List Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article. There are different article types: Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. The Medicare program provides limited benefits for outpatient prescription drugs. The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. Draft articles are articles written in support of a Proposed LCD. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD.

Under Article Text removed sentence “Muscle testing, manual (CPT® codes 95831-95834)The series of codes 95831-95834 are intended to report manual test of muscles or muscle groups for strength based on grading scales”

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Under CMS National Coverage Policy updated section headings for regulations and removed the following: CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Change Request 10308, Transmittal 3877, dated October 6, 2017 and CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Change Request 9771, Transmittal 3618, dated October 7, 2017. Typographical errors were corrected throughout the article.

K-L44643/10, Single row tapered roller bearing cup & cone set 1.00 ID 1.980 OD 0.560 Width Tapered roller bearings are designed to accommodate combined ...

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CPT codes, descriptions, and other data only are copyright 2024 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Other Comments1. The related policy is based on impairments of structure/function and functional limitations. While the pathophysiology is an important factor, the purpose of the related Home Health Occupational Therapy L34560 policy is to show the specific functional limitation of the patient.2. "Clinical note means a notation of a contact with a patient that is written and dated by a member of the health team and that describes signs and symptoms, treatment and drugs administered and the patient's reaction and any changes in physical or emotional condition". (42 CFR §484.2)3. "Progress note means a written notation, dated and signed by a member of the health team, that summarizes facts about care furnished and the patient's response during a given period of time". (42 CFR §484.2)

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2) Try using the MCD Search and enter your information in the "Enter keyword, code, or document ID" box. Your information could include a keyword or topic you're interested in; a Local Coverage Determination (LCD) policy or Article ID; or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code. Try entering any of this type of information provided in your denial letter.

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted F02.81, F03.91 and added G71.031, G71.032, G71.033, G71.0341, G71.0342, G71.0349, G71.035, G71.038, M62.5A0, M62.5A1, M62.5A2, S06.0XAA, S06.0XAD, S06.0XAS, S06.1XAA, S06.1XAD, S06.1XAS, S06.2XAA, S06.2XAD, S06.2XAS, S06.30AA, S06.30AD, S06.30AS, S06.31AA, S06.31AD, S06.31AS, S06.32AA, S06.32AD, S06.32AS, S06.34AA, S06.34AD, S06.34AS, S06.35AA, S06.35AD, S06.35AS, S06.37AA, S06.37AD, S06.37AS, S06.38AA, S06.38AD, S06.38AS, S06.4XAA, S06.4XAD, S06.4XAS, S06.5XAA, S06.5XAD, S06.5XAS, S06.6XAA, S06.6XAD, S06.6XAS, S06.81AA, S06.81AD, S06.81AS, S06.82AA, S06.82AD, S06.82AS, S06.89AA, S06.89AD, S06.89AS, S06.8A0A, S06.8A0D, S06.8A0S, S06.8A1A, S06.8A1D, S06.8A1S, S06.8A2A, S06.8A2D, S06.8A2S, S06.8A3A, S06.8A3D, S06.8A3S, S06.8A4A, S06.8A4D, S06.8A4S, S06.8A5A, S06.8A5D, S06.8A5S, S06.8A6A, S06.8A6D, S06.8A6S, S06.8A7A, S06.8A8A, S06.8A9A, S06.8A9D, S06.8A9S, S06.8AAA, S06.8AAD, S06.8AAS, F02.818, F02.A18, F02.B18, F02.C18. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

Articles which directly support an LCD are known as “LCD Reference Articles”. The referenced LCD may be cited in the Article Text field and may also be linked to in the Related Documents field. Examples may include but are not limited to Response to Comments and some Billing and Coding Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article.

Under CPT/HCPCS Codes Group 1: Codes deleted 97037 as this code was added in error. This revision is retroactive effective for dates of service on or after 1/1/24.

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 7, §40.2.4 Application of the General Principles to Occupational Therapy

Under CPT/HCPCS Codes Group 1: Codes CPT® codes 90911, 95831, 95832, 95833, 95834 and HCPCS code G0515 were deleted and the descriptions for CPT® codes 97760 and 97761 were changed.

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In order for CMS to change billing and claims processing systems to accommodate the coverage conditions within the NCD, we instruct contractors and system maintainers to modify the claims processing systems at the national or local level through CR Transmittals. CRs are not policy, rather CRs are used to relay instructions regarding the edits of the various claims processing systems in very descriptive, technical language usually employing the codes or code combinations likely to be encountered with claims subject to the policy in question. As clinical or administrative codes change or system or policy requirements dictate, CR instructions are updated to ensure the systems are applying the most appropriate claims processing instructions applicable to the policy.

Each insurer subject to this article shall supply each insured, and upon request each prospective insured prior to enrollment, written disclosure information.

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Under Article Title changed the title from “Occupational Therapy for Home Health” to “Billing and Coding: Home Health Occupational Therapy”. Under Article Text added the verbiage “The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Home Health Occupational Therapy L34560” to the first paragraph. Added the subheadings Fabrication/Application of Casts, Splints and Strapping; Muscle testing, manual; Range of Motion (ROM) Measurements; Therapeutic Exercise; Self-Care/Home Management Training; Wheelchair Management Training; and Electrical Stimulation Therapy along with the corresponding verbiage under each subheading. Under subheading Non-Covered ICD-10 Codes the first sentence was corrected to reflect ICD-10 codes being listed in the article. CPT® was inserted throughout the article where applicable. Formatting, punctuation and typographical errors were corrected throughout the article.

Articles are often related to an LCD, and the relationship can be seen in the “Associated Documents” section of the Article or the LCD. Article document IDs begin with the letter “A” (e.g., A12345). Draft articles have document IDs that begin with “DA” (e.g., DA12345).

Under Article Text Coding Guideline revised the cited therapy OASIS code to read M2200. Under #6 deleted the “s” from therapist, added CMS Internet-Only Manual, and revised the section cited to now read 40.2.4. Under Article Text- Other Comments added quotation marks for statements #2 and #3 as these were cited from 42 CFR 484.2. Punctuation was corrected throughout the Article Text section.

Articles identified as “Not an LCD Reference Article” are articles that do not directly support a Local Coverage Determination (LCD). They do not include a citation of an LCD. An example would include, but is not limited to, the Self-Administered Drug (SAD) Exclusion List Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article.

These materials contain NUBC Official UB-04 Specifications (UB-04 Data), which is copyrighted by the American Hospital Association (AHA).

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 97032, 97033, 97034, 97035 and added 97037, 97550 and 97551. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/24.

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Under Covered ICD-10 Codes Group 1: Codes code descriptions for G43.A0, G43.A1, I70.238, I70.248, J44.0 and M66.88 were revised. ICD-10 codes L89.006, L89.016, L89.026, L89.106, L89.116, L89.126, L89.136, L89.146, L89.156, L89.206, L89.216, L89.226, L89.306, L89.316, L89.326, L89.46, L89.506, L89.516, L89.526, L89.606, L89.616, L89.626, L89.816, L89.896, Q66.00, Q66.01, Q66.02, Q66.10, Q66.11, Q66.12, Q66.211, Q66.212, Q66.219, Q66.221, Q66.222, Q66.229, Q66.30, Q66.31, Q66.32, Q66.40, Q66.41, Q66.42, Q66.70, Q66.71, Q66.72, Q66.91, Q66.92, S02.121A, S02.121B, S02.121D, S02.121G, S02.121K, S02.121S, S02.122A, S02.122B, S02.122D, S02.122G, S02.122K, S02.122S, S02.129A, S02.129B, S02.129D, S02.129G, S02.129K and S02.129S were added.

Articles are a type of document published by the Medicare Administrative Contractors (MACs). Articles often contain coding or other guidelines and may or may not be in support of a Local Coverage Determination (LCD).

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16020/C3 SKF. Radial ball bearing 16020 /C3 SKF, 100x150x16mm. ... Ships inThe delivery time is longer for products longer than 1800 mm or 2300 mm due to import ...

HCPCS G0283 - Electrical stimulation (unattended), to 1 or more areas for indication(s) other than wound care, as part of a therapy plan of care. See CPT® code 97032 for instructions in manual electrical stimulation Most non-wound care electrical stimulation treatment provided as part of a therapy plan of care should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/assistive personnel) without constant, direct contact required throughout the treatment. Code G0283 is classified as a “supervised” modality. A supervised modality does not require direct (1-on-1) patient contact by the provider. Typically, electrical stimulation conducted via the application of electrodes is considered unattended electrical stimulation. Examples of unattended electrical stimulation modalities include, but are not limited to, Interferential Current (IFC), Transcutaneous Electrical Nerve Stimulation (TENS), cyclical muscle stimulation (Russian stimulation). Utilization of electrical stimulation may be necessary during the initial phase of treatment but there must be an improvement in function. These modalities should be utilized with appropriate therapeutic procedures to effect continued improvement. Note: Coverage for this indication is limited to those patients where the nerve supply to the muscle is intact, including brain, spinal cord and peripheral nerves and other non-neurological reasons for disuse are causing the atrophy (e.g., post-casting or splinting of a limb, and contracture due to soft tissue scarring). Documentation must clearly support the medical necessity of unattended electrical stimulation used for control of pain and swelling, with objective and/or subjective changes noted in swelling and/or pain within 12 visits. If no improvement is noted, a change in treatment plan (alternative strategies) should be implemented or documentation should support the need for continued use of this modality. Typically, patients can be trained in the use of a TENS unit for self-management of their pain. Up to 2 visits should be necessary to complete the training. Once training is successfully completed, this procedure should not be billed as a treatment modality in the clinic, as the patient would be independent in application and use of the modality.

Your MCD session is currently set to expire in 5 minutes due to inactivity. If your session expires, you will lose all items in your basket and any active searches. If you would like to extend your session, you may select the Continue Button.

This code is used for reporting the time associated with training the patient/client and/or caregiver in transfers in and out of the chair as well as propulsion on all surfaces.

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

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This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Home Health Occupational Therapy L34560 LCD and placed in this article.

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Under CPT/HCPCS Codes Group 1: Codes the description was revised for 29799. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/23.

NCDs do not contain claims processing information like diagnosis or procedure codes nor do they give instructions to the provider on how to bill Medicare for the service or item. For this supplementary claims processing information we rely on other CMS publications, namely Change Requests (CR) Transmittals and inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM).

Any ICD-10 code not listed in the ICD-10-CM Codes that Support Medical Necessity section of this billing and coding article may be subject to medical review.Non-covered Indications

This revision is due to the 2nd Quarter CPT®/HCPCS Code Update and is effective for dates of service on or after 4/1/2020

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted M54.5 and R63.3, added G04.82, M35.05, M35.06, M35.07, M45.A1, M45.A2, M45.A3, M45.A4, M45.A5, M45.A6, M45.A7, M45.A8, M45.AB, M54.51, M54.59, R63.39, and the description was revised for G71.20. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/21.

To use CPT® code 95851 for extremity ROM testing, every joint of an extremity would need to be tested with documentation of why such a thorough assessment was warranted.

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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An occupational therapist may use this code when addressing impairments of exercise tolerance due to cardiopulmonary impairments.

All coding located in the Coding Information section has been removed from the related Home Health Occupational Therapy L34560 LCD and added to this article.

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If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document. The contractor information can be found at the top of the document in the Contractor Information section (expand the section to see the details).

This code should not be used globally for all home instructions. When instructing the patient in a self-management program, use the code that best describes the focus of the self-management activity.