LCD L32710 - Therapy Services (PT, OT, SLP) · PDF fileLCD L32710 - Therapy Services (PT, OT, SLP) Contractor Information Contractor Name: Novitas Solutions, Inc. Contractor Number(s):

LCD L32710 - Therapy Services (PT, OT, SLP)

Contractor Information

Contractor Name:

Novitas Solutions, Inc.

Contractor Number(s):

04911, 07101, 07102, 07201, 07202, 07301, 07302, 04111, 04112, 04211, 04212, 04311, 04312, 04411, 04412

Contractor Type:

MAC Part A & B

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LCD Information

Document Information

LCD ID Number

L32710

LCD Title

Therapy Services (PT, OT, SLP)

Contractor’s Determination Number

L32710

AMA CPT/ADA CDT Copyright Statement

CPT only copyright 2002-2011 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association.

Primary Geographic Jurisdiction

Arkansas, Louisiana, Mississippi, Colorado, Texas, Oklahoma, New Mexico

Oversight Region

Central Office

Original Determination Effective Date

For services performed on or after 08/13/2012

Original Determination Ending Date

N/A

Revision Effective Date

For services performed on or after N/A

Revision Ending Date

N/A

CMS National Coverage Policy

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for therapy services. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for therapy services and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies regarding therapy services are found in the following Internet-Only Manuals (IOMs) published on the CMS Web site: Jurisdiction “H” Notice: Jurisdiction “H” comprises the states of Arkansas, Louisiana, Mississippi, Colorado, New Mexico, Oklahoma, and Texas. Novitas is responsible for claims payment and Local Coverage Determination (LCD) development for this jurisdiction. This LCD was created as a part of the legacy transition (8/13/2012 – 11/19/2012); and, is a consolidation of the previous legacy contractors’ policies. Coverage of each LCD begins when the state/contract number combination officially is integrated into the Jurisdiction. On the CMS MCD, this date is known as either the Original Effective Date or the Revision Effective Date. The following table details the official effective dates for each state/contract number combination.

ST Legacy A

Contractor

&

Contract Number

Legacy B

Contractor

&

Contract Number

J "H" MAC A

Contractor

&

Contract Number

J "H" MAC B

Contractor

&

Contract Number

J "H"

Effective

Date

AR PBSI: 00520 (J7) Novitas: 07102 08/13/12LA PBSI: 00528 (J7) Novitas: 07202 08/13/12AR PBSI: 00020 (J7) Novitas: 07101 08/20/12LA PBSI: 00233 (J7) Novitas: 07201 08/20/12MS PBSI: 00233 (J7) Novitas: 07301 08/20/12MS Cahaba: 00512 (J7) Novitas: 07302 10/22/12J 4 States

Trailblazer: 04901 Novitas: 04911 10/29/12

CO Trailblazer: 04101 Novitas: 04111 10/29/12NM Trailblazer: 04201 Novitas: 04211 10/29/12OK Trailblazer: 04301 Novitas: 04311 10/29/12TX Trailblazer: 04401 Novitas: 04411 10/29/12CO Trailblazer: 04102 Novitas: 04112 11/19/12NM Trailblazer: 04202 Novitas: 04212 11/19/12

Page 1 of 104(J12) LCD L32710 - Therapy Services (PT, OT, SLP) (Effective 08/13/2012)

7/30/2012https://www.novitas-solutions.com/policy/jh/l32710.html

ST Legacy A

Contractor

&

Contract Number

Legacy B

Contractor

&

Contract Number

J "H" MAC A

Contractor

&

Contract Number

J "H" MAC B

Contractor

&

Contract Number

J "H"

Effective

Date

OK Trailblazer: 04302 Novitas: 04312 11/19/12TX Trailblazer: 04402 Novitas: 04412 11/19/12 Indications and Limitations of Coverage and/or Medical Necessity

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for therapy services. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for therapy services and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies regarding therapy services are found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:

IOM Pub. 100-02, Chapter 15, Sections 220 and 230 (http://www.cms.gov/manuals/Downloads/bp102c15.pdf). •

IOM Pub. 100-04, Chapter 5 (http://www.cms.gov/manuals/downloads/clm104c05.pdf). •

The cornerstones of rehabilitative therapy are mobilization, education and therapeutic exercise. The goal of rehabilitative medicine is discernible, functional progress toward the restoration or maximization of impaired neuromuscular and musculoskeletal function. To that end, the dynamic component of therapy, mobilization and patient education should predominate. Passive modalities should be used in the “warm-up” phase of the patient encounter as preparation for or as an adjunct to therapeutic procedures, and in the “cool-down” phase for reduction of pain, swelling and other post-treatment syndromes. Though passive modalities may predominate in the earlier phases of rehabilitation where the patient’s ability to participate in therapeutic exercise is restricted, Medicare expects these modalities to never be the sole or predominant constituent of a therapy plan of care. Further, Medicare expects the patient’s record to clearly reflect medical necessity for passive modalities, especially those that exceed 25 percent of the cumulative service hours of rehabilitative therapy provided for any beneficiary under a plan of care. Complicating factors that may influence treatment, e.g., they may influence the type, frequency and/or duration of treatment, may be represented by diagnoses (see Pub. 100-04, Medicare Claims Processing Manual, Chapter 5, Section 10.2.C.3); by patient factors such as age, severity, acuity, multiple conditions, co-morbidities, and motivation; or by the patient’s social circumstances, such as the support of a significant other or the availability of transportation to therapy. In more refractory cases, the practitioner will support the need for continued care with documentation that clearly outlines the factors that affect the rate of recovery and reinforces the anticipation that further functional gain is expected. The contractor recognizes variability in strength, recovery time and the ability to be educated, and allows for a recertification for additional therapy, as long as adequate medical documentation by the supervising physician or therapist is recorded in the medical record and the patient continues to demonstrate progress. In all cases, whether the duration and intensity of rehabilitative services rendered are limited or extensive, Medicare expects the patient’s medical record to clearly demonstrate medical reasonableness and necessity for all therapy services, both active and passive. If an individual’s expected rehabilitation potential is insignificant, or the patient’s maximum rehabilitation potential have been realized, therapy is not reasonable and necessary and should not be reported to Medicare as a payable service. Though this LCD establishes limitations to duration and intensity of outpatient rehabilitation, Medicare expects that most patients will not require maximum numbers of services. Providing maximal services as a routine is of concern and will result in Medicare auditing. General Physical Medicine & Rehabilitation (PM&R) Guidelines This LCD applies to the therapy services coded with the 97XXX series of CPT codes. Per CMS definitions, therapy services include these services with a few exceptions. Please refer to the documents found at http://www.cms.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage for the complete listing of CPT codes that are “always” considered therapy services and those that are “sometimes” considered therapy services for coverage, requirement for plan of care, and coding purposes. Intervention with Physical Medicine and Rehabilitation (PM&R) modalities and procedures is indicated when an assessment by a physician, NPP and/or therapist supports utilization of the intervention, there is documentation of objective physical and functional limitations (signs and symptoms), and the written plan of care incorporates those treatment elements that are expected to result in improvement of these limitations in a reasonable and generally predictable period of time. PM&R services must be furnished on an outpatient basis and provided while the patient is or was under the care of a physician or NPP. Medicare covers therapy services personally performed only by one of the following:

Licensed therapy professionals: licensed PTs, OTs and SLPs. •

Licensed physical therapy assistants when supervised directly by a licensed PT. •

Licensed occupational therapy assistants when supervised directly by a licensed OT. •

Medical Doctors (MDs) and Doctors of Osteopathy (DOs). •

Doctors of Optometry (ODs) and Podiatric Medicine (DPMs) when performing services within their licenses’ scope of practice and their training and

competency.

•

Qualified NPPs, including Advanced Nurse Practitioners (ANPs), Physician Assistants (PAs) or Clinical Nurse Specialists (CNS) when performing

services within their licenses’ scope of practice and their training and competency (ANP, PA, CNS).

•

“Qualified” personnel when directly supervised by a physician (MD, DO, OD, DPM) or qualified NPP, and when all conditions of billing services

“incident to” a physician have been met. Qualified personnel have met the educational and degree requirements of a licensed therapy professional

(PT, OT, SLP), but are not required to be licensed. Please note that unless these therapy services are performed by a “qualified” person,

the services are not covered and must not be reported for Medicare payment.

•



Other specific requirements include the following: Medicare covers therapy services that require the skill of a trained and licensed practitioner to perform or supervise. Medicare does not cover

therapy services that do not require the skill of a trained and licensed practitioner to perform even when one of the persons in the list above

performs them.

•

A written plan of care, consisting of diagnoses (long-term treatment goals and type, amount, duration and frequency of therapy services), must be

established by the physician, NPP or therapist providing the services before the services are begun.

•

The plan must be periodically reviewed by the physician or NPP. ◦

A therapist may not significantly alter a plan of care established or certified by the physician or NPP without their documented written or verbal

approval.

◦

The plan must be certified and recertified periodically (see “Documentation Requirements” for details) by the physician or NPP. New or

significantly modified plans of care must be certified within 30 calendar days after the initial treatment under that plan, unless delayed

certification criteria are met.

◦

If certification is obtained verbally, it must be followed by a signature within 14 days to be timely. ◦

Recertifications must be obtained within the duration of the initial plan of care or within 90 calendar days of the initial treatment under that

plan, whichever is less.

◦

Services provided concurrently by a physician, PT and OT may be covered if separate and distinct goals are documented in the treatment

plans.

◦

The type, frequency and duration of services must be medically necessary for the patient’s condition under accepted medical, physical therapy and

occupational therapy practice standards and relate directly to a written treatment plan. There must be an expectation that the condition or level of

function will improve within a reasonable (and generally predictable) time or the services must be necessary to establish a safe and effective

maintenance regimen required in connection with a specific disease.

•

It is not medically necessary for a qualified professional to perform or supervise maintenance programs that do not require the professional skills of a qualified professional. These situations include:

Services related to activities for the general good and welfare of patients (i.e., general exercises to promote overall fitness and flexibility). ◦

Repetitive exercises to maintain gait or maintain strength and endurance, and assisted walking such as that provided in support for feeble or

unstable patients.

◦

Range of motion and passive exercises that are not related to restoration of a specific loss of function, but are useful in maintaining range of motion

in paralyzed extremities.

◦

Maintenance therapies after the patient has achieved therapeutic goals or for patients who show no further meaningful progress and should become

patient- or caregiver-directed.

◦

For all PM&R modalities and therapeutic procedures on a given day, it is usually not medically necessary to have more than one treatment session per discipline. Treatment times per session vary based upon the patient’s medical initial therapy needs and progress to date toward established goals. Treatment times per session typically will not exceed 45–60 minutes. Additional time is sometimes required for more complex and/or slow-to-respond patients. However, documentation of the exceptional circumstances must be maintained in the patient’s medical record and available upon request. For purposes of this policy, a “service” is defined as a 15-minute billing increment of a specific therapy CPT code. For codes that are defined as per 15 minutes or each 15 minutes, Medicare would not expect to see the qualified professional billing per treatment site. Report these codes based on the actual amount of time spent on a cumulative basis for the specified modality or procedure. For additional information, review unusual length of time issues in the “Documentation Requirements” section of this policy.

PM&R services in patients’ homes, qualified professionals’ offices, Skilled Nursing Facilities (SNFs), outpatient hospital clinics, Outpatient

Rehabilitation Facilities (ORFs) and Comprehensive Outpatient Rehabilitation Facilities (CORFs) are covered when reasonable and medically

necessary for the treatment of the patient’s condition (signs and symptoms).

•

Example Qualified professional ABC123XYZ orders ultrasound for the right and left shoulder areas and lower back. The medical records indicate the following:

US – R shoulder x 10 minutes. •

US – L shoulder x 10 minutes. •

US – Lower back x 10 minutes. •

The proper coding is 97035 x QB 2. Note: The actual number of minutes involved is 30, which equals a quantity of two.

For claims submitted by a physician or NPP: •

Services performed by non-employees or those not under a physician’s or NPP’s direct supervision are not covered. ◦

Services not relating to a written treatment plan are not medically necessary. ◦

Services that do not require the professional skills of a physician or NPP to perform or supervise are not medically necessary.

◦

For claims submitted by a Physical or Occupational Therapist (PT or OT) or Speech-Language Pathologist (SLP) in independent practice: •

An order, sometimes called a referral, for therapy service, if it is documented in the medical record, provides evidence of both the need for

care and that the patient is under the care of a physician.

◦

Claims submitted by anyone other than a therapist enrolled as a Medicare provider are not covered. ◦

Services not performed by or under the direct supervision of the therapist are not covered. ◦

Services performed by people who are not employees of the therapist are not covered. ◦

Services not furnished in the therapist’s office or in the patient’s home are not covered. ◦

Physical therapy services that do not require the professional skills of a qualified PT to perform or supervise are not medically necessary. ◦

Occupational therapy services that do not require the professional skills of a qualified OT to perform or supervise are not medically necessary. ◦

Speech-language pathology services that do not require the professional skills of a qualified SLP to perform or supervise are not medically

necessary.

◦

Maintenance Therapy



Maintenance therapy after therapeutic goals and/or rehabilitative potentials are reached is medically reasonable and necessary but is not covered. However, a qualified professional may develop a maintenance program for the patient to pursue outside of a therapy program and plan of care, generally administered and supervised by family or caregivers. Periodic evaluations of the patient’s condition and response to treatment may be covered when medically necessary if the judgment and skills of a qualified professional are required. Examples include:

Design of a maintenance regimen required to delay or minimize muscular and functional deterioration in patients suffering from a chronic disease. •

Instructing the patient, family member(s) or caregiver(s) in carrying out the maintenance program. •

Infrequent re-evaluations required to assess the patient’s condition and adjust the program. •

If a maintenance program is not established until after the therapy program has been completed (and the skills of a therapist are not necessary), development of a maintenance program is not considered reasonable and necessary for the patient’s condition. Note: Bill these services (e.g., codes 99212–99215, 97002, 97004) with the appropriate evaluation/re-evaluation. It is expected these services will be infrequently required. General Modality Guidelines (Codes 97012 and 97018–97039)

Modality codes 97012© (mechanical traction) and 97016©–97028© (vasopneumatic device, paraffin bath therapy, whirlpool therapy, diathermy,

and ultraviolet therapy) require supervision by the qualified professional; codes 97032©–97039© (electrical stimulation, contrast bath therapy,

ultrasound therapy, hydrotherapy, and physical therapy treatment unlisted) require direct (one-on-one) contact with the patient by the qualified

professional.

•

Therapeutic exercise and activities are essential for rehabilitation. The use of modalities as stand-alone treatment is not indicated as a sole

approach to rehabilitation. Therefore, an overall course of rehabilitative treatment is expected to consist predominantly of therapeutic procedures

(such as codes 97110© (therapeutic exercises), 97112© (neuromuscular re-education, 97116© (gait training therapy) and/or 97530©

(therapeutic activities)), with adjunctive use of modalities. Although passive modalities may play a larger role in the early stages of rehabilitation

and in treating exacerbations it is expected that modalities will comprise a small portion of the total therapy service time involved during the course

of rehabilitative therapy. Further, it is expected that the record will demonstrate both the patient’s clinical progress and concomitant appropriate

increasingly active therapeutic treatment.

•

When modality codes 97012© (mechanical traction) and 97018© (paraffin bath therapy) are used alone (absent therapeutic procedures and not as

a precursor to active treatment) and solely to promote healing, relieve muscle spasm, reduce inflammation and edema, or as analgesia, a limited

number of visits (e.g., 1–2) visits may be medically necessary to determine the effectiveness of treatment and for patient education. It is usually

not medically reasonable and necessary to continue modality-only treatment by the qualified professional.

•

Generally, adjunctive use of services billed with modality codes 97012© (mechanical traction) and 97018© (paraffin bath therapy) is coverable

only if they enhance the therapeutic procedures. Documentation supporting the medical necessity and clinical justification for the services’

continued use must be made available to Medicare upon request.

•

Generally, only one heating modality per day of therapy is reasonable and necessary. Medicare would not expect to see multiple heating modalities

billed routinely on the same day. Exceptions could include musculoskeletal pathology/injuries in which both superficial and deep structures are

impaired. Documentation containing clinical justification supporting the medical necessity for multiple heating modalities such as codes 97018,

97024, and 97035 on the same day is essential.

•

Generally, only one hydrotherapy modality is coverable per day when the sole purpose is to relieve muscle spasm, inflammation or edema.

Documentation must be available supporting the use of multiple modalities as contributing to the patient’s progress and restoration of function.

Because some of the modalities are considered components of other modalities and procedures they are not separately reimbursed. Please refer to

the Correct Coding Initiative.

•

Medicare does not provide payment for the therapeutic modality described as iontophoresis. •

Medicare does not provide payment for the therapeutic modality described as phonophoresis. •

Specific Modality Guidelines The following clinical guidelines pertain to the specific modalities listed. Please refer to the “ICD-9-CM Codes That Support Medical Necessity” section of this policy for appropriate covered diagnoses to be used with these modalities. G0283 – This modality includes the following types of electrical stimulation:

Transcutaneous Electrical Nerve Stimulation (TENS). •

Microamperage E-Stimulation (MENS). •

Percutaneous Electrical Nerve Stimulation (PENS). •

Electrogalvanic stimulation (high voltage pulsed current). •

Functional electrical stimulation. •

Interferential current/medium current. •

These types of electrical stimulation may be necessary during the initial phase of treatment, but there must be an expectation of improvement in function. Electrical stimulation must be utilized with appropriate therapeutic procedures (e.g., 97110) to effect continued improvement. Electrical stimulation is typically used in conjunction with therapeutic exercises. It is expected this modality will be used in a clearly adjunctive role and not as a major component of the therapeutic encounter. When electrical stimulation is used for muscle strengthening or retraining, the nerve supply to the muscle must be intact. It is not medically necessary for completely denervated motor nerve disorders in which there is no potential for recovery or restoration of function. 97012© (mechanical traction) – This modality, when provided by physicians or independent PTs, is typically used in conjunction with therapeutic procedures, not as an isolated treatment; however, it may be used in weaning an acute patient to a self-administered home program. 97016© (vasopneumatic device therapy) – Education for the home use of a lymphedema pump is sometimes provided by the lymphedema pump supplier. If the supplier does not provide this education, limited therapy professional visits for such purposes are allowable. Medicare does not expect to be routinely billed for repeated lymphedema treatments. Medicare expects that documentation in the physician’s medical record must support the necessity of repeated services. 97018© (paraffin bath therapy) – Also known as hot wax treatment, this modality may be medically necessary as an adjunct to other physical/occupational therapy interventions but this service is primarily used for pain relief in chronic joint problems of the wrists, hands



or feet. Most patients will be capable of self managing these treatments after education. Therefore, when not used as an adjunct to other physical/occupational therapy interventions, Medicare payment for these services will usually be limited to two or three visits. Documentation supporting the medical necessity for repetitive treatments must be made available to Medicare upon request. 97022©(whirlpool therapy) and 97036© (hydrotherapy) – These modalities involve the use of agitated water to relieve muscle spasms, improve circulation or cleanse wounds (e.g., ulcers, exfoliative skin conditions).

Physician or therapist supervision of the whirlpool modality must be medically necessary for the following indications: •

The patient’s condition is complicated by: •

Circulatory deficiency. ◦

Areas of desensitization. ◦

Impaired mobility or limitations in the positioning of the patient. ◦

Concerns about safety, if left unsupervised. ◦

Documentation supporting the medical necessity for additional sessions must be made available to Medicare upon request. •

It is not medically necessary to have more than one form of hydrotherapy during a treatment session. •

97028© (ultraviolet therapy) – Ultraviolet must be prescribed by the attending physician. Minimal erythema dosage must be documented and made available to Medicare upon request. 97032© (electrical stimulation) – See procedure code G0283 for clinical guidelines for this procedure. 97034© (contrast bath therapy) and 97035© (ultrasound therapy) – These modalities are generally used as adjuncts to a therapeutic procedure. 97039 – For all claims submitted with an unlisted modality code, a complete narrative description (detailing the service or procedure being performed) must be included on the claim. This code applies only to a procedure in which constant attendance was a requisite. General Guidelines for Therapeutic Procedures 97110–97546

Therapeutic procedures are procedures that attempt to reduce impairment and improve function through the application of clinical skills and/or

services.

•

Use of these procedures requires that the practitioner have direct (one-on-one) patient contact. •

Codes 97110© (therapeutic exercises), 97112© (neuromuscular re-education), 97113© (aquatic therapy/exercises) and 97530© (therapeutic

activities) describe several different types of therapeutic interventions. The expected goals documented in the treatment plan, affected by the use

of each of these procedures, will help define whether these procedures are reasonable and medically necessary. Therefore, since any one or a

combination of more than one of codes 97110© (therapeutic exercises), 97112© (neuromuscular re-education), 97113© (aquatic

therapy/exercises) and 97530© (therapeutic activities) may be used in a treatment plan, documentation must support the use of each code as it

relates to specific therapeutic goal(s).

•

Documentation supporting the medical necessity for continued treatment must be made available to Medicare upon request. •

Specific Guidelines for Therapeutic Procedures The following clinical guidelines pertain to the specific listed therapeutic procedures. Please refer to the “ICD-9-CM Codes That Support Medical Necessity” section of this policy for appropriate covered diagnoses to use for these therapeutic procedures. Per Change Request 2083 In accordance with established conditions, all rehabilitation services to beneficiaries with a primary vision impairment diagnosis must be provided pursuant to a written treatment plan established by a Medicare physician and implemented by approved Medicare qualified professionals (PTs or OTs) or as “incident to” physician services. Some of the following rehabilitation programs/services for beneficiaries with vision impairment may include Medicare covered therapeutic services.

Mobility. •

Activities of daily living. •

Other medically necessary services, including low-vision services. •

The patient must have a potential for restoration or improvement of lost functions, and must be expected to improve significantly within a reasonable and generally predictable amount of time. Rehabilitation services are not covered if the patient is unable to cooperate in the treatment program or if clear goals are not definable. Most rehabilitation is short-term and intensive, and maintenance therapy – services required to maintain a level of functioning – is not covered. For example, a person with an ICD-9-CM diagnosis of 369.08 (profound impairment in both eyes, i.e., best corrected visual acuity is less than 20/400 or visual field is 10 degrees or less) would generally be eligible for, and may be provided, rehabilitation services under CPT/HCPCS code 97535© (self-care/home management training, i.e., activities of daily living, compensatory training, meal preparation, safety procedures, and instruction in the use of adaptive equipment). 97110© (therapeutic exercises) – Therapeutic exercise to develop strength and endurance, range of motion, and flexibility: active, active-assisted or passive (e.g., treadmill, isokinetic exercise, lumbar stabilization, stretching, strengthening). The exercise may be reasonable and medically necessary for a loss or restriction of joint motion, strength, functional capacity or mobility that has resulted from a specific disease or injury. Documentation must show objective loss of joint motion, strength or mobility (e.g., degrees of motion, strength grades, levels of assistance). This therapeutic procedure is measured in 15-minute units with therapy sessions frequently consisting of several units. 97112© (neuromuscular re-education) – This therapeutic procedure is provided to improve balance, coordination, kinesthetic sense, posture, and proprioception (e.g., proprioceptive neuromuscular facilitation, Feldenkrais, Bobath, BAP’s boards and desensitization techniques). The procedure may be reasonable and medically necessary for impairments that affect the body’s neuromuscular system (e.g., poor static or dynamic sitting/standing balance, loss of gross and fine motor coordination, hypo/hypertonicity). 97113© (aquatic therapy) – This procedure uses the therapeutic properties of water (e.g., buoyancy, resistance). The procedure may be reasonable and medically necessary for a loss or restriction of joint motion, strength, mobility or function that has resulted from a specific disease or injury.



Documentation must show objective loss of joint motion, strength or mobility (e.g., degrees of motion, strength grades, levels of assistance). Do not use this code for situations where no exercise is being performed in the water environment (e.g., debridement of ulcers). When aquatic therapy is provided in a community pool, the provider must rent or lease at least a portion of the pool for the exclusive use of the patients. Other forms of exercise therapy may be medically necessary in addition to aquatic therapy when the patient cannot perform land-based exercises effectively to treat his condition without first undergoing the aquatic therapy, or when aquatic therapy facilitates progress to land-based exercise or increased function. Documentation must be available in the record to support medical necessity. It is not medically necessary to employ hydrotherapy and aquatic therapy during the same treatment session. Note: Hydrotherapy refers to codes 97022 and 97036. 97116© (gait training therapy) – This procedure may be medically necessary for training patients whose walking abilities have been impaired by neurological, muscular, or skeletal abnormalities or trauma. This procedure is not reasonable and necessary or medically necessary when the patient’s walking ability is not expected to improve. Repetitive walk-strengthening exercises for feeble or unstable patients or to increase endurance do not require qualified professional supervision and will be denied as not reasonable and necessary. Generally, CPT code 97116© (gait training therapy) should not be reported with 97760© (orthotic management and training). However, if a service represented by code 97760© (orthotic management and training) was performed on an upper extremity and a service represented by code 97116© (gait training) was also performed, both codes may be billed with modifier 59 to denote separate anatomic sites. 97124© (massage therapy) – This procedure may be medically necessary as adjunctive treatment to another therapeutic procedure on the same day, which is designed to restore muscle function, reduce edema, improve joint motion or for relief of muscle spasm. In most cases, postural drainage and pulmonary exercises can be carried out safely and effectively by ancillary personnel. If the attending physician determines that for the safe and effective administration of these procedures, the professional skills of a PT are required, coverage may be allowed. Documentation of the severity of the pulmonary condition and referral by the physician must be available. 97139© (physical medicine procedure unlisted) – For all claims submitted with an unlisted procedure code, a complete narrative description (detailing the service or procedure being performed) must be included on the claim. For Example: Report phonophoresis with CPT code 97139©. However, because there is no evidence from published, controlled clinical studies demonstrating the efficacy of this modality, phonophoresis will be denied as not proven safe and effective, and therefore is not a covered service. 97140© (manual yherapy) – Manual therapy such as mobilization, manipulation, manual traction and manual lymphatic drainage. Myofascial Release/Soft Tissue Mobilization This procedure may be medically necessary for the treatment of restricted motion of soft tissues involving the extremities, neck and/or trunk. Skilled manual techniques (active and/or passive) are applied to effect changes in the soft tissues, articular structures, neural or vascular systems. Examples include:

Facilitation of fluid exchange. •

Restoration of movement in acutely edematous; muscles. •

Stretching of shortened connective tissue. •

This procedure may be medically necessary as an adjunct to other therapeutic procedures such as codes 97110© (therapeutic exercises), 97112© (neuromuscular re-education) or 97530© (therapeutic activities). Manipulation CPT description for code 97140© (manual therapy) includes manual therapy and techniques such as manipulation, soft tissue mobilization or joint mobilization. Individual techniques should not be separately coded or billed since it is a time-based code. All techniques applied on the same date of service should be totaled into the time calculated for the code. This procedure may be medically necessary as an adjunct to other therapeutic procedures such as those represented by code 97110© (therapeutic exercises), 97112© (neuromuscular re-education) or 97530© (therapeutic activities). Joint Mobilization This procedure may be medically necessary as an adjunct to therapeutic exercises when loss of articular motion and flexibility impedes the therapeutic procedure. CPT description for code 97140© (manual therapy) includes manual therapy and techniques such as manipulation, soft tissue mobilization or joint mobilization. Individual techniques should not be separately coded or billed since it is a time-based code. All techniques applied on the same date of service should be totaled into the time calculated for the code. Documentation supporting the medical necessity for continued treatment must be made available to Medicare upon request. 97150© (group therapeutic procedures) – In the case of group therapy (untimed), Medicare expects that skilled, medically necessary services will be provided as appropriate to each patient’s plan of care. Therefore, group therapy sessions (two or more patients) should be of sufficient length to address the needs of each of the patients in the group. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one patient contact is not required.



Documentation must identify the specific treatment technique(s) used in the group, how the treatment technique will restore function, the frequency and duration of the particular group setting, and the treatment goal in the individualized (patient-specific) plan. The number of persons in the group must also be documented. These records must be made available to Medicare upon request. 97530© (therapeutic activities) – This procedure involves using functional activities (e.g., bending, lifting, carrying, reaching, catching and overhead activities) to improve functional performance in a progressive manner. The activities are usually directed at a loss or restriction of mobility, strength, balance or coordination. They require the professional skills of a qualified professional and are designed to address a specific functional need of the patient. These dynamic activities must be part of an active treatment plan and directed at a specific outcome. 97532© (cognitive skills development) – This activity focuses on cognitive skills development to improve attention, memory and problem-solving, with direct one-on-one patient contact by the qualified professional, each 15 minutes. 97533© (sensory integrative techniques) – This activity focuses on sensory integrative techniques to enhance sensory processing and to promote adaptive responses to environmental demands, with direct one-on-one contact by the qualified professional, each 15 minutes. 97535© (self care management training) – This procedure is medically necessary only when it requires the professional skills of a qualified professional, is designed to address specific needs of the patient and is part of an active treatment plan directed at a specific goal. The patient or caregiver must have the capacity to learn from instructions. Documentation supporting the medical necessity for continued treatment must be made available to Medicare upon request. Services provided concurrently by physicians, PTs and OTs may be covered if separate and distinct goals are documented in the treatment plans, and an integrated treatment plan is maintained by the requesting physician. Documentation must relate the training to expected functional goals the patient can attain. 97537© (community/work reintegration training) – This training may be medically necessary when performed in conjunction with a patient’s individual treatment plan aimed at improving or restoring specific functions that were impaired by an identified illness or injury, and when expected outcomes that are attainable by the patient are specified in the plan. This training is medically necessary only when it requires the professional skills of a qualified professional. Generally speaking, the professional skills of a qualified professional are not required to effect improvement or restoration of function when a patient suffers a temporary loss or reduction of function that could reasonably be expected to improve as the patient gradually resumes normal activities. General activity programs and all activities that are primarily social or diversional in nature will be denied because the professional skills of a qualified professional are not required. Services that are related solely to specific employment opportunities, work skills or work settings are not reasonable and necessary for the diagnosis and treatment of an illness or injury and are excluded from coverage by Section 1862(a)(1) of the Social Security Act. 97542© (wheelchair management training) – This procedure is medically necessary only when it requires the professional skills of a qualified professional, is designed to address specific needs of the patient and is part of an active treatment plan directed at a specific goal. The patient or caregiver must have the capacity to learn from instructions. Documentation of medical necessity must be available on request for an unusual frequency or duration of training sessions. Typically, up to four sessions within one month is sufficient. When billing code 97542 for wheelchair propulsion training, documentation must relate the training to expected functional goals the patient can attain. 97545© (work hardening) and 97546© (work hardening add-on) – These services are related solely to specific work skills and will be denied as not medically necessary for the diagnosis or treatment of an illness or injury. 97750© (physical performance test) – This testing may be medically necessary for patients with neurological or musculoskeletal conditions when such tests are needed to formulate or evaluate a specific treatment plan or to determine a patient’s capacity. The patient’s medical record must document the problem requiring tests, the specific tests performed and a measurement report. Documentation must be submitted with the claim identifying the need for more than 30 minutes of time. 97755© (assistive technology assessment) – Assistive technology assessment to restore, augment or compensate for existing function or optimize functional tasks requires direct one-on-one contact with the qualified professional, and a written report, each 15 minutes. 97760© (orthotic management and training) – The medical record should document the distinct treatments rendered when orthotic training for a lower extremity is performed during the same treatment session as gait training (97116) or self-care/home management training (97535). It is unusual to require more than 30 minutes of static orthotics training. In some cases, dynamic training may require additional time. Documentation supporting the medical necessity for additional time must be made available to Medicare upon request. Generally, CPT code 97116 should not be reported with 97760. However, if a service represented by code 97760 was performed on an upper extremity and a service represented by code 97116© (gait training) was also performed, both codes may be billed with modifier 59



to denote separate anatomic sites. 97761© (prosthetic training) – The medical record should document the distinct goal(s) and service(s) rendered when prosthetic training for a lower extremity is performed during the same treatment session as gait training (97116) or self-care/home-management training (97535). It is unusual to require more than 30 minutes of prosthetic training per day. Documentation supporting the medical necessity for additional time must be made available to Medicare upon request. 97762© (check-out for orthotic use) – These assessments may be medically necessary when a device is newly issued or there is a modification or reissue of the device. These assessments may be medically necessary when patients experience loss of function directly related to the orthotic or prosthetic device (e.g., pain, skin breakdown or falls). Documentation must be submitted with the claim identifying the need for more than 30 minutes of time. 97799 – For all claims submitted with an unlisted procedure code, a complete narrative description (detailing the service or procedure being performed) must be included on the claim. 97001–97004 (PT and OT evaluations) – These services are separately billable under one of the three different types of practitioners referenced in the “Description” section of this policy. However, physicians may not report any of these codes in conjunction with an evaluation and management code performed on the same day. 95992 – If canalith repositioning is performed by therapy personnel under a therapy plan of care, Medicare expects a physical therapist to perform the service. Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules. As published in CMS IOM 100-08, Section 13.5.1, in order to be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:

Safe and effective. •

Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19,

2000, that meet the requirements of the Clinical Trials NCD are considered reasonable and necessary).

•

Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is: •

Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient's condition or to improve the

function of a malformed body member.

◦

Furnished in a setting appropriate to the patient’s medical needs and condition. ◦

Ordered and furnished by qualified personnel. ◦

One that meets, but does not exceed, the patient’s medical needs. ◦

At least as beneficial as an existing and available medically appropriate alternative. ◦

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Coding Information

Bill Type Codes

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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

012x Hospital Inpatient (Medicare Part B only)

013x Hospital Outpatient

018x Hospital - Swing Beds

021x Skilled Nursing - Inpatient (Including Medicare Part A)

022x Skilled Nursing - Inpatient (Medicare Part B only)

023x Skilled Nursing - Outpatient

071x Clinic - Rural Health

074x Clinic - Outpatient Rehabilitation Facility (ORF)

075x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)

085x Critical Access Hospital

Revenue Codes

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 policy 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 policy should be assumed to apply equally to all Revenue Codes.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.

042X Physical Therapy - General Classification

043X Occupational Therapy - General Classification

044X Speech Therapy - Language Pathology - General Classification

CPT/HCPCS Codes

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical

Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in

policies published on the Web.

95992 Canalith repositioning proc

97001 Pt evaluation

97002 Pt re-evaluation

97003 Ot evaluation

97004 Ot re-evaluation

97012 Mechanical traction therapy

97016 Vasopneumatic device therapy

97018 Paraffin bath therapy

97022 Whirlpool therapy

97024 Diathermy eg microwave

97028 Ultraviolet therapy

97032 Electrical stimulation

97034 Contrast bath therapy

97035 Ultrasound therapy

97036 Hydrotherapy

97039 Physical therapy treatment

97110 Therapeutic exercises

97112 Neuromuscular reeducation

97113 Aquatic therapy/exercises

97116 Gait training therapy

97124 Massage therapy

97139 Physical medicine procedure

97140 Manual therapy

97150 Group therapeutic procedures

97530 Therapeutic activities

97532 Cognitive skills development

97533 Sensory integration

97535 Self care mngment training

97537 Community/work reintegration

97542 Wheelchair mngment training

97545 Work hardening

97546 Work hardening add-on

97750 Physical performance test

97755 Assistive technology assess

97760 Orthotic mgmt and training

97761 Prosthetic training



97762 C/o for orthotic/prosth use

97799 Physical medicine procedure

G0283 Elec stim other than wound

ICD-9 Codes that Support Medical Necessity

Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims. Note: Limited coverage for CPT codes 97001, 97002, 97003, 97004, 97016, 97139, 97150, 97532, 97533 and 97755 is not being established at this time. The CPT/HCPCS codes included in this policy will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary. Medicare is establishing the following limited coverage for CPT/HCPCS codes G0283 – electrical stimulation and 97032 – electrical stimulation, manual:

Covered for:

191.0 - 191.9MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE

274.00 GOUTY ARTHROPATHY, UNSPECIFIED

274.02 - 274.03CHRONIC GOUTY ARTHROPATHY WITHOUT MENTION OF TOPHUS (TOPHI) - CHRONIC GOUTY ARTHROPATHY WITH TOPHUS (TOPHI)

274.9 GOUT UNSPECIFIED

333.79 OTHER ACQUIRED TORSION DYSTONIA

333.83 SPASMODIC TORTICOLLIS

337.20 - 337.22 REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED - REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER LIMB

337.29 REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED SITE

338.0 CENTRAL PAIN SYNDROME

338.19 OTHER ACUTE PAIN

338.3 NEOPLASM RELATED PAIN (ACUTE) (CHRONIC)

342.00 - 342.02 FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

342.10 - 342.12 SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

342.80 - 342.82 OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

342.90 - 342.92 UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

344.60 - 344.61CAUDA EQUINA SYNDROME WITHOUT NEUROGENIC BLADDER - CAUDA EQUINA SYNDROME WITH NEUROGENIC BLADDER

346.00 - 346.03MIGRAINE WITH AURA, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - MIGRAINE WITH AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.10 - 346.13MIGRAINE WITHOUT AURA, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - MIGRAINE WITHOUT AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.20 - 346.23VARIANTS OF MIGRAINE, NOT ELSEWHERE CLASSIFIED, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - VARIANTS OF MIGRAINE, NOT ELSEWHERE CLASSIFIED, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.30 - 346.33HEMIPLEGIC MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - HEMIPLEGIC MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.40 - 346.43MENSTRUAL MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - MENSTRUAL MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.50 - 346.53PERSISTENT MIGRAINE AURA WITHOUT CEREBRAL INFARCTION, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - PERSISTENT MIGRAINE AURA WITHOUT CEREBRAL INFARCTION, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS



346.60 - 346.63PERSISTENT MIGRAINE AURA WITH CEREBRAL INFARCTION, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - PERSISTENT MIGRAINE AURA WITH CEREBRAL INFARCTION, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.70 - 346.73CHRONIC MIGRAINE WITHOUT AURA, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - CHRONIC MIGRAINE WITHOUT AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.80 - 346.83OTHER FORMS OF MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - OTHER FORMS OF MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

350.1 TRIGEMINAL NEURALGIA

353.0 - 353.6 BRACHIAL PLEXUS LESIONS - PHANTOM LIMB (SYNDROME)

353.8 OTHER NERVE ROOT AND PLEXUS DISORDERS

354.0 - 354.5 CARPAL TUNNEL SYNDROME - MONONEURITIS MULTIPLEX

354.8 - 354.9 OTHER MONONEURITIS OF UPPER LIMB - MONONEURITIS OF UPPER LIMB UNSPECIFIED

355.0 - 355.6 LESION OF SCIATIC NERVE - LESION OF PLANTAR NERVE

355.71 CAUSALGIA OF LOWER LIMB

355.8 - 355.9 MONONEURITIS OF LOWER LIMB UNSPECIFIED - MONONEURITIS OF UNSPECIFIED SITE

457.0 POSTMASTECTOMY LYMPHEDEMA SYNDROME

524.60 - 524.63 TEMPOROMANDIBULAR JOINT DISORDERS UNSPECIFIED - TEMPOROMANDIBULAR JOINT DISORDERS ARTICULAR DISC DISORDER (REDUCING OR NON-REDUCING)

524.69 TEMPOROMANDIBULAR JOINT DISORDERS OTHER SPECIFIED TEMPOROMANDIBULAR JOINT DISORDERS

564.6 ANAL SPASM

569.42 ANAL OR RECTAL PAIN

596.51 HYPERTONICITY OF BLADDER

596.55 DETRUSOR SPHINCTER DYSSYNERGIA

601.1 CHRONIC PROSTATITIS

602.8 OTHER SPECIFIED DISORDERS OF PROSTATE

608.9 UNSPECIFIED DISORDER OF MALE GENITAL ORGANS

616.10 VAGINITIS AND VULVOVAGINITIS UNSPECIFIED

617.0 ENDOMETRIOSIS OF UTERUS

618.01 CYSTOCELE, MIDLINE

618.04 RECTOCELE

618.1 UTERINE PROLAPSE WITHOUT VAGINAL WALL PROLAPSE

618.83 PELVIC MUSCLE WASTING

625.0 - 625.1 DYSPAREUNIA - VAGINISMUS

625.3 DYSMENORRHEA

625.6 STRESS INCONTINENCE FEMALE

625.9 UNSPECIFIED SYMPTOM ASSOCIATED WITH FEMALE GENITAL ORGANS

665.60 - 665.61 DAMAGE TO PELVIC JOINTS AND LIGAMENTS UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - DAMAGE TO PELVIC JOINTS AND LIGAMENTS WITH DELIVERY

665.64 DAMAGE TO PELVIC JOINTS AND LIGAMENTS POSTPARTUM

711.50 - 711.59 ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH OTHER VIRAL DISEASES - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH OTHER VIRAL DISEASES

711.60 - 711.69 ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH MYCOSES - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH MYCOSES

711.70 - 711.79ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH HELMINTHIASIS - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH HELMINTHIASIS

711.80 - 711.89ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH OTHER INFECTIOUS AND PARASITIC DISEASES - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH OTHER INFECTIOUS AND PARASITIC DISEASES

711.90 - 711.99 UNSPECIFIED INFECTIVE ARTHRITIS SITE UNSPECIFIED - UNSPECIFIED INFECTIVE ARTHRITIS INVOLVING MULTIPLE SITES



712.10 - 712.19 CHONDROCALCINOSIS DUE TO DICALCIUM PHOSPHATE CRYSTALS INVOLVING UNSPECIFIED SITE - CHONDROCALCINOSIS DUE TO DICALCIUM PHOSPHATE CRYSTALS INVOLVING MULTIPLE SITES

712.20 - 712.29 CHONDROCALCINOSIS DUE TO PYROPHOSPHATE CRYSTALS INVOLVING UNSPECIFIED SITE - CHONDROCALCINOSIS DUE TO PYROPHOSPHATE CRYSTALS INVOLVING MULTIPLE SITES

712.30 - 712.39 CHONDROCALCINOSIS CAUSE UNSPECIFIED INVOLVING UNSPECIFIED SITE - CHONDROCALCINOSIS CAUSE UNSPECIFIED INVOLVING MULTIPLE SITES

712.80 - 712.89OTHER SPECIFIED CRYSTAL ARTHROPATHIES SITE UNSPECIFIED - OTHER SPECIFIED CRYSTAL ARTHROPATHIES INVOLVING MULTIPLE SITES

712.90 - 712.99UNSPECIFIED CRYSTAL ARTHROPATHY SITE UNSPECIFIED - UNSPECIFIED CRYSTAL ARTHROPATHY INVOLVING MULTIPLE SITES

713.0 - 713.8ARTHROPATHY ASSOCIATED WITH OTHER ENDOCRINE AND METABOLIC DISORDERS - ARTHROPATHY ASSOCIATED WITH OTHER CONDITIONS CLASSIFIABLE ELSEWHERE

714.0 - 714.2 RHEUMATOID ARTHRITIS - OTHER RHEUMATOID ARTHRITIS WITH VISCERAL OR SYSTEMIC INVOLVEMENT

714.30 - 714.33 CHRONIC OR UNSPECIFIED POLYARTICULAR JUVENILE RHEUMATOID ARTHRITIS - MONOARTICULAR JUVENILE RHEUMATOID ARTHRITIS

714.4 CHRONIC POSTRHEUMATIC ARTHROPATHY

714.81 RHEUMATOID LUNG

714.89 OTHER SPECIFIED INFLAMMATORY POLYARTHROPATHIES

714.9 UNSPECIFIED INFLAMMATORY POLYARTHROPATHY

715.00 OSTEOARTHROSIS GENERALIZED INVOLVING UNSPECIFIED SITE

715.04 OSTEOARTHROSIS GENERALIZED INVOLVING HAND

715.09 OSTEOARTHROSIS GENERALIZED INVOLVING MULTIPLE SITES

715.10 - 715.18 OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING OTHER SPECIFIED SITES

715.20 - 715.28OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING OTHER SPECIFIED SITES

715.30 - 715.38OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY INVOLVING OTHER SPECIFIED SITES

715.80 OSTEOARTHROSIS INVOLVING OR WITH MORE THAN ONE SITE BUT NOT SPECIFIED AS GENERALIZED AND INVOLVING UNSPECIFIED SITE

715.89 OSTEOARTHROSIS INVOLVING OR WITH MULTIPLE SITES BUT NOT SPECIFIED AS GENERALIZED

715.90 - 715.98OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING OTHER SPECIFIED SITES

716.00 - 716.09 KASCHIN-BECK DISEASE SITE UNSPECIFIED - KASCHIN-BECK DISEASE INVOLVING MULTIPLE SITES

716.10 - 716.19 TRAUMATIC ARTHROPATHY SITE UNSPECIFIED - TRAUMATIC ARTHROPATHY INVOLVING MULTIPLE SITES

716.20 - 716.29 ALLERGIC ARTHRITIS SITE UNSPECIFIED - ALLERGIC ARTHRITIS INVOLVING MULTIPLE SITES

716.30 - 716.39 CLIMACTERIC ARTHRITIS SITE UNSPECIFIED - CLIMACTERIC ARTHRITIS INVOLVING MULTIPLE SITES

716.40 - 716.49 TRANSIENT ARTHROPATHY SITE UNSPECIFIED - TRANSIENT ARTHROPATHY INVOLVING MULTIPLE SITES

716.50 - 716.59UNSPECIFIED POLYARTHROPATHY OR POLYARTHRITIS SITE UNSPECIFIED - UNSPECIFIED POLYARTHROPATHY OR POLYARTHRITIS INVOLVING MULTIPLE SITES

717.0 - 717.3OLD BUCKET HANDLE TEAR OF MEDIAL MENISCUS - OTHER AND UNSPECIFIED DERANGEMENT OF MEDIAL MENISCUS

717.40 - 717.43DERANGEMENT OF LATERAL MENISCUS UNSPECIFIED - DERANGEMENT OF POSTERIOR HORN OF LATERAL MENISCUS

717.49 OTHER DERANGEMENT OF LATERAL MENISCUS

717.5 DERANGEMENT OF MENISCUS NOT ELSEWHERE CLASSIFIED

717.81 - 717.85OLD DISRUPTION OF LATERAL COLLATERAL LIGAMENT - OLD DISRUPTION OF OTHER LIGAMENTS OF KNEE

718.20 - 718.29 PATHOLOGICAL DISLOCATION OF JOINT SITE UNSPECIFIED - PATHOLOGICAL DISLOCATION OF JOINT OF MULTIPLE SITES



718.30 - 718.39 RECURRENT DISLOCATION OF JOINT SITE UNSPECIFIED - RECURRENT DISLOCATION OF JOINT OF MULTIPLE SITES

718.40 - 718.49 CONTRACTURE OF JOINT SITE UNSPECIFIED - CONTRACTURE OF JOINT OF MULTIPLE SITES

719.00 - 719.09 EFFUSION OF JOINT SITE UNSPECIFIED - EFFUSION OF JOINT OF MULTIPLE SITES

719.10 - 719.19 HEMARTHROSIS SITE UNSPECIFIED - HEMARTHROSIS INVOLVING MULTIPLE SITES

719.20 - 719.29VILLONODULAR SYNOVITIS SITE UNSPECIFIED - VILLONODULAR SYNOVITIS INVOLVING MULTIPLE SITES

719.30 - 719.39 PALINDROMIC RHEUMATISM SITE UNSPECIFIED - PALINDROMIC RHEUMATISM INVOLVING MULTIPLE SITES

719.40 - 719.49 PAIN IN JOINT SITE UNSPECIFIED - PAIN IN JOINT INVOLVING MULTIPLE SITES

719.50 - 719.59 STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING UNSPECIFIED SITE - STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING MULTIPLE SITES

720.0 - 720.2 ANKYLOSING SPONDYLITIS - SACROILIITIS NOT ELSEWHERE CLASSIFIED

720.81 INFLAMMATORY SPONDYLOPATHIES IN DISEASES CLASSIFIED ELSEWHERE

720.89 OTHER INFLAMMATORY SPONDYLOPATHIES

722.0 DISPLACEMENT OF CERVICAL INTERVERTEBRAL DISC WITHOUT MYELOPATHY

722.10 - 722.11DISPLACEMENT OF LUMBAR INTERVERTEBRAL DISC WITHOUT MYELOPATHY - DISPLACEMENT OF THORACIC INTERVERTEBRAL DISC WITHOUT MYELOPATHY

722.2 DISPLACEMENT OF INTERVERTEBRAL DISC SITE UNSPECIFIED WITHOUT MYELOPATHY

722.30 - 722.32 SCHMORL'S NODES OF UNSPECIFIED REGION - SCHMORL'S NODES OF LUMBAR REGION

722.39 SCHMORL'S NODES OF OTHER SPINAL REGION

722.4 DEGENERATION OF CERVICAL INTERVERTEBRAL DISC

722.51 - 722.52 DEGENERATION OF THORACIC OR THORACOLUMBAR INTERVERTEBRAL DISC - DEGENERATION OF LUMBAR OR LUMBOSACRAL INTERVERTEBRAL DISC

722.6 DEGENERATION OF INTERVERTEBRAL DISC SITE UNSPECIFIED

722.70 - 722.73 INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY UNSPECIFIED REGION - INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY LUMBAR REGION

722.80 - 722.83 POSTLAMINECTOMY SYNDROME OF UNSPECIFIED REGION - POSTLAMINECTOMY SYNDROME OF LUMBAR REGION

722.90 - 722.93OTHER AND UNSPECIFIED DISC DISORDER OF UNSPECIFIED REGION - OTHER AND UNSPECIFIED DISC DISORDER OF LUMBAR REGION

723.0 - 723.5 SPINAL STENOSIS IN CERVICAL REGION - TORTICOLLIS UNSPECIFIED

724.01 - 724.03SPINAL STENOSIS OF THORACIC REGION - SPINAL STENOSIS, LUMBAR REGION, WITH NEUROGENIC CLAUDICATION

724.09 SPINAL STENOSIS OF OTHER REGION

724.1 - 724.6 PAIN IN THORACIC SPINE - DISORDERS OF SACRUM

724.70 - 724.71 UNSPECIFIED DISORDER OF COCCYX - HYPERMOBILITY OF COCCYX

724.79 OTHER DISORDERS OF COCCYX

724.8 OTHER SYMPTOMS REFERABLE TO BACK

726.0 ADHESIVE CAPSULITIS OF SHOULDER

726.10 - 726.13 DISORDERS OF BURSAE AND TENDONS IN SHOULDER REGION UNSPECIFIED - PARTIAL TEAR OF ROTATOR CUFF

726.19 OTHER SPECIFIED DISORDERS OF BURSAE AND TENDONS IN SHOULDER REGION

726.2 OTHER AFFECTIONS OF SHOULDER REGION NOT ELSEWHERE CLASSIFIED

726.30 - 726.33 ENTHESOPATHY OF ELBOW UNSPECIFIED - OLECRANON BURSITIS

726.39 OTHER ENTHESOPATHY OF ELBOW REGION

726.4 - 726.5 ENTHESOPATHY OF WRIST AND CARPUS - ENTHESOPATHY OF HIP REGION

726.60 - 726.65 ENTHESOPATHY OF KNEE UNSPECIFIED - PREPATELLAR BURSITIS

726.69 OTHER ENTHESOPATHY OF KNEE

726.70 - 726.73 ENTHESOPATHY OF ANKLE AND TARSUS UNSPECIFIED - CALCANEAL SPUR

726.79 OTHER ENTHESOPATHY OF ANKLE AND TARSUS



726.8 OTHER PERIPHERAL ENTHESOPATHIES

726.90 - 726.91 ENTHESOPATHY OF UNSPECIFIED SITE - EXOSTOSIS OF UNSPECIFIED SITE

727.00 - 727.06 SYNOVITIS AND TENOSYNOVITIS UNSPECIFIED - TENOSYNOVITIS OF FOOT AND ANKLE

727.09 OTHER SYNOVITIS AND TENOSYNOVITIS

727.1 - 727.3 BUNION - OTHER BURSITIS DISORDERS

727.40 - 727.43 SYNOVIAL CYST UNSPECIFIED - GANGLION UNSPECIFIED

727.49 OTHER GANGLION AND CYST OF SYNOVIUM TENDON AND BURSA

727.50 - 727.51 RUPTURE OF SYNOVIUM UNSPECIFIED - SYNOVIAL CYST OF POPLITEAL SPACE

727.59 OTHER RUPTURE OF SYNOVIUM

727.60 - 727.67 NONTRAUMATIC RUPTURE OF UNSPECIFIED TENDON - NONTRAUMATIC RUPTURE OF ACHILLES TENDON

727.81 CONTRACTURE OF TENDON (SHEATH)

728.11 - 728.12 PROGRESSIVE MYOSITIS OSSIFICANS - TRAUMATIC MYOSITIS OSSIFICANS

728.2 MUSCULAR WASTING AND DISUSE ATROPHY NOT ELSEWHERE CLASSIFIED

728.6 CONTRACTURE OF PALMAR FASCIA

728.71 PLANTAR FASCIAL FIBROMATOSIS

728.83 RUPTURE OF MUSCLE NONTRAUMATIC

728.85 SPASM OF MUSCLE

729.1 MYALGIA AND MYOSITIS UNSPECIFIED

729.4 - 729.5 FASCIITIS UNSPECIFIED - PAIN IN LIMB

729.71 - 729.72 NONTRAUMATIC COMPARTMENT SYNDROME OF UPPER EXTREMITY - NONTRAUMATIC COMPARTMENT SYNDROME OF LOWER EXTREMITY

729.81 - 729.82 SWELLING OF LIMB - CRAMP OF LIMB

780.96 GENERALIZED PAIN

782.3 EDEMA

784.60 SYMBOLIC DYSFUNCTION UNSPECIFIED

788.1 DYSURIA

788.21 INCOMPLETE BLADDER EMPTYING

788.31 - 788.33 URGE INCONTINENCE - MIXED INCONTINENCE (MALE) (FEMALE)

788.41 URINARY FREQUENCY

799.3 - 799.4 DEBILITY UNSPECIFIED - CACHEXIA

808.0 - 808.3 CLOSED FRACTURE OF ACETABULUM - OPEN FRACTURE OF PUBIS

808.41 - 808.44CLOSED FRACTURE OF ILIUM - MULTIPLE CLOSED PELVIC FRACTURES WITHOUT DISRUPTION OF PELVIC CIRCLE

808.49 CLOSED FRACTURE OF OTHER SPECIFIED PART OF PELVIS

808.51 - 808.54OPEN FRACTURE OF ILIUM - MULTIPLE OPEN PELVIC FRACTURES WITHOUT DISRUPTION OF PELVIC CIRCLE

808.59 OPEN FRACTURE OF OTHER SPECIFIED PART OF PELVIS

808.8 - 808.9 UNSPECIFIED CLOSED FRACTURE OF PELVIS - UNSPECIFIED OPEN FRACTURE OF PELVIS

809.0 - 809.1 FRACTURE OF BONES OF TRUNK CLOSED - FRACTURE OF BONES OF TRUNK OPEN

810.00 - 810.03CLOSED FRACTURE OF CLAVICLE UNSPECIFIED PART - CLOSED FRACTURE OF ACROMIAL END OF CLAVICLE

810.11 - 810.13 OPEN FRACTURE OF STERNAL END OF CLAVICLE - OPEN FRACTURE OF ACROMIAL END OF CLAVICLE

811.01 - 811.03CLOSED FRACTURE OF ACROMIAL PROCESS OF SCAPULA - CLOSED FRACTURE OF GLENOID CAVITY AND NECK OF SCAPULA

811.09 CLOSED FRACTURE OF OTHER PART OF SCAPULA

811.10 - 811.13OPEN FRACTURE OF SCAPULA UNSPECIFIED PART - OPEN FRACTURE OF GLENOID CAVITY AND NECK OF SCAPULA

811.19 OPEN FRACTURE OF OTHER PART OF SCAPULA



812.00 - 812.03 FRACTURE OF UNSPECIFIED PART OF UPPER END OF HUMERUS CLOSED - FRACTURE OF GREATER TUBEROSITY OF HUMERUS CLOSED

812.09 OTHER CLOSED FRACTURES OF UPPER END OF HUMERUS

812.10 - 812.13 FRACTURE OF UNSPECIFIED PART OF UPPER END OF HUMERUS OPEN - FRACTURE OF GREATER TUBEROSITY OF HUMERUS OPEN

812.19 OTHER OPEN FRACTURE OF UPPER END OF HUMERUS

812.20 - 812.21 FRACTURE OF UNSPECIFIED PART OF HUMERUS CLOSED - FRACTURE OF SHAFT OF HUMERUS CLOSED

812.30 - 812.31 FRACTURE OF UNSPECIFIED PART OF HUMERUS OPEN - FRACTURE OF SHAFT OF HUMERUS OPEN

812.40 - 812.44FRACTURE OF UNSPECIFIED PART OF LOWER END OF HUMERUS CLOSED - FRACTURE OF UNSPECIFIED CONDYLE(S) OF HUMERUS CLOSED

812.49 OTHER CLOSED FRACTURES OF LOWER END OF HUMERUS

812.50 - 812.54 FRACTURE OF UNSPECIFIED PART OF LOWER END OF HUMERUS OPEN - FRACTURE OF UNSPECIFIED CONDYLE(S) OF HUMERUS OPEN

812.59 OTHER FRACTURE OF LOWER END OF HUMERUS OPEN

813.00 - 813.08 CLOSED FRACTURE OF UPPER END OF FOREARM UNSPECIFIED - FRACTURE OF RADIUS WITH ULNA UPPER END (ANY PART) CLOSED

813.10 - 813.18 OPEN FRACTURE OF UPPER END OF FOREARM UNSPECIFIED - FRACTURE OF RADIUS WITH ULNA UPPER END (ANY PART) OPEN

813.20 - 813.23 FRACTURE OF SHAFT OF RADIUS OR ULNA UNSPECIFIED CLOSED - FRACTURE OF SHAFT OF RADIUS WITH ULNA CLOSED

813.30 - 813.33 FRACTURE OF SHAFT OF RADIUS OR ULNA UNSPECIFIED OPEN - FRACTURE OF SHAFT OF RADIUS WITH ULNA OPEN

813.40 - 813.44CLOSED FRACTURE OF LOWER END OF FOREARM UNSPECIFIED - FRACTURE OF LOWER END OF RADIUS WITH ULNA CLOSED

813.50 - 813.54OPEN FRACTURE OF LOWER END OF FOREARM UNSPECIFIED - FRACTURE OF LOWER END OF RADIUS WITH ULNA OPEN

813.90 - 813.93FRACTURE OF UNSPECIFIED PART OF FOREARM OPEN - FRACTURE OF UNSPECIFIED PART OF RADIUS WITH ULNA OPEN

814.00 - 814.09 CLOSED FRACTURE OF CARPAL BONE UNSPECIFIED - CLOSED FRACTURE OF OTHER BONE OF WRIST

814.10 - 814.19 OPEN FRACTURE OF CARPAL BONE UNSPECIFIED - OPEN FRACTURE OF OTHER BONE OF WRIST

815.00 - 815.04CLOSED FRACTURE OF METACARPAL BONE(S) SITE UNSPECIFIED - CLOSED FRACTURE OF NECK OF METACARPAL BONE(S)

815.09 CLOSED FRACTURE OF MULTIPLE SITES OF METACARPUS

815.10 - 815.14OPEN FRACTURE OF METACARPAL BONE(S) SITE UNSPECIFIED - OPEN FRACTURE OF NECK OF METACARPAL BONE(S)

815.19 OPEN FRACTURE OF MULTIPLE SITES OF METACARPUS

816.00 - 816.03CLOSED FRACTURE OF PHALANX OR PHALANGES OF HAND UNSPECIFIED - CLOSED FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND

816.10 - 816.13 OPEN FRACTURE OF PHALANX OR PHALANGES OF HAND UNSPECIFIED - OPEN FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND

817.0 - 817.1 MULTIPLE CLOSED FRACTURES OF HAND BONES - MULTIPLE OPEN FRACTURES OF HAND BONES

820.00 - 820.03 FRACTURE OF UNSPECIFIED INTRACAPSULAR SECTION OF NECK OF FEMUR CLOSED - FRACTURE OF BASE OF NECK OF FEMUR CLOSED

820.09 OTHER TRANSCERVICAL FRACTURE OF FEMUR CLOSED

820.10 - 820.13 FRACTURE OF UNSPECIFIED INTRACAPSULAR SECTION OF NECK OF FEMUR OPEN - FRACTURE OF BASE OF NECK OF FEMUR OPEN

820.19 OTHER TRANSCERVICAL FRACTURE OF FEMUR OPEN

820.20 - 820.22 FRACTURE OF UNSPECIFIED TROCHANTERIC SECTION OF FEMUR CLOSED - FRACTURE OF SUBTROCHANTERIC SECTION OF FEMUR CLOSED

820.30 - 820.32 FRACTURE OF UNSPECIFIED TROCHANTERIC SECTION OF FEMUR OPEN - FRACTURE OF SUBTROCHANTERIC SECTION OF FEMUR OPEN

820.8 - 820.9 FRACTURE OF UNSPECIFIED PART OF NECK OF FEMUR CLOSED - FRACTURE OF UNSPECIFIED PART OF NECK OF FEMUR OPEN

821.00 - 821.01 FRACTURE OF UNSPECIFIED PART OF FEMUR CLOSED - FRACTURE OF SHAFT OF FEMUR CLOSED

821.10 - 821.11 FRACTURE OF UNSPECIFIED PART OF FEMUR OPEN - FRACTURE OF SHAFT OF FEMUR OPEN



821.20 - 821.23 FRACTURE OF LOWER END OF FEMUR UNSPECIFIED PART CLOSED - SUPRACONDYLAR FRACTURE OF FEMUR CLOSED

821.29 OTHER FRACTURE OF LOWER END OF FEMUR CLOSED

821.30 - 821.33 FRACTURE OF LOWER END OF FEMUR UNSPECIFIED PART OPEN - SUPRACONDYLAR FRACTURE OF FEMUR OPEN

821.39 OTHER FRACTURE OF LOWER END OF FEMUR OPEN

822.0 - 822.1 CLOSED FRACTURE OF PATELLA - OPEN FRACTURE OF PATELLA

823.00 - 823.02 CLOSED FRACTURE OF UPPER END OF TIBIA - CLOSED FRACTURE OF UPPER END OF FIBULA WITH TIBIA

823.10 - 823.12 OPEN FRACTURE OF UPPER END OF TIBIA - OPEN FRACTURE OF UPPER END OF FIBULA WITH TIBIA

823.20 - 823.22 CLOSED FRACTURE OF SHAFT OF TIBIA - CLOSED FRACTURE OF SHAFT OF FIBULA WITH TIBIA

823.30 - 823.32 OPEN FRACTURE OF SHAFT OF TIBIA - OPEN FRACTURE OF SHAFT OF FIBULA WITH TIBIA

823.80 - 823.82CLOSED FRACTURE OF UNSPECIFIED PART OF TIBIA - CLOSED FRACTURE OF UNSPECIFIED PART OF FIBULA WITH TIBIA

823.90 - 823.92 OPEN FRACTURE OF UNSPECIFIED PART OF TIBIA - OPEN FRACTURE OF UNSPECIFIED PART OF FIBULA WITH TIBIA

824.0 - 824.9 FRACTURE OF MEDIAL MALLEOLUS CLOSED - UNSPECIFIED FRACTURE OF ANKLE OPEN

825.0 - 825.1 FRACTURE OF CALCANEUS CLOSED - FRACTURE OF CALCANEUS OPEN

825.20 - 825.25FRACTURE OF UNSPECIFIED BONE(S) OF FOOT (EXCEPT TOES) CLOSED - FRACTURE OF METATARSAL BONE(S) CLOSED

825.29 OTHER FRACTURE OF TARSAL AND METATARSAL BONES CLOSED

825.30 - 825.35FRACTURE OF UNSPECIFIED BONE(S) OF FOOT (EXCEPT TOES) OPEN - FRACTURE OF METATARSAL BONE(S) OPEN

825.39 OTHER FRACTURES OF TARSAL AND METATARSAL BONES OPEN

826.0 - 826.1CLOSED FRACTURE OF ONE OR MORE PHALANGES OF FOOT - OPEN FRACTURE OF ONE OR MORE PHALANGES OF FOOT

830.0 - 830.1 CLOSED DISLOCATION OF JAW - OPEN DISLOCATION OF JAW

831.00 - 831.04 CLOSED DISLOCATION OF SHOULDER UNSPECIFIED SITE - CLOSED DISLOCATION OF ACROMIOCLAVICULAR (JOINT)

831.09 CLOSED DISLOCATION OF OTHER SITE OF SHOULDER

831.10 - 831.14 OPEN DISLOCATION OF SHOULDER UNSPECIFIED - OPEN DISLOCATION OF ACROMIOCLAVICULAR (JOINT)

831.19 OPEN DISLOCATION OF OTHER SITE OF SHOULDER

832.00 - 832.04 CLOSED DISLOCATION OF ELBOW UNSPECIFIED SITE - CLOSED LATERAL DISLOCATION OF ELBOW

832.09 CLOSED DISLOCATION OF OTHER SITE OF ELBOW

832.10 - 832.14 OPEN DISLOCATION OF ELBOW UNSPECIFIED SITE - OPEN LATERAL DISLOCATION OF ELBOW

832.19 OPEN DISLOCATION OF OTHER SITE OF ELBOW

833.00 - 833.05 CLOSED DISLOCATION OF WRIST UNSPECIFIED PART - CLOSED DISLOCATION OF METACARPAL (BONE) PROXIMAL END

833.09 CLOSED DISLOCATION OF OTHER PART OF WRIST

833.10 - 833.15 OPEN DISLOCATION OF WRIST UNSPECIFIED PART - OPEN DISLOCATION OF METACARPAL (BONE) PROXIMAL END

833.19 OPEN DISLOCATION OF OTHER PART OF WRIST

834.00 - 834.02 CLOSED DISLOCATION OF FINGER UNSPECIFIED PART - CLOSED DISLOCATION OF INTERPHALANGEAL (JOINT) HAND

834.10 - 834.12OPEN DISLOCATION OF FINGER UNSPECIFIED PART - OPEN DISLOCATION INTERPHALANGEAL (JOINT) HAND

835.00 - 835.03 CLOSED DISLOCATION OF HIP UNSPECIFIED SITE - OTHER CLOSED ANTERIOR DISLOCATION OF HIP

835.10 - 835.13 OPEN DISLOCATION OF HIP UNSPECIFIED SITE - OTHER OPEN ANTERIOR DISLOCATION OF HIP

836.0 - 836.4 TEAR OF MEDIAL CARTILAGE OR MENISCUS OF KNEE CURRENT - DISLOCATION OF PATELLA OPEN

836.50 - 836.54 CLOSED DISLOCATION OF KNEE UNSPECIFIED PART - LATERAL DISLOCATION OF TIBIA PROXIMAL END CLOSED

836.59 OTHER DISLOCATION OF KNEE CLOSED



836.60 - 836.64 DISLOCATION OF KNEE UNSPECIFIED PART OPEN - LATERAL DISLOCATION OF TIBIA PROXIMAL END OPEN

836.69 OTHER DISLOCATION OF KNEE OPEN

837.0 - 837.1 CLOSED DISLOCATION OF ANKLE - OPEN DISLOCATION OF ANKLE

838.00 - 838.06 CLOSED DISLOCATION OF FOOT UNSPECIFIED PART - CLOSED DISLOCATION OF INTERPHALANGEAL (JOINT) FOOT

838.10 - 838.16 OPEN DISLOCATION OF FOOT UNSPECIFIED PART - OPEN DISLOCATION OF INTERPHALANGEAL (JOINT) FOOT

840.0 - 840.6 ACROMIOCLAVICULAR (JOINT) (LIGAMENT) SPRAIN - SUPRASPINATUS (MUSCLE) (TENDON) SPRAIN

840.8 - 840.9 SPRAIN OF OTHER SPECIFIED SITES OF SHOULDER AND UPPER ARM - SPRAIN OF UNSPECIFIED SITE OF SHOULDER AND UPPER ARM

841.0 - 841.3 RADIAL COLLATERAL LIGAMENT SPRAIN - ULNOHUMERAL (JOINT) SPRAIN

841.8 - 841.9 SPRAIN OF OTHER SPECIFIED SITES OF ELBOW AND FOREARM - SPRAIN OF UNSPECIFIED SITE OF ELBOW AND FOREARM

845.00 - 845.03 UNSPECIFIED SITE OF ANKLE SPRAIN - TIBIOFIBULAR (LIGAMENT) SPRAIN DISTAL

845.09 OTHER ANKLE SPRAIN

845.10 - 845.13 UNSPECIFIED SITE OF FOOT SPRAIN - INTERPHALANGEAL (JOINT) TOE SPRAIN

845.19 OTHER FOOT SPRAIN

846.0 - 846.3 LUMBOSACRAL (JOINT) (LIGAMENT) SPRAIN - SACROTUBEROUS (LIGAMENT) SPRAIN

846.8 - 846.9OTHER SPECIFIED SITES OF SACROILIAC REGION SPRAIN - UNSPECIFIED SITE OF SACROILIAC REGION SPRAIN

847.0 - 847.4 NECK SPRAIN - SPRAIN OF COCCYX

847.9 SPRAIN OF UNSPECIFIED SITE OF BACK

848.0 - 848.3 SPRAIN OF SEPTAL CARTILAGE OF NOSE - SPRAIN OF RIBS

848.40 - 848.42 STERNUM SPRAIN UNSPECIFIED PART - CHONDROSTERNAL (JOINT) SPRAIN

848.5 PELVIC SPRAIN

923.00 - 923.03 CONTUSION OF SHOULDER REGION - CONTUSION OF UPPER ARM

923.09 CONTUSION OF MULTIPLE SITES OF SHOULDER AND UPPER ARM

923.10 - 923.11 CONTUSION OF FOREARM - CONTUSION OF ELBOW

923.20 - 923.21 CONTUSION OF HAND(S) - CONTUSION OF WRIST

923.3 CONTUSION OF FINGER

923.8 - 923.9 CONTUSION OF MULTIPLE SITES OF UPPER LIMB - CONTUSION OF UNSPECIFIED PART OF UPPER LIMB

924.00 - 924.01 CONTUSION OF THIGH - CONTUSION OF HIP

924.10 - 924.11 CONTUSION OF LOWER LEG - CONTUSION OF KNEE

924.20 - 924.21 CONTUSION OF FOOT - CONTUSION OF ANKLE

924.3 - 924.4 CONTUSION OF TOE - CONTUSION OF MULTIPLE SITES OF LOWER LIMB

926.0 CRUSHING INJURY OF EXTERNAL GENITALIA

926.11 - 926.12 CRUSHING INJURY OF BACK - CRUSHING INJURY OF BUTTOCK

926.19 CRUSHING INJURY OF OTHER SPECIFIED SITES OF TRUNK

926.8 - 926.9 CRUSHING INJURY OF MULTIPLE SITES OF TRUNK - CRUSHING INJURY OF UNSPECIFIED SITE OF TRUNK

927.00 - 927.03 CRUSHING INJURY OF SHOULDER REGION - CRUSHING INJURY OF UPPER ARM

927.10 - 927.11 CRUSHING INJURY OF FOREARM - CRUSHING INJURY OF ELBOW

927.20 - 927.21 CRUSHING INJURY OF HAND(S) - CRUSHING INJURY OF WRIST

927.3 CRUSHING INJURY OF FINGER(S)

927.8 - 927.9 CRUSHING INJURY OF MULTIPLE SITES OF UPPER LIMB - CRUSHING INJURY OF UNSPECIFIED SITE OF UPPER LIMB

928.00 - 928.01 CRUSHING INJURY OF THIGH - CRUSHING INJURY OF HIP

928.10 - 928.11 CRUSHING INJURY OF LOWER LEG - CRUSHING INJURY OF KNEE

928.20 - 928.21 CRUSHING INJURY OF FOOT - CRUSHING INJURY OF ANKLE



928.3 CRUSHING INJURY OF TOE(S)

928.8 CRUSHING INJURY OF MULTIPLE SITES OF LOWER LIMB

953.0 - 953.5 INJURY TO CERVICAL NERVE ROOT - INJURY TO LUMBOSACRAL PLEXUS

953.8 INJURY TO MULTIPLE SITES OF NERVE ROOTS AND SPINAL PLEXUS

955.0 - 955.9INJURY TO AXILLARY NERVE - INJURY TO UNSPECIFIED NERVE OF SHOULDER GIRDLE AND UPPER LIMB

956.0 - 956.5INJURY TO SCIATIC NERVE - INJURY TO OTHER SPECIFIED NERVE(S) OF PELVIC GIRDLE AND LOWER LIMB

956.8 INJURY TO MULTIPLE NERVES OF PELVIC GIRDLE AND LOWER LIMB

997.61 NEUROMA OF AMPUTATION STUMP

V43.60 - V43.66 UNSPECIFIED JOINT REPLACEMENT - ANKLE JOINT REPLACEMENT

V43.69 OTHER JOINT REPLACEMENT

V43.7 LIMB REPLACED BY OTHER MEANS

V45.4 POSTSURGICAL ARTHRODESIS STATUS

V49.60 - V49.67 UNSPECIFIED LEVEL UPPER LIMB AMPUTATION STATUS - SHOULDER AMPUTATION STATUS

V49.70 - V49.77 UNSPECIFIED LEVEL LOWER LIMB AMPUTATION STATUS - HIP AMPUTATION STATUS

V54.09 OTHER AFTERCARE INVOLVING INTERNAL FIXATION DEVICE

V54.10 - V54.17AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF ARM UNSPECIFIED - AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF VERTEBRAE

V54.19 AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF OTHER BONE

V54.20 - V54.27AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF ARM UNSPECIFIED - AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF VERTEBRAE

V54.29 AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF OTHER BONE

V54.81 - V54.82AFTERCARE FOLLOWING JOINT REPLACEMENT - AFTERCARE FOLLOWING EXPLANTATION OF JOINT PROSTHESIS

V54.89 OTHER ORTHOPEDIC AFTERCARE

Medicare is establishing the following limited coverage for CPT/HCPCS code 97012 – mechanical traction: Covered for:



353.2 CERVICAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED

353.4 LUMBOSACRAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED


722.10 DISPLACEMENT OF LUMBAR INTERVERTEBRAL DISC WITHOUT MYELOPATHY


722.52 DEGENERATION OF LUMBAR OR LUMBOSACRAL INTERVERTEBRAL DISC

722.91 OTHER AND UNSPECIFIED DISC DISORDER OF CERVICAL REGION

722.93 OTHER AND UNSPECIFIED DISC DISORDER OF LUMBAR REGION

723.1 CERVICALGIA

723.5 TORTICOLLIS UNSPECIFIED

723.8 OTHER SYNDROMES AFFECTING CERVICAL REGION

724.02 SPINAL STENOSIS, LUMBAR REGION, WITHOUT NEUROGENIC CLAUDICATION

724.03 SPINAL STENOSIS, LUMBAR REGION, WITH NEUROGENIC CLAUDICATION

724.2 - 724.5 LUMBAGO - BACKACHE UNSPECIFIED

847.0 NECK SPRAIN

847.2 LUMBAR SPRAIN

953.0 INJURY TO CERVICAL NERVE ROOT

953.2 - 953.3 INJURY TO LUMBAR NERVE ROOT - INJURY TO SACRAL NERVE ROOT



Medicare is establishing the following limited coverage for CPT/HCPCS code 97018 – paraffin bath: Covered for:


274.02 - 274.03 CHRONIC GOUTY ARTHROPATHY WITHOUT MENTION OF TOPHUS (TOPHI) - CHRONIC GOUTY ARTHROPATHY WITH TOPHUS (TOPHI)

337.21 - 337.22 REFLEX SYMPATHETIC DYSTROPHY OF THE UPPER LIMB - REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER LIMB

354.0 - 354.3 CARPAL TUNNEL SYNDROME - LESION OF RADIAL NERVE

354.5 MONONEURITIS MULTIPLEX


355.3 - 355.6 LESION OF LATERAL POPLITEAL NERVE - LESION OF PLANTAR NERVE

355.79 OTHER MONONEURITIS OF LOWER LIMB


711.14ARTHROPATHY INVOLVING HAND ASSOCIATED WITH REITER'S DISEASE AND NONSPECIFIC URETHRITIS

711.17ARTHROPATHY INVOLVING ANKLE AND FOOT ASSOCIATED WITH REITER'S DISEASE AND NONSPECIFIC URETHRITIS

712.14 CHONDROCALCINOSIS DUE TO DICALCIUM PHOSPHATE CRYSTALS INVOLVING HAND

712.17 CHONDROCALCINOSIS DUE TO DICALCIUM PHOSPHATE CRYSTALS INVOLVING ANKLE AND FOOT

712.24 CHONDROCALCINOSIS DUE TO PYROPHOSPHATE CRYSTALS INVOLVING HAND

712.27 CHONDROCALCINOSIS DUE TO PYROPHOSPHATE CRYSTALS INVOLVING ANKLE AND FOOT


714.30 - 714.33CHRONIC OR UNSPECIFIED POLYARTICULAR JUVENILE RHEUMATOID ARTHRITIS - MONOARTICULAR JUVENILE RHEUMATOID ARTHRITIS






715.17 OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING ANKLE AND FOOT

715.24 OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING HAND

715.27 OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING ANKLE AND FOOT

718.44 CONTRACTURE OF HAND JOINT

718.47 CONTRACTURE OF ANKLE AND FOOT JOINT

719.04 EFFUSION OF HAND JOINT

719.07 EFFUSION OF ANKLE AND FOOT JOINT

726.4 ENTHESOPATHY OF WRIST AND CARPUS


727.03 - 727.06 TRIGGER FINGER (ACQUIRED) - TENOSYNOVITIS OF FOOT AND ANKLE

727.62 - 727.64NONTRAUMATIC RUPTURE OF TENDONS OF BICEPS (LONG HEAD) - NONTRAUMATIC RUPTURE OF FLEXOR TENDONS OF HAND AND WRIST

727.67 - 727.68 NONTRAUMATIC RUPTURE OF ACHILLES TENDON - NONTRAUMATIC RUPTURE OF OTHER TENDONS OF FOOT AND ANKLE




729.5 PAIN IN LIMB




813.50 - 813.54 OPEN FRACTURE OF LOWER END OF FOREARM UNSPECIFIED - FRACTURE OF LOWER END OF RADIUS WITH ULNA OPEN



815.00 - 815.04 CLOSED FRACTURE OF METACARPAL BONE(S) SITE UNSPECIFIED - CLOSED FRACTURE OF NECK OF METACARPAL BONE(S)


815.10 - 815.14 OPEN FRACTURE OF METACARPAL BONE(S) SITE UNSPECIFIED - OPEN FRACTURE OF NECK OF METACARPAL BONE(S)


816.00 - 816.03 CLOSED FRACTURE OF PHALANX OR PHALANGES OF HAND UNSPECIFIED - CLOSED FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND

816.10 - 816.13 OPEN FRACTURE OF PHALANX OR PHALANGES OF HAND UNSPECIFIED - OPEN FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND


818.0 - 818.1 ILL-DEFINED CLOSED FRACTURES OF UPPER LIMB - ILL-DEFINED OPEN FRACTURES OF UPPER LIMB







826.0 - 826.1CLOSED FRACTURE OF ONE OR MORE PHALANGES OF FOOT - OPEN FRACTURE OF ONE OR MORE PHALANGES OF FOOT






834.10 - 834.12 OPEN DISLOCATION OF FINGER UNSPECIFIED PART - OPEN DISLOCATION INTERPHALANGEAL (JOINT) HAND




842.00 - 842.02 SPRAIN OF UNSPECIFIED SITE OF WRIST - SPRAIN OF RADIOCARPAL (JOINT) (LIGAMENT) OF WRIST

842.09 OTHER WRIST SPRAIN

842.10 - 842.13 SPRAIN OF UNSPECIFIED SITE OF HAND - SPRAIN OF INTERPHALANGEAL (JOINT) OF HAND

842.19 OTHER HAND SPRAIN
















924.3 CONTUSION OF TOE




956.3 - 956.4 INJURY TO PERONEAL NERVE - INJURY TO CUTANEOUS SENSORY NERVE LOWER LIMB

997.60 - 997.61 UNSPECIFIED LATE COMPLICATION OF AMPUTATION STUMP - NEUROMA OF AMPUTATION STUMP

Medicare is establishing the following limited coverage for CPT/HCPCS codes 97022 – whirlpool, and 97036 – Hubbard tank: Covered for:







353.8 - 353.9 OTHER NERVE ROOT AND PLEXUS DISORDERS - UNSPECIFIED NERVE ROOT AND PLEXUS DISORDER

354.0 - 354.3 CARPAL TUNNEL SYNDROME - LESION OF RADIAL NERVE

440.23 - 440.24 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH ULCERATION - ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH GANGRENE

454.0 - 454.2 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER - VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER AND INFLAMMATION

454.9 ASYMPTOMATIC VARICOSE VEINS


682.3 - 682.7 CELLULITIS AND ABSCESS OF UPPER ARM AND FOREARM - CELLULITIS AND ABSCESS OF FOOT EXCEPT TOES

695.81 RITTER'S DISEASE

695.89 OTHER SPECIFIED ERYTHEMATOUS CONDITIONS

707.00 - 707.07 PRESSURE ULCER, UNSPECIFIED SITE - PRESSURE ULCER, HEEL

707.09 PRESSURE ULCER, OTHER SITE

707.10 - 707.15 UNSPECIFIED ULCER OF LOWER LIMB - ULCER OF OTHER PART OF FOOT

707.20 - 707.25 PRESSURE ULCER, UNSPECIFIED STAGE - PRESSURE ULCER, UNSTAGEABLE

711.00 - 711.09 PYOGENIC ARTHRITIS SITE UNSPECIFIED - PYOGENIC ARTHRITIS INVOLVING MULTIPLE SITES

711.10 - 711.19ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH REITER'S DISEASE AND NONSPECIFIC URETHRITIS - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH REITER'S DISEASE AND NONSPECIFIC URETHRITIS

711.20 - 711.29ARTHROPATHY IN BEHCET'S SYNDROME SITE UNSPECIFIED - ARTHROPATHY IN BEHCET'S SYNDROME INVOLVING MULTIPLE SITES

711.30 - 711.39POSTDYSENTERIC ARTHROPATHY SITE UNSPECIFIED - POSTDYSENTERIC ARTHROPATHY INVOLVING MULTIPLE SITES

711.40 - 711.49 ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH OTHER BACTERIAL DISEASES - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH OTHER BACTERIAL DISEASES





711.70 - 711.79 ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH HELMINTHIASIS - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH HELMINTHIASIS


711.90 - 711.99UNSPECIFIED INFECTIVE ARTHRITIS SITE UNSPECIFIED - UNSPECIFIED INFECTIVE ARTHRITIS INVOLVING MULTIPLE SITES

712.10 - 712.19CHONDROCALCINOSIS DUE TO DICALCIUM PHOSPHATE CRYSTALS INVOLVING UNSPECIFIED SITE - CHONDROCALCINOSIS DUE TO DICALCIUM PHOSPHATE CRYSTALS INVOLVING MULTIPLE SITES



712.80 - 712.89 OTHER SPECIFIED CRYSTAL ARTHROPATHIES SITE UNSPECIFIED - OTHER SPECIFIED CRYSTAL ARTHROPATHIES INVOLVING MULTIPLE SITES

712.90 - 712.99 UNSPECIFIED CRYSTAL ARTHROPATHY SITE UNSPECIFIED - UNSPECIFIED CRYSTAL ARTHROPATHY INVOLVING MULTIPLE SITES

713.1 - 713.8ARTHROPATHY ASSOCIATED WITH GASTROINTESTINAL CONDITIONS OTHER THAN INFECTIONS - ARTHROPATHY ASSOCIATED WITH OTHER CONDITIONS CLASSIFIABLE ELSEWHERE

714.0 - 714.2RHEUMATOID ARTHRITIS - OTHER RHEUMATOID ARTHRITIS WITH VISCERAL OR SYSTEMIC INVOLVEMENT









715.20 - 715.28 OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING OTHER SPECIFIED SITES










716.50 - 716.59 UNSPECIFIED POLYARTHROPATHY OR POLYARTHRITIS SITE UNSPECIFIED - UNSPECIFIED POLYARTHROPATHY OR POLYARTHRITIS INVOLVING MULTIPLE SITES







717.81 - 717.85 OLD DISRUPTION OF LATERAL COLLATERAL LIGAMENT - OLD DISRUPTION OF OTHER LIGAMENTS OF KNEE






719.20 - 719.29 VILLONODULAR SYNOVITIS SITE UNSPECIFIED - VILLONODULAR SYNOVITIS INVOLVING MULTIPLE SITES








722.10 - 722.11 DISPLACEMENT OF LUMBAR INTERVERTEBRAL DISC WITHOUT MYELOPATHY - DISPLACEMENT OF THORACIC INTERVERTEBRAL DISC WITHOUT MYELOPATHY





722.51 - 722.52DEGENERATION OF THORACIC OR THORACOLUMBAR INTERVERTEBRAL DISC - DEGENERATION OF LUMBAR OR LUMBOSACRAL INTERVERTEBRAL DISC


722.70 - 722.73INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY UNSPECIFIED REGION - INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY LUMBAR REGION

722.80 - 722.83POSTLAMINECTOMY SYNDROME OF UNSPECIFIED REGION - POSTLAMINECTOMY SYNDROME OF LUMBAR REGION

722.90 - 722.93 OTHER AND UNSPECIFIED DISC DISORDER OF UNSPECIFIED REGION - OTHER AND UNSPECIFIED DISC DISORDER OF LUMBAR REGION

724.01 - 724.03 SPINAL STENOSIS OF THORACIC REGION - SPINAL STENOSIS, LUMBAR REGION, WITH NEUROGENIC CLAUDICATION






726.10 - 726.13DISORDERS OF BURSAE AND TENDONS IN SHOULDER REGION UNSPECIFIED - PARTIAL TEAR OF ROTATOR CUFF





















727.60 - 727.67NONTRAUMATIC RUPTURE OF UNSPECIFIED TENDON - NONTRAUMATIC RUPTURE OF ACHILLES TENDON









729.4 FASCIITIS UNSPECIFIED

729.5 PAIN IN LIMB

729.71 - 729.72NONTRAUMATIC COMPARTMENT SYNDROME OF UPPER EXTREMITY - NONTRAUMATIC COMPARTMENT SYNDROME OF LOWER EXTREMITY









810.00 - 810.03 CLOSED FRACTURE OF CLAVICLE UNSPECIFIED PART - CLOSED FRACTURE OF ACROMIAL END OF CLAVICLE

810.10 - 810.13 OPEN FRACTURE OF CLAVICLE UNSPECIFIED PART - OPEN FRACTURE OF ACROMIAL END OF CLAVICLE

811.01 - 811.03 CLOSED FRACTURE OF ACROMIAL PROCESS OF SCAPULA - CLOSED FRACTURE OF GLENOID CAVITY AND NECK OF SCAPULA


811.10 - 811.13 OPEN FRACTURE OF SCAPULA UNSPECIFIED PART - OPEN FRACTURE OF GLENOID CAVITY AND NECK OF SCAPULA










812.40 - 812.44 FRACTURE OF UNSPECIFIED PART OF LOWER END OF HUMERUS CLOSED - FRACTURE OF UNSPECIFIED CONDYLE(S) OF HUMERUS CLOSED







813.30 - 813.33FRACTURE OF SHAFT OF RADIUS OR ULNA UNSPECIFIED OPEN - FRACTURE OF SHAFT OF RADIUS WITH ULNA OPEN



813.80 - 813.83 CLOSED FRACTURE OF UNSPECIFIED PART OF FOREARM - FRACTURE OF UNSPECIFIED PART OF RADIUS WITH ULNA CLOSED

813.90 - 813.93 FRACTURE OF UNSPECIFIED PART OF FOREARM OPEN - FRACTURE OF UNSPECIFIED PART OF RADIUS WITH ULNA OPEN








816.11 - 816.13 OPEN FRACTURE OF MIDDLE OR PROXIMAL PHALANX OR PHALANGES OF HAND - OPEN FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND







820.30 - 820.32FRACTURE OF UNSPECIFIED TROCHANTERIC SECTION OF FEMUR OPEN - FRACTURE OF SUBTROCHANTERIC SECTION OF FEMUR OPEN

820.8 - 820.9FRACTURE OF UNSPECIFIED PART OF NECK OF FEMUR CLOSED - FRACTURE OF UNSPECIFIED PART OF NECK OF FEMUR OPEN



821.20 - 821.23FRACTURE OF LOWER END OF FEMUR UNSPECIFIED PART CLOSED - SUPRACONDYLAR FRACTURE OF FEMUR CLOSED


821.30 - 821.33FRACTURE OF LOWER END OF FEMUR UNSPECIFIED PART OPEN - SUPRACONDYLAR FRACTURE OF FEMUR OPEN













825.20 - 825.25 FRACTURE OF UNSPECIFIED BONE(S) OF FOOT (EXCEPT TOES) CLOSED - FRACTURE OF METATARSAL BONE(S) CLOSED


825.30 - 825.35 FRACTURE OF UNSPECIFIED BONE(S) OF FOOT (EXCEPT TOES) OPEN - FRACTURE OF METATARSAL BONE(S) OPEN


826.0 - 826.1 CLOSED FRACTURE OF ONE OR MORE PHALANGES OF FOOT - OPEN FRACTURE OF ONE OR MORE PHALANGES OF FOOT









833.00 - 833.05CLOSED DISLOCATION OF WRIST UNSPECIFIED PART - CLOSED DISLOCATION OF METACARPAL (BONE) PROXIMAL END


833.10 - 833.15OPEN DISLOCATION OF WRIST UNSPECIFIED PART - OPEN DISLOCATION OF METACARPAL (BONE) PROXIMAL END


834.00 - 834.02CLOSED DISLOCATION OF FINGER UNSPECIFIED PART - CLOSED DISLOCATION OF INTERPHALANGEAL (JOINT) HAND





836.50 - 836.54CLOSED DISLOCATION OF KNEE UNSPECIFIED PART - LATERAL DISLOCATION OF TIBIA PROXIMAL END CLOSED


836.60 - 836.64DISLOCATION OF KNEE UNSPECIFIED PART OPEN - LATERAL DISLOCATION OF TIBIA PROXIMAL END OPEN




838.10 - 838.16OPEN DISLOCATION OF FOOT UNSPECIFIED PART - OPEN DISLOCATION OF INTERPHALANGEAL (JOINT) FOOT




840.8 - 840.9 SPRAIN OF OTHER SPECIFIED SITES OF SHOULDER AND UPPER ARM - SPRAIN OF UNSPECIFIED SITE OF SHOULDER AND UPPER ARM







843.0 - 843.1 ILIOFEMORAL (LIGAMENT) SPRAIN - ISCHIOCAPSULAR (LIGAMENT) SPRAIN

843.8 - 843.9SPRAIN OF OTHER SPECIFIED SITES OF HIP AND THIGH - SPRAIN OF UNSPECIFIED SITE OF HIP AND THIGH

844.0 - 844.3SPRAIN OF LATERAL COLLATERAL LIGAMENT OF KNEE - SPRAIN OF TIBIOFIBULAR (JOINT) (LIGAMENT) SUPERIOR OF KNEE

844.8 - 844.9 SPRAIN OF OTHER SPECIFIED SITES OF KNEE AND LEG - SPRAIN OF UNSPECIFIED SITE OF KNEE AND LEG






846.8 - 846.9 OTHER SPECIFIED SITES OF SACROILIAC REGION SPRAIN - UNSPECIFIED SITE OF SACROILIAC REGION SPRAIN





848.49 OTHER SPRAIN OF STERNUM

848.5 PELVIC SPRAIN

880.00 - 880.03OPEN WOUND OF SHOULDER REGION WITHOUT COMPLICATION - OPEN WOUND OF UPPER ARM WITHOUT COMPLICATION

880.09 OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM WITHOUT COMPLICATION

880.10 - 880.13 OPEN WOUND OF SHOULDER REGION COMPLICATED - OPEN WOUND OF UPPER ARM COMPLICATED

880.19 OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM COMPLICATED

880.20 - 880.23OPEN WOUND OF SHOULDER REGION WITH TENDON INVOLVEMENT - OPEN WOUND OF UPPER ARM WITH TENDON INVOLVEMENT

880.29 OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM WITH TENDON INVOLVEMENT

881.00 - 881.02OPEN WOUND OF FOREARM WITHOUT COMPLICATION - OPEN WOUND OF WRIST WITHOUT COMPLICATION

881.10 - 881.12 OPEN WOUND OF FOREARM COMPLICATED - OPEN WOUND OF WRIST COMPLICATED

881.20 - 881.22OPEN WOUND OF FOREARM WITH TENDON INVOLVEMENT - OPEN WOUND OF WRIST WITH TENDON INVOLVEMENT

882.0 - 882.2OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITHOUT COMPLICATION - OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITH TENDON INVOLVEMENT

883.0 - 883.2 OPEN WOUND OF FINGERS WITHOUT COMPLICATION - OPEN WOUND OF FINGERS WITH TENDON INVOLVEMENT

884.0 - 884.2 MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITHOUT COMPLICATION - MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITH TENDON INVOLVEMENT

890.0 - 890.2 OPEN WOUND OF HIP AND THIGH WITHOUT COMPLICATION - OPEN WOUND OF HIP AND THIGH WITH TENDON INVOLVEMENT

891.0 - 891.2 OPEN WOUND OF KNEE LEG (EXCEPT THIGH) AND ANKLE WITHOUT COMPLICATION - OPEN WOUND OF KNEE LEG (EXCEPT THIGH) AND ANKLE WITH TENDON INVOLVEMENT

892.0 - 892.2OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE WITHOUT COMPLICATION - OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE WITH TENDON INVOLVEMENT



893.0 - 893.2 OPEN WOUND OF TOE(S) WITHOUT COMPLICATION - OPEN WOUND OF TOE(S) WITH TENDON INVOLVEMENT














926.8 - 926.9CRUSHING INJURY OF MULTIPLE SITES OF TRUNK - CRUSHING INJURY OF UNSPECIFIED SITE OF TRUNK


927.09 CRUSHING INJURY OF MULTIPLE SITES OF UPPER ARM










942.20 - 942.25BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF TRUNK - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF GENITALIA

942.29BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF OTHER AND MULTIPLE SITES OF TRUNK

942.30 - 942.35FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF TRUNK - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF GENITALIA

942.39 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF OTHER AND MULTIPLE SITES OF TRUNK

942.40 - 942.45DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF TRUNK UNSPECIFIED SITE WITHOUT LOSS OF BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF GENITALIA WITHOUT LOSS OF GENITALIA

942.49DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF OTHER AND MULTIPLE SITES OF TRUNK WITHOUT LOSS OF BODY PART

942.50 - 942.55DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF TRUNK WITH LOSS OF BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF GENITALIA WITH LOSS OF GENITALIA

942.59 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF OTHER AND MULTIPLE SITES OF TRUNK WITH LOSS OF A BODY PART

943.20 - 943.26 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF SCAPULAR REGION

943.29 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND

943.30 - 943.36FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF UPPER LIMB - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF SCAPULAR REGION



943.39 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND

943.40 - 943.46DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB WITHOUT LOSS OF A BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF SCAPULAR REGION WITHOUT LOSS OF SCAPULA

943.49DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND WITHOUT LOSS OF UPPER LIMB

943.50 - 943.56DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB WITH LOSS OF A BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF SCAPULAR REGION WITH LOSS OF SCAPULA

943.59 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND WITH LOSS OF UPPER LIMB

944.20 - 944.28BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF HAND - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF WRIST(S) AND HAND(S)

944.30 - 944.38FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF HAND - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF WRIST(S) AND HAND(S)

944.40 - 944.47DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF HAND WITHOUT LOSS OF HAND - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF WRIST WITHOUT LOSS OF WRIST

945.20 - 945.26BLISTERS EPIDERMAL LOSS (SECOND DEGREE) OF UNSPECIFIED SITE OF LOWER LIMB (LEG) - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF THIGH (ANY PART)

945.29BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF LOWER LIMB(S)

945.30 - 945.36 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF LOWER LIMB - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF THIGH (ANY PART)

945.39 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF LOWER LIMB(S)

945.40 - 945.46DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF LOWER LIMB (LEG) WITHOUT LOSS OF A BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF THIGH (ANY PART) WITHOUT LOSS OF THIGH

945.49DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF LOWER LIMB(S) WITHOUT LOSS OF A BODY PART

945.50 - 945.56DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE LOWER LIMB (LEG) WITH LOSS OF A BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF THIGH (ANY PART) WITH LOSS OF THIGH

945.59 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF LOWER LIMB(S) WITH LOSS OF A BODY PART

946.2 - 946.5BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SPECIFIED SITES - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SPECIFIED SITES WITH LOSS OF A BODY PART

948.00 BURN (ANY DEGREE) INVOLVING LESS THAN 10 PERCENT OF BODY SURFACE WITH THIRD DEGREE BURN OF LESS THAN 10 PERCENT OR UNSPECIFIED AMOUNT

948.10 - 948.11BURN (ANY DEGREE) INVOLVING 10-19 PERCENT OF BODY SURFACE WITH THIRD DEGREE BURN OF LESS THAN 10 PERCENT OR UNSPECIFIED AMOUNT - BURN (ANY DEGREE) INVOLVING 10-19 PERCENT OF BODY SURFACE WITH THIRD DEGREE BURN OF 10-19%










948.90 - 948.99

BURN (ANY DEGREE) INVOLVING 90 PERCENT OR MORE OF BODY SURFACE WITH THIRD DEGREE BURN OF LESS THAN 10 PERCENT OR UNSPECIFIED AMOUNT - BURN (ANY DEGREE) INVOLVING 90 PERCENT OR MORE OF BODY SURFACE WITH THIRD DEGREE BURN OF 90% OR MORE OF BODY SURFACE

953.1 - 953.5 INJURY TO DORSAL NERVE ROOT - INJURY TO LUMBOSACRAL PLEXUS


955.0 - 955.9 INJURY TO AXILLARY NERVE - INJURY TO UNSPECIFIED NERVE OF SHOULDER GIRDLE AND UPPER LIMB


956.8 - 956.9INJURY TO MULTIPLE NERVES OF PELVIC GIRDLE AND LOWER LIMB - INJURY TO UNSPECIFIED NERVE OF PELVIC GIRDLE AND LOWER LIMB

997.60 - 997.61 UNSPECIFIED LATE COMPLICATION OF AMPUTATION STUMP - NEUROMA OF AMPUTATION STUMP












V54.81 - V54.82 AFTERCARE FOLLOWING JOINT REPLACEMENT - AFTERCARE FOLLOWING EXPLANTATION OF JOINT PROSTHESIS


Medicare is establishing the following limited coverage for CPT/HCPCS code 97024 – diathermy: Covered for:






337.20 - 337.29 REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED - REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED SITE



354.0 - 354.9 CARPAL TUNNEL SYNDROME - MONONEURITIS OF UPPER LIMB UNSPECIFIED


355.71 - 355.79 CAUSALGIA OF LOWER LIMB - OTHER MONONEURITIS OF LOWER LIMB






711.20 - 711.29 ARTHROPATHY IN BEHCET'S SYNDROME SITE UNSPECIFIED - ARTHROPATHY IN BEHCET'S SYNDROME INVOLVING MULTIPLE SITES


711.40 - 711.49ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH OTHER BACTERIAL DISEASES - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH OTHER BACTERIAL DISEASES



















716.10 - 716.19TRAUMATIC ARTHROPATHY SITE UNSPECIFIED - TRAUMATIC ARTHROPATHY INVOLVING MULTIPLE SITES






717.40 - 717.43 DERANGEMENT OF LATERAL MENISCUS UNSPECIFIED - DERANGEMENT OF POSTERIOR HORN OF LATERAL MENISCUS










719.11 - 719.19 HERARTHROSIS INVOLVING SHOULDER REGION - HEMARTHROSIS INVOLVING MULTIPLE SITES





















































728.83 - 728.85 RUPTURE OF MUSCLE NONTRAUMATIC - SPASM OF MUSCLE






808.41 - 808.44 CLOSED FRACTURE OF ILIUM - MULTIPLE CLOSED PELVIC FRACTURES WITHOUT DISRUPTION OF PELVIC CIRCLE


808.51 - 808.54 OPEN FRACTURE OF ILIUM - MULTIPLE OPEN PELVIC FRACTURES WITHOUT DISRUPTION OF PELVIC CIRCLE










812.00 - 812.03FRACTURE OF UNSPECIFIED PART OF UPPER END OF HUMERUS CLOSED - FRACTURE OF GREATER TUBEROSITY OF HUMERUS CLOSED


812.10 - 812.13FRACTURE OF UNSPECIFIED PART OF UPPER END OF HUMERUS OPEN - FRACTURE OF GREATER TUBEROSITY OF HUMERUS OPEN
















813.80 - 813.83 CLOSED FRACTURE OF UNSPECIFIED PART OF FOREARM - FRACTURE OF UNSPECIFIED PART OF RADIUS WITH ULNA CLOSED







816.11 OPEN FRACTURE OF MIDDLE OR PROXIMAL PHALANX OR PHALANGES OF HAND

816.13 OPEN FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND


820.00 - 820.03FRACTURE OF UNSPECIFIED INTRACAPSULAR SECTION OF NECK OF FEMUR CLOSED - FRACTURE OF BASE OF NECK OF FEMUR CLOSED




















823.40 - 823.42 TORUS FRACTURE OF TIBIA ALONE - TORUS FRACTURE OF FIBULA WITH TIBIA

823.80 - 823.82 CLOSED FRACTURE OF UNSPECIFIED PART OF TIBIA - CLOSED FRACTURE OF UNSPECIFIED PART OF FIBULA WITH TIBIA

































838.09 CLOSED DISLOCATION OF OTHER PART OF FOOT


840.0 - 840.9ACROMIOCLAVICULAR (JOINT) (LIGAMENT) SPRAIN - SPRAIN OF UNSPECIFIED SITE OF SHOULDER AND UPPER ARM










843.9 SPRAIN OF UNSPECIFIED SITE OF HIP AND THIGH

844.0 - 844.3 SPRAIN OF LATERAL COLLATERAL LIGAMENT OF KNEE - SPRAIN OF TIBIOFIBULAR (JOINT) (LIGAMENT) SUPERIOR OF KNEE

844.8 - 844.9SPRAIN OF OTHER SPECIFIED SITES OF KNEE AND LEG - SPRAIN OF UNSPECIFIED SITE OF KNEE AND LEG












848.5 PELVIC SPRAIN

848.8 - 848.9 OTHER SPECIFIED SITES OF SPRAINS AND STRAINS - UNSPECIFIED SITE OF SPRAIN AND STRAIN




























943.20 - 943.26BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF SCAPULAR REGION

943.29BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND

943.30 - 943.36FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF UPPER LIMB - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF SCAPULAR REGION

943.39 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND

943.40 - 943.46DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB WITHOUT LOSS OF A BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF SCAPULAR REGION WITHOUT LOSS OF SCAPULA

943.49DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND WITHOUT LOSS OF UPPER LIMB

943.50 - 943.56DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB WITH LOSS OF A BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF SCAPULAR REGION WITH LOSS OF SCAPULA

943.59 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND WITH LOSS OF UPPER LIMB

944.20 - 944.28BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF HAND - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF WRIST(S) AND HAND(S)

944.30 - 944.38FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF HAND - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF WRIST(S) AND HAND(S)

944.40 - 944.48

DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF HAND WITHOUT LOSS OF HAND - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF WRIST(S) AND HAND(S) WITHOUT LOSS OF A BODY PART

944.50 - 944.58DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF HAND WITH LOSS OF HAND - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF WRIST(S) AND HAND(S) WITH LOSS OF A BODY PART

945.20 - 945.26 BLISTERS EPIDERMAL LOSS (SECOND DEGREE) OF UNSPECIFIED SITE OF LOWER LIMB (LEG) - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF THIGH (ANY PART)

945.29BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF LOWER LIMB(S)

945.30 - 945.36FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF LOWER LIMB - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF THIGH (ANY PART)

945.39FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF LOWER LIMB(S)

945.40 - 945.46DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF LOWER LIMB (LEG) WITHOUT LOSS OF A BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF THIGH (ANY PART) WITHOUT LOSS OF THIGH

945.49 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF LOWER LIMB(S) WITHOUT LOSS OF A BODY PART

945.50 - 945.56DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE LOWER LIMB (LEG) WITH LOSS OF A BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF THIGH (ANY PART) WITH LOSS OF THIGH

945.59 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF LOWER LIMB(S) WITH LOSS OF A BODY PART

946.2 - 946.5BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SPECIFIED SITES - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SPECIFIED SITES WITH LOSS OF A BODY PART

948.00BURN (ANY DEGREE) INVOLVING LESS THAN 10 PERCENT OF BODY SURFACE WITH THIRD DEGREE BURN OF LESS THAN 10 PERCENT OR UNSPECIFIED AMOUNT











948.90 - 948.99

BURN (ANY DEGREE) INVOLVING 90 PERCENT OR MORE OF BODY SURFACE WITH THIRD DEGREE BURN OF LESS THAN 10 PERCENT OR UNSPECIFIED AMOUNT - BURN (ANY DEGREE) INVOLVING 90 PERCENT OR MORE OF BODY SURFACE WITH THIRD DEGREE BURN OF 90% OR MORE OF BODY SURFACE





956.8 - 956.9 INJURY TO MULTIPLE NERVES OF PELVIC GIRDLE AND LOWER LIMB - INJURY TO UNSPECIFIED NERVE OF PELVIC GIRDLE AND LOWER LIMB


Medicare is establishing the following limited coverage for CPT/HCPCS code 97028 – ultraviolet: Covered for:

202.10 MYCOSIS FUNGOIDES UNSPECIFIED SITE

202.20 SEZARY'S DISEASE UNSPECIFIED SITE

202.80 OTHER MALIGNANT LYMPHOMAS UNSPECIFIED SITE

692.9 CONTACT DERMATITIS AND OTHER ECZEMA UNSPECIFIED CAUSE

696.1 - 696.2 OTHER PSORIASIS AND SIMILAR DISORDERS - PARAPSORIASIS

697.0 LICHEN PLANUS

Medicare is establishing the following limited coverage for CPT/HCPCS code 97034 – contrast baths: Covered for:

337.20 REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED

337.21 REFLEX SYMPATHETIC DYSTROPHY OF THE UPPER LIMB

337.22 REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER LIMB


727.04 - 727.06 RADIAL STYLOID TENOSYNOVITIS - TENOSYNOVITIS OF FOOT AND ANKLE

727.2 SPECIFIC BURSITIDES OFTEN OF OCCUPATIONAL ORIGIN

729.0 RHEUMATISM UNSPECIFIED AND FIBROSITIS





729.81 SWELLING OF LIMB

Medicare is establishing the following limited coverage for CPT/HCPCS code 97035 – ultrasound: Covered for:








353.1 - 353.6 LUMBOSACRAL PLEXUS LESIONS - PHANTOM LIMB (SYNDROME)







355.8 MONONEURITIS OF LOWER LIMB UNSPECIFIED



















713.0 - 713.8 ARTHROPATHY ASSOCIATED WITH OTHER ENDOCRINE AND METABOLIC DISORDERS - ARTHROPATHY ASSOCIATED WITH OTHER CONDITIONS CLASSIFIABLE ELSEWHERE










715.10 - 715.18OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING OTHER SPECIFIED SITES

715.20 - 715.28OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING OTHER SPECIFIED SITES









716.40 - 716.49TRANSIENT ARTHROPATHY SITE UNSPECIFIED - TRANSIENT ARTHROPATHY INVOLVING MULTIPLE SITES


717.0 - 717.3 OLD BUCKET HANDLE TEAR OF MEDIAL MENISCUS - OTHER AND UNSPECIFIED DERANGEMENT OF MEDIAL MENISCUS






















































728.11 PROGRESSIVE MYOSITIS OSSIFICANS


729.82 CRAMP OF LIMB



782.3 EDEMA







809.0 FRACTURE OF BONES OF TRUNK CLOSED

809.1 FRACTURE OF BONES OF TRUNK OPEN


















813.10 - 813.18OPEN FRACTURE OF UPPER END OF FOREARM UNSPECIFIED - FRACTURE OF RADIUS WITH ULNA UPPER END (ANY PART) OPEN

813.20 - 813.23FRACTURE OF SHAFT OF RADIUS OR ULNA UNSPECIFIED CLOSED - FRACTURE OF SHAFT OF RADIUS WITH ULNA CLOSED


813.40 - 813.44 CLOSED FRACTURE OF LOWER END OF FOREARM UNSPECIFIED - FRACTURE OF LOWER END OF RADIUS WITH ULNA CLOSED





























































836.50 - 836.54 CLOSED DISLOCATION OF KNEE UNSPECIFIED PART - LATERAL DISLOCATION OF TIBIA PROXIMAL END CLOSED


836.60 - 836.64 DISLOCATION OF KNEE UNSPECIFIED PART OPEN - LATERAL DISLOCATION OF TIBIA PROXIMAL END OPEN






840.8 SPRAIN OF OTHER SPECIFIED SITES OF SHOULDER AND UPPER ARM

840.9 SPRAIN OF UNSPECIFIED SITE OF SHOULDER AND UPPER ARM























848.5 PELVIC SPRAIN


























951.4 INJURY TO FACIAL NERVE







Medicare is establishing the following limited coverage for CPT/HCPCS code 97110 – therapeutic exercise: Covered for:

191.0 - 191.9 MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE






332.0 - 332.1 PARALYSIS AGITANS - SECONDARY PARKINSONISM



333.90 - 333.91UNSPECIFIED EXTRAPYRAMIDAL DISEASE AND ABNORMAL MOVEMENT DISORDER - STIFF-MAN SYNDROME

334.0 - 334.4 FRIEDREICH'S ATAXIA - CEREBELLAR ATAXIA IN DISEASES CLASSIFIED ELSEWHERE

334.8 OTHER SPINOCEREBELLAR DISEASES

335.0 WERDNIG-HOFFMANN DISEASE

335.10 - 335.11 SPINAL MUSCULAR ATROPHY UNSPECIFIED - KUGELBERG-WELANDER DISEASE

335.19 OTHER SPINAL MUSCULAR ATROPHY

335.20 - 335.24 AMYOTROPHIC LATERAL SCLEROSIS - PRIMARY LATERAL SCLEROSIS

335.29 OTHER MOTOR NEURON DISEASES

335.8 - 335.9 OTHER ANTERIOR HORN CELL DISEASES - ANTERIOR HORN CELL DISEASE UNSPECIFIED

336.0 - 336.3 SYRINGOMYELIA AND SYRINGOBULBIA - MYELOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE

336.8 OTHER MYELOPATHY

337.20 - 337.22REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED - REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER LIMB





340 MULTIPLE SCLEROSIS

341.1 SCHILDER'S DISEASE

341.22 IDIOPATHIC TRANSVERSE MYELITIS

341.8 - 341.9OTHER DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM - DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM UNSPECIFIED





343.0 - 343.4 CONGENITAL DIPLEGIA - INFANTILE HEMIPLEGIA

343.8 - 343.9 OTHER SPECIFIED INFANTILE CEREBRAL PALSY - INFANTILE CEREBRAL PALSY UNSPECIFIED

344.00 - 344.04 QUADRIPLEGIA UNSPECIFIED - QUADRIPLEGIA C5-C7 INCOMPLETE

344.09 OTHER QUADRIPLEGIA

344.1 - 344.2 PARAPLEGIA - DIPLEGIA OF UPPER LIMBS

344.30 - 344.32 MONOPLEGIA OF LOWER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE

344.40 - 344.42 MONOPLEGIA OF UPPER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SDE

344.5 UNSPECIFIED MONOPLEGIA

344.60 - 344.61 CAUDA EQUINA SYNDROME WITHOUT NEUROGENIC BLADDER - CAUDA EQUINA SYNDROME WITH NEUROGENIC BLADDER

344.81 LOCKED-IN STATE

344.89 OTHER SPECIFIED PARALYTIC SYNDROME



344.9 PARALYSIS UNSPECIFIED










348.1 ANOXIC BRAIN DAMAGE

349.0 - 349.1REACTION TO SPINAL OR LUMBAR PUNCTURE - NERVOUS SYSTEM COMPLICATIONS FROM SURGICALLY IMPLANTED DEVICE


351.1 GENICULATE GANGLIONITIS









356.0 - 356.4 HEREDITARY PERIPHERAL NEUROPATHY - IDIOPATHIC PROGRESSIVE POLYNEUROPATHY

356.8 - 356.9 OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY - UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY

357.0 ACUTE INFECTIVE POLYNEURITIS

357.9 UNSPECIFIED INFLAMMATORY AND TOXIC NEUROPATHIES

358.00 - 358.01 MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION - MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION

358.1 - 358.2 MYASTHENIC SYNDROMES IN DISEASES CLASSIFIED ELSEWHERE - TOXIC MYONEURAL DISORDERS

358.30 - 358.31 LAMBERT-EATON SYNDROME, UNSPECIFIED - LAMBERT-EATON SYNDROME IN NEOPLASTIC DISEASE

358.39 LAMBERT-EATON SYNDROME IN OTHER DISEASES CLASSIFIED ELSEWHERE

358.8 - 358.9 OTHER SPECIFIED MYONEURAL DISORDERS - MYONEURAL DISORDERS UNSPECIFIED

359.0 - 359.1 CONGENITAL HEREDITARY MUSCULAR DYSTROPHY - HEREDITARY PROGRESSIVE MUSCULAR DYSTROPHY

359.3 - 359.6 PERIODIC PARALYSIS - SYMPTOMATIC INFLAMMATORY MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE



359.71 INCLUSION BODY MYOSITIS

359.79 OTHER INFLAMMATORY AND IMMUNE MYOPATHIES, NEC

359.81 CRITICAL ILLNESS MYOPATHY

359.89 OTHER MYOPATHIES

359.9 MYOPATHY UNSPECIFIED

386.00 - 386.04 MÉNIÈRE'S DISEASE, UNSPECIFIED - INACTIVE MÉNIÈRE'S DISEASE

386.10 - 386.12 PERIPHERAL VERTIGO UNSPECIFIED - VESTIBULAR NEURONITIS

386.2 VERTIGO OF CENTRAL ORIGIN

386.30 - 386.35 LABYRINTHITIS UNSPECIFIED - VIRAL LABYRINTHITIS

386.9 UNSPECIFIED VERTIGINOUS SYNDROMES AND LABYRINTHINE DISORDERS

428.0 - 428.1 CONGESTIVE HEART FAILURE UNSPECIFIED - LEFT HEART FAILURE

436 ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE

438.20 - 438.22 HEMIPLEGIA AFFECTING UNSPECIFIED SIDE - HEMIPLEGIA AFFECTING NONDOMINANT SIDE

457.0 - 457.1 POSTMASTECTOMY LYMPHEDEMA SYNDROME - OTHER LYMPHEDEMA

490 BRONCHITIS NOT SPECIFIED AS ACUTE OR CHRONIC

491.0 - 491.1 SIMPLE CHRONIC BRONCHITIS - MUCOPURULENT CHRONIC BRONCHITIS

491.20 OBSTRUCTIVE CHRONIC BRONCHITIS WITHOUT EXACERBATION

491.8 OTHER CHRONIC BRONCHITIS

492.0 EMPHYSEMATOUS BLEB

492.8 OTHER EMPHYSEMA

493.20 CHRONIC OBSTRUCTIVE ASTHMA UNSPECIFIED

493.81 - 493.82 EXERCISE-INDUCED BRONCHOSPASM - COUGH VARIANT ASTHMA

494.0 - 494.1 BRONCHIECTASIS WITHOUT ACUTE EXACERBATION - BRONCHIECTASIS WITH ACUTE EXACERBATION

496 CHRONIC AIRWAY OBSTRUCTION NOT ELSEWHERE CLASSIFIED

500 - 504 COAL WORKERS' PNEUMOCONIOSIS - PNEUMONOPATHY DUE TO INHALATION OF OTHER DUST

506.0 BRONCHITIS AND PNEUMONITIS DUE TO FUMES AND VAPORS

506.4 CHRONIC RESPIRATORY CONDITIONS DUE TO FUMES AND VAPORS

506.9 UNSPECIFIED RESPIRATORY CONDITIONS DUE TO FUMES AND VAPORS

508.1 CHRONIC AND OTHER PULMONARY MANIFESTATIONS DUE TO RADIATION

515 POSTINFLAMMATORY PULMONARY FIBROSIS

518.1 INTERSTITIAL EMPHYSEMA

518.7 TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI)

518.89* OTHER DISEASES OF LUNG NOT ELSEWHERE CLASSIFIED

524.60 - 524.63TEMPOROMANDIBULAR JOINT DISORDERS UNSPECIFIED - TEMPOROMANDIBULAR JOINT DISORDERS ARTICULAR DISC DISORDER (REDUCING OR NON-REDUCING)


564.6 ANAL SPASM










618.04 RECTOCELE






625.3 DYSMENORRHEA



665.60 - 665.61 DAMAGE TO PELVIC JOINTS AND LIGAMENTS UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - DAMAGE TO PELVIC JOINTS AND LIGAMENTS WITH DELIVERY


681.00 - 681.01 UNSPECIFIED CELLULITIS AND ABSCESS OF FINGER - FELON


711.00 - 711.08 PYOGENIC ARTHRITIS SITE UNSPECIFIED - PYOGENIC ARTHRITIS INVOLVING OTHER SPECIFIED SITES






























715.80OSTEOARTHROSIS INVOLVING OR WITH MORE THAN ONE SITE BUT NOT SPECIFIED AS GENERALIZED AND INVOLVING UNSPECIFIED SITE














718.10 - 718.15 LOOSE BODY IN JOINT SITE UNSPECIFIED - LOOSE BODY IN JOINT OF PELVIC REGION AND THIGH

718.17 - 718.19 LOOSE BODY IN ANKLE AND FOOT JOINT - LOOSE BODY IN JOINT OF MULTIPLE SITES




718.80 - 718.89 OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING UNSPECIFIED SITE - OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING MULTIPLE SITES




719.30 - 719.39PALINDROMIC RHEUMATISM SITE UNSPECIFIED - PALINDROMIC RHEUMATISM INVOLVING MULTIPLE SITES


719.50 - 719.59STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING UNSPECIFIED SITE - STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING MULTIPLE SITES

719.7 DIFFICULTY IN WALKING




721.42 SPONDYLOSIS WITH MYELOPATHY LUMBAR REGION











































727.9 UNSPECIFIED DISORDER OF SYNOVIUM TENDON AND BURSA









728.87 MUSCLE WEAKNESS (GENERALIZED)




730.10 - 730.19 CHRONIC OSTEOMYELITIS SITE UNSPECIFIED - CHRONIC OSTEOMYELITIS INVOLVING MULTIPLE SITES

736.00 UNSPECIFIED DEFORMITY OF FOREARM EXCLUDING FINGERS

736.04 VARUS DEFORMITY OF WRIST (ACQUIRED)

757.0 HEREDITARY EDEMA OF LEGS

780.71 - 780.72 CHRONIC FATIGUE SYNDROME - FUNCTIONAL QUADRIPLEGIA


781.0 - 781.3 ABNORMAL INVOLUNTARY MOVEMENTS - LACK OF COORDINATION

781.92 ABNORMAL POSTURE

781.99 OTHER SYMPTOMS INVOLVING NERVOUS AND MUSCULOSKELETAL SYSTEMS

782.3 EDEMA


787.60 - 787.62 FULL INCONTINENCE OF FECES - FECAL SMEARING

788.1 DYSURIA




799.4 CACHEXIA

805.00 - 805.08 CLOSED FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL - CLOSED FRACTURE OF MULTIPLE CERVICAL VERTEBRAE

805.10 - 805.18 OPEN FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL - OPEN FRACTURE OF MULTIPLE CERVICAL VERTEBRAE

805.2 - 805.9 CLOSED FRACTURE OF DORSAL (THORACIC) VERTEBRA WITHOUT SPINAL CORD INJURY - OPEN FRACTURE OF UNSPECIFIED PART OF VERTEBRAL COLUMN WITHOUT SPINAL CORD INJURY

806.00 - 806.09CLOSED FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY

806.10 - 806.19OPEN FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - OPEN FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY

806.20 - 806.29 CLOSED FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY

806.30 - 806.39 OPEN FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - OPEN FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY

806.4 - 806.5 CLOSED FRACTURE OF LUMBAR SPINE WITH SPINAL CORD INJURY - OPEN FRACTURE OF LUMBAR SPINE WITH SPINAL CORD INJURY

806.60 - 806.62 CLOSED FRACTURE OF SACRUM AND COCCYX WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF SACRUM AND COCCYX WITH OTHER CAUDA EQUINA INJURY

806.69 CLOSED FRACTURE OF SACRUM AND COCCYX WITH OTHER SPINAL CORD INJURY

806.70 - 806.72 OPEN FRACTURE OF SACRUM AND COCCYX WITH UNSPECIFIED SPINAL CORD INJURY - OPEN FRACTURE OF SACRUM AND COCCYX WITH OTHER CAUDA EQUINA INJURY

806.79 OPEN FRACTURE OF SACRUM AND COCCYX WITH OTHER SPINAL CORD INJURY

806.8 CLOSED FRACTURE OF UNSPECIFIED VERTEBRA WITH SPINAL CORD INJURY

807.00 - 807.09 CLOSED FRACTURE OF RIB(S) UNSPECIFIED - CLOSED FRACTURE OF MULTIPLE RIBS UNSPECIFIED

807.10 - 807.19 OPEN FRACTURE OF RIB(S) UNSPECIFIED - OPEN FRACTURE OF MULTIPLE RIBS UNSPECIFIED



807.2 - 807.5 CLOSED FRACTURE OF STERNUM - CLOSED FRACTURE OF LARYNX AND TRACHEA

























813.10 - 813.18OPEN FRACTURE OF UPPER END OF FOREARM UNSPECIFIED - FRACTURE OF RADIUS WITH ULNA UPPER END (ANY PART) OPEN

813.20 - 813.23FRACTURE OF SHAFT OF RADIUS OR ULNA UNSPECIFIED CLOSED - FRACTURE OF SHAFT OF RADIUS WITH ULNA CLOSED
















818.0 - 818.1 ILL-DEFINED CLOSED FRACTURES OF UPPER LIMB - ILL-DEFINED OPEN FRACTURES OF UPPER LIMB





















824.0 - 824.7 FRACTURE OF MEDIAL MALLEOLUS CLOSED - TRIMALLEOLAR FRACTURE OPEN

824.8 - 824.9 UNSPECIFIED FRACTURE OF ANKLE CLOSED - UNSPECIFIED FRACTURE OF ANKLE OPEN







827.0 - 827.1 OTHER MULTIPLE AND ILL-DEFINED FRACTURES OF LOWER LIMB CLOSED - OTHER MULTIPLE AND ILL-DEFINED FRACTURES OF LOWER LIMB OPEN





























840.8 SPRAIN OF OTHER SPECIFIED SITES OF SHOULDER AND UPPER ARM

840.9 SPRAIN OF UNSPECIFIED SITE OF SHOULDER AND UPPER ARM























848.5 PELVIC SPRAIN


























952.00 - 952.09C1-C4 LEVEL SPINAL CORD INJURY UNSPECIFIED - C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY

952.2 - 952.4 LUMBAR SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY - CAUDA EQUINA SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY

952.8 MULTIPLE SITES OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY





956.8 - 956.9 INJURY TO MULTIPLE NERVES OF PELVIC GIRDLE AND LOWER LIMB - INJURY TO UNSPECIFIED NERVE OF PELVIC GIRDLE AND LOWER LIMB






V49.67 SHOULDER AMPUTATION STATUS









Note: Use this code for patients who have become oxygen dependent following an illness. Medicare is establishing the following limited coverage for CPT/HCPCS code 97112 – balance and coordination and 97116 – gait training: Covered for:

138 LATE EFFECTS OF ACUTE POLIOMYELITIS

191.0 - 191.9 MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE





333.0 OTHER DEGENERATIVE DISEASES OF THE BASAL GANGLIA





334.8 - 334.9 OTHER SPINOCEREBELLAR DISEASES - SPINOCEREBELLAR DISEASE UNSPECIFIED

















341.8 - 341.9 OTHER DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM - DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM UNSPECIFIED






342.90 - 342.92UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE






344.60 - 344.61CAUDA EQUINA SYNDROME WITHOUT NEUROGENIC BLADDER - CAUDA EQUINA SYNDROME WITH NEUROGENIC BLADDER













349.0 - 349.1 REACTION TO SPINAL OR LUMBAR PUNCTURE - NERVOUS SYSTEM COMPLICATIONS FROM SURGICALLY IMPLANTED DEVICE


351.1 GENICULATE GANGLIONITIS












356.8 - 356.9OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY - UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY

357.0 - 357.9 ACUTE INFECTIVE POLYNEURITIS - UNSPECIFIED INFLAMMATORY AND TOXIC NEUROPATHIES

358.00 - 358.01MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION - MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION

358.1 - 358.2 MYASTHENIC SYNDROMES IN DISEASES CLASSIFIED ELSEWHERE - TOXIC MYONEURAL DISORDERS




359.0 - 359.1 CONGENITAL HEREDITARY MUSCULAR DYSTROPHY - HEREDITARY PROGRESSIVE MUSCULAR DYSTROPHY

359.3 - 359.6PERIODIC PARALYSIS - SYMPTOMATIC INFLAMMATORY MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE



359.81 CRITICAL ILLNESS MYOPATHY

359.89 OTHER MYOPATHIES


369.01 BETTER EYE: TOTAL VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT

369.03 - 369.08 BETTER EYE: NEAR-TOTAL VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT - BETTER EYE: PROFOUND VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT

369.12 - 369.14 BETTER EYE: SEVERE VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT - BETTER EYE: SEVERE VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT

369.16 - 369.18 BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT - BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT

369.24 - 369.25 BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: SEVERE VISION IMPAIRMENT - BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: MODERATE VISION IMPAIRMENT









564.6 ANAL SPASM










618.04 RECTOCELE






625.3 DYSMENORRHEA



665.60 - 665.61DAMAGE TO PELVIC JOINTS AND LIGAMENTS UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - DAMAGE TO PELVIC JOINTS AND LIGAMENTS WITH DELIVERY





711.30 - 711.39 POSTDYSENTERIC ARTHROPATHY SITE UNSPECIFIED - POSTDYSENTERIC ARTHROPATHY INVOLVING MULTIPLE SITES





711.80 - 711.84ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH OTHER INFECTIOUS AND PARASITIC DISEASES - ARTHROPATHY INVOLVING HAND ASSOCIATED WITH OTHER INFECTIOUS AND PARASITIC DISEASES

711.86 - 711.89ARTHROPATHY INVOLVING LOWER LEG ASSOCIATED WITH OTHER INFECTIOUS AND PARASITIC DISEASES - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH OTHER INFECTIOUS AND PARASITIC DISEASES


712.10 - 712.19CHONDROCALCINOSIS DUE TO DICALCIUM PHOSPHATE CRYSTALS INVOLVING UNSPECIFIED SITE - CHONDROCALCINOSIS DUE TO DICALCIUM PHOSPHATE CRYSTALS INVOLVING MULTIPLE SITES

712.20 - 712.29CHONDROCALCINOSIS DUE TO PYROPHOSPHATE CRYSTALS INVOLVING UNSPECIFIED SITE - CHONDROCALCINOSIS DUE TO PYROPHOSPHATE CRYSTALS INVOLVING MULTIPLE SITES

712.30 - 712.39CHONDROCALCINOSIS CAUSE UNSPECIFIED INVOLVING UNSPECIFIED SITE - CHONDROCALCINOSIS CAUSE UNSPECIFIED INVOLVING MULTIPLE SITES































































724.1 PAIN IN THORACIC SPINE







































730.10 - 730.19CHRONIC OSTEOMYELITIS SITE UNSPECIFIED - CHRONIC OSTEOMYELITIS INVOLVING MULTIPLE SITES



736.79 OTHER ACQUIRED DEFORMITIES OF ANKLE AND FOOT

755.30 - 755.38UNSPECIFIED REDUCTION DEFORMITY OF LOWER LIMB CONGENITAL - LONGITUDINAL DEFICIENCY TARSALS OR METATARSALS COMPLETE OR PARTIAL (WITH OR WITHOUT INCOMPLETE PHALANGEAL DEFICIENCY)

755.61 - 755.64 COXA VALGA CONGENITAL - CONGENITAL DEFORMITY OF KNEE (JOINT)







782.3 EDEMA


788.1 DYSURIA





































816.11 - 816.13OPEN FRACTURE OF MIDDLE OR PROXIMAL PHALANX OR PHALANGES OF HAND - OPEN FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND




820.10 - 820.13FRACTURE OF UNSPECIFIED INTRACAPSULAR SECTION OF NECK OF FEMUR OPEN - FRACTURE OF BASE OF NECK OF FEMUR OPEN


820.20 - 820.22FRACTURE OF UNSPECIFIED TROCHANTERIC SECTION OF FEMUR CLOSED - FRACTURE OF SUBTROCHANTERIC SECTION OF FEMUR CLOSED







































834.10 - 834.12 OPEN DISLOCATION OF FINGER UNSPECIFIED PART - OPEN DISLOCATION INTERPHALANGEAL (JOINT) HAND









838.00 - 838.06CLOSED DISLOCATION OF FOOT UNSPECIFIED PART - CLOSED DISLOCATION OF INTERPHALANGEAL (JOINT) FOOT



840.8 - 840.9SPRAIN OF OTHER SPECIFIED SITES OF SHOULDER AND UPPER ARM - SPRAIN OF UNSPECIFIED SITE OF SHOULDER AND UPPER ARM


841.8 - 841.9SPRAIN OF OTHER SPECIFIED SITES OF ELBOW AND FOREARM - SPRAIN OF UNSPECIFIED SITE OF ELBOW AND FOREARM








843.8 - 843.9 SPRAIN OF OTHER SPECIFIED SITES OF HIP AND THIGH - SPRAIN OF UNSPECIFIED SITE OF HIP AND THIGH








846.8 - 846.9OTHER SPECIFIED SITES OF SACROILIAC REGION SPRAIN - UNSPECIFIED SITE OF SACROILIAC REGION SPRAIN





848.5 PELVIC SPRAIN






























956.0 - 956.5 INJURY TO SCIATIC NERVE - INJURY TO OTHER SPECIFIED NERVE(S) OF PELVIC GIRDLE AND LOWER LIMB










V54.10 - V54.17 AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF ARM UNSPECIFIED - AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF VERTEBRAE


V54.20 - V54.27 AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF ARM UNSPECIFIED - AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF VERTEBRAE


V54.81 - V54.82 AFTERCARE FOLLOWING JOINT REPLACEMENT - AFTERCARE FOLLOWING EXPLANTATION OF JOINT PROSTHESIS


V57.81 CARE INVOLVING ORTHOTIC TRAINING

Medicare is establishing the following limited coverage for CPT/HCPCS code 97113 – aquatic therapy: Covered for:


342.00 - 342.02FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

342.10 - 342.12SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE







711.50 - 711.59ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH OTHER VIRAL DISEASES - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH OTHER VIRAL DISEASES


































718.20 - 718.29PATHOLOGICAL DISLOCATION OF JOINT SITE UNSPECIFIED - PATHOLOGICAL DISLOCATION OF JOINT OF MULTIPLE SITES

718.30 - 718.39RECURRENT DISLOCATION OF JOINT SITE UNSPECIFIED - RECURRENT DISLOCATION OF JOINT OF MULTIPLE SITES



719.20 - 719.29VILLONODULAR SYNOVITIS SITE UNSPECIFIED - VILLONODULAR SYNOVITIS INVOLVING MULTIPLE SITES

719.30 - 719.39PALINDROMIC RHEUMATISM SITE UNSPECIFIED - PALINDROMIC RHEUMATISM INVOLVING MULTIPLE SITES


719.50 - 719.59STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING UNSPECIFIED SITE - STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING MULTIPLE SITES
























































781.2 - 781.3 ABNORMALITY OF GAIT - LACK OF COORDINATION

V49.71 - V49.77 GREAT TOE AMPUTATION STATUS - HIP AMPUTATION STATUS

Medicare is establishing the following limited coverage for CPT/HCPCS code 97124 – massage: Covered for:

333.6 GENETIC TORSION DYSTONIA


333.83 - 333.84 SPASMODIC TORTICOLLIS - ORGANIC WRITERS' CRAMP




457.1 OTHER LYMPHEDEMA

480.0 - 480.3 PNEUMONIA DUE TO ADENOVIRUS - PNEUMONIA DUE TO SARS-ASSOCIATED CORONAVIRUS

480.8 - 480.9 PNEUMONIA DUE TO OTHER VIRUS NOT ELSEWHERE CLASSIFIED - VIRAL PNEUMONIA UNSPECIFIED

481 PNEUMOCOCCAL PNEUMONIA [STREPTOCOCCUS PNEUMONIAE PNEUMONIA]

482.0 - 482.2PNEUMONIA DUE TO KLEBSIELLA PNEUMONIAE - PNEUMONIA DUE TO HEMOPHILUS INFLUENZAE (H. INFLUENZAE)

482.30 - 482.32 PNEUMONIA DUE TO STREPTOCOCCUS UNSPECIFIED - PNEUMONIA DUE TO STREPTOCOCCUS GROUP B

482.39 PNEUMONIA DUE TO OTHER STREPTOCOCCUS

482.40 - 482.41PNEUMONIA DUE TO STAPHYLOCOCCUS UNSPECIFIED - METHICILLIN SUSCEPTIBLE PNEUMONIA DUE TO STAPHYLOCOCCUS AUREUS

482.49 OTHER STAPHYLOCOCCUS PNEUMONIA

482.81 - 482.83 PNEUMONIA DUE TO ANAEROBES - PNEUMONIA DUE TO OTHER GRAM-NEGATIVE BACTERIA

482.89 PNEUMONIA DUE TO OTHER SPECIFIED BACTERIA

483.0 PNEUMONIA DUE TO MYCOPLASMA PNEUMONIAE

483.8 PNEUMONIA DUE TO OTHER SPECIFIED ORGANISM

484.1 PNEUMONIA IN CYTOMEGALIC INCLUSION DISEASE

484.3 PNEUMONIA IN WHOOPING COUGH

484.5 PNEUMONIA IN ANTHRAX

484.8 PNEUMONIA IN OTHER INFECTIOUS DISEASES CLASSIFIED ELSEWHERE

485 BRONCHOPNEUMONIA ORGANISM UNSPECIFIED

486 PNEUMONIA ORGANISM UNSPECIFIED

487.0 - 487.1 INFLUENZA WITH PNEUMONIA - INFLUENZA WITH OTHER RESPIRATORY MANIFESTATIONS

487.8 INFLUENZA WITH OTHER MANIFESTATIONS



491.20 - 491.21OBSTRUCTIVE CHRONIC BRONCHITIS WITHOUT EXACERBATION - OBSTRUCTIVE CHRONIC BRONCHITIS WITH (ACUTE) EXACERBATION



491.8 - 491.9 OTHER CHRONIC BRONCHITIS - UNSPECIFIED CHRONIC BRONCHITIS


495.0 - 495.9 FARMERS' LUNG - UNSPECIFIED ALLERGIC ALVEOLITIS AND PNEUMONITIS


500 COAL WORKERS' PNEUMOCONIOSIS

501 ASBESTOSIS

502 PNEUMOCONIOSIS DUE TO OTHER SILICA OR SILICATES

503 PNEUMOCONIOSIS DUE TO OTHER INORGANIC DUST

504 PNEUMONOPATHY DUE TO INHALATION OF OTHER DUST

505 PNEUMOCONIOSIS UNSPECIFIED

506.0 - 506.4BRONCHITIS AND PNEUMONITIS DUE TO FUMES AND VAPORS - CHRONIC RESPIRATORY CONDITIONS DUE TO FUMES AND VAPORS


507.0 - 507.1PNEUMONITIS DUE TO INHALATION OF FOOD OR VOMITUS - PNEUMONITIS DUE TO INHALATION OF OILS AND ESSENCES

507.8 PNEUMONITIS DUE TO OTHER SOLIDS AND LIQUIDS

508.0 - 508.2ACUTE PULMONARY MANIFESTATIONS DUE TO RADIATION - RESPIRATORY CONDITIONS DUE TO SMOKE INHALATION

508.8 - 508.9 RESPIRATORY CONDITIONS DUE TO OTHER SPECIFIED EXTERNAL AGENTS - RESPIRATORY CONDITIONS DUE TO UNSPECIFIED EXTERNAL AGENT

513.0 ABSCESS OF LUNG

514 PULMONARY CONGESTION AND HYPOSTASIS


516.1 - 516.2 IDIOPATHIC PULMONARY HEMOSIDEROSIS - PULMONARY ALVEOLAR MICROLITHIASIS

516.30 - 516.37IDIOPATHIC INTERSTITIAL PNEUMONIA, NOT OTHERWISE SPECIFIED - DESQUAMATIVE INTERSTITIAL PNEUMONIA

516.4 - 516.5 LYMPHANGIOLEIOMYOMATOSIS - ADULT PULMONARY LANGERHANS CELL HISTIOCYTOSIS

516.8 - 516.9OTHER SPECIFIED ALVEOLAR AND PARIETOALVEOLAR PNEUMONOPATHIES - UNSPECIFIED ALVEOLAR AND PARIETOALVEOLAR PNEUMONOPATHY

517.1 - 517.2 RHEUMATIC PNEUMONIA - LUNG INVOLVEMENT IN SYSTEMIC SCLEROSIS

517.8 LUNG INVOLVEMENT IN OTHER DISEASES CLASSIFIED ELSEWHERE

524.60 - 524.63TEMPOROMANDIBULAR JOINT DISORDERS UNSPECIFIED - TEMPOROMANDIBULAR JOINT DISORDERS ARTICULAR DISC DISORDER (REDUCING OR NON-REDUCING)

524.69TEMPOROMANDIBULAR JOINT DISORDERS OTHER SPECIFIED TEMPOROMANDIBULAR JOINT DISORDERS

724.1 - 724.2 PAIN IN THORACIC SPINE - LUMBAGO

724.5 BACKACHE UNSPECIFIED





726.30 ENTHESOPATHY OF ELBOW UNSPECIFIED

726.31 - 726.33 MEDIAL EPICONDYLITIS - OLECRANON BURSITIS










726.90 ENTHESOPATHY OF UNSPECIFIED SITE




728.79 OTHER FIBROMATOSES OF MUSCLE LIGAMENT AND FASCIA


729.5 PAIN IN LIMB


754.1 CONGENITAL MUSCULOSKELETAL DEFORMITIES OF STERNOCLEIDOMASTOID MUSCLE


782.3 EDEMA

840.0 - 840.9ACROMIOCLAVICULAR (JOINT) (LIGAMENT) SPRAIN - SPRAIN OF UNSPECIFIED SITE OF SHOULDER AND UPPER ARM


841.8 - 841.9SPRAIN OF OTHER SPECIFIED SITES OF ELBOW AND FOREARM - SPRAIN OF UNSPECIFIED SITE OF ELBOW AND FOREARM



















848.5 PELVIC SPRAIN

848.8 OTHER SPECIFIED SITES OF SPRAINS AND STRAINS

Medicare is establishing the following limited coverage for CPT/HCPCS code 97760 – orthotics management and training: Covered for:

714.0 RHEUMATOID ARTHRITIS


715.14 OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING HAND

715.94 OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING HAND

726.70 ENTHESOPATHY OF ANKLE AND TARSUS UNSPECIFIED





736.70 - 736.76 UNSPECIFIED DEFORMITY OF ANKLE AND FOOT ACQUIRED - OTHER ACQUIRED CALCANEUS DEFORMITY

736.79 OTHER ACQUIRED DEFORMITIES OF ANKLE AND FOOT

952.00 - 952.09 C1-C4 LEVEL SPINAL CORD INJURY UNSPECIFIED - C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY

952.10 - 952.17 T1-T6 LEVEL SPINAL CORD INJURY UNSPECIFIED - T7-T12 LEVEL WITH ANTERIOR CORD SYNDROME


952.8 - 952.9 MULTIPLE SITES OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY - UNSPECIFIED SITE OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY

956.0 - 956.3 INJURY TO SCIATIC NERVE - INJURY TO PERONEAL NERVE

956.5 INJURY TO OTHER SPECIFIED NERVE(S) OF PELVIC GIRDLE AND LOWER LIMB

V49.1 - V49.2 MECHANICAL PROBLEMS WITH LIMBS - MOTOR PROBLEMS WITH LIMBS

V49.61 - V49.67 THUMB AMPUTATION STATUS - SHOULDER AMPUTATION STATUS


V53.7 - V53.8 FITTING AND ADJUSTMENT OF ORTHOPEDIC DEVICES - FITTING AND ADJUSTMENT OF WHEELCHAIR

V53.90 FITTING AND ADJUSTMENT OF UNSPECIFIED DEVICE

V53.99 FITTING AND ADJUSTMENT OF OTHER DEVICE

V57.81 CARE INVOLVING ORTHOTIC TRAINING

Medicare is establishing the following limited coverage for CPT/HCPCS code 97761 – prosthetic training: Covered for:


885.0 - 885.1TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) COMPLICATED

886.0 - 886.1 TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) COMPLICATED

887.0 - 887.7TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL BELOW ELBOW WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED

896.0 - 896.3 TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) UNILATERAL WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) BILATERAL COMPLICATED

897.0 - 897.7TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL BELOW KNEE WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED

V49.61 - V49.67 THUMB AMPUTATION STATUS - SHOULDER AMPUTATION STATUS

V49.71 - V49.77 GREAT TOE AMPUTATION STATUS - HIP AMPUTATION STATUS

V52.0 - V52.1FITTING AND ADJUSTMENT OF ARTIFICIAL ARM (COMPLETE) (PARTIAL) - FITTING AND ADJUSTMENT OF ARTIFICIAL LEG (COMPLETE) (PARTIAL)

V52.8 FITTING AND ADJUSTMENT OF OTHER SPECIFIED PROSTHETIC DEVICE

V53.7 FITTING AND ADJUSTMENT OF ORTHOPEDIC DEVICES

Note: Use this code for patients who have become oxygen dependent following an illness. Medicare is establishing the following limited coverage for CPT/HCPCS code 97530 – therapeutic activities and 97140 – manual therapy techniques: Covered for:

191.0 - 191.9MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE







333.6 GENETIC TORSION DYSTONIA


333.83 - 333.84 SPASMODIC TORTICOLLIS - ORGANIC WRITERS' CRAMP













































349.0 - 349.1REACTION TO SPINAL OR LUMBAR PUNCTURE - NERVOUS SYSTEM COMPLICATIONS FROM SURGICALLY IMPLANTED DEVICE


351.0 BELL'S PALSY











368.40 - 368.41 VISUAL FIELD DEFECT UNSPECIFIED - SCOTOMA INVOLVING CENTRAL AREA

368.45 - 368.47 GENERALIZED VISUAL FIELD CONTRACTION OR CONSTRICTION - HETERONYMOUS BILATERAL FIELD DEFECTS

369.01 - 369.08 BETTER EYE: TOTAL VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT - BETTER EYE: PROFOUND VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT

369.12 - 369.18BETTER EYE: SEVERE VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT - BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT

369.22 BETTER EYE: SEVERE VISION IMPAIRMENT; LESSER EYE: SEVERE VISION IMPAIRMENT

369.24 - 369.25BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: SEVERE VISION IMPAIRMENT - BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: MODERATE VISION IMPAIRMENT






428.0 - 428.1 CONGESTIVE HEART FAILURE UNSPECIFIED - LEFT HEART FAILURE



457.0 - 457.1 POSTMASTECTOMY LYMPHEDEMA SYNDROME - OTHER LYMPHEDEMA







492.0 EMPHYSEMATOUS BLEB














564.6 ANAL SPASM

681.00 - 681.02 UNSPECIFIED CELLULITIS AND ABSCESS OF FINGER - ONYCHIA AND PARONYCHIA OF FINGER

681.10 - 681.11 UNSPECIFIED CELLULITIS AND ABSCESS OF TOE - ONYCHIA AND PARONYCHIA OF TOE


709.2 SCAR CONDITIONS AND FIBROSIS OF SKIN

710.1 SYSTEMIC SCLEROSIS

710.3 - 710.4 DERMATOMYOSITIS - POLYMYOSITIS

710.8 OTHER SPECIFIED DIFFUSE DISEASES OF CONNECTIVE TISSUE








































716.60 - 716.68 UNSPECIFIED MONOARTHRITIS SITE UNSPECIFIED - UNSPECIFIED MONOARTHRITIS INVOLVING OTHER SPECIFIED SITES

716.80 - 716.89 OTHER SPECIFIED ARTHROPATHY NO SITE SPECIFIED - OTHER SPECIFIED ARTHROPATHY INVOLVING MULTIPLE SITES
























720.9 UNSPECIFIED INFLAMMATORY SPONDYLOPATHY













723.8 OTHER SYNDROMES AFFECTING CERVICAL REGION






























727.81 - 727.82 CONTRACTURE OF TENDON (SHEATH) - CALCIUM DEPOSITS IN TENDON AND BURSA






728.79 OTHER FIBROMATOSES OF MUSCLE LIGAMENT AND FASCIA








730.10 - 730.19 CHRONIC OSTEOMYELITIS SITE UNSPECIFIED - CHRONIC OSTEOMYELITIS INVOLVING MULTIPLE SITES



754.1 CONGENITAL MUSCULOSKELETAL DEFORMITIES OF STERNOCLEIDOMASTOID MUSCLE







782.3 EDEMA

784.0 HEADACHE


787.60 - 787.62 FULL INCONTINENCE OF FECES - FECAL SMEARING

799.3 DEBILITY UNSPECIFIED

799.4 CACHEXIA






806.00 - 806.09 CLOSED FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY


806.20 - 806.29CLOSED FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY

806.30 - 806.39OPEN FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - OPEN FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY







806.9 OPEN FRACTURE OF UNSPECIFIED VERTEBRA WITH SPINAL CORD INJURY



807.2 - 807.6 CLOSED FRACTURE OF STERNUM - OPEN FRACTURE OF LARYNX AND TRACHEA

































































824.8 - 824.9 UNSPECIFIED FRACTURE OF ANKLE CLOSED - UNSPECIFIED FRACTURE OF ANKLE OPEN







827.0 - 827.1 OTHER MULTIPLE AND ILL-DEFINED FRACTURES OF LOWER LIMB CLOSED - OTHER MULTIPLE AND ILL-DEFINED FRACTURES OF LOWER LIMB OPEN


























840.8 - 840.9SPRAIN OF OTHER SPECIFIED SITES OF SHOULDER AND UPPER ARM - SPRAIN OF UNSPECIFIED SITE OF SHOULDER AND UPPER ARM












844.8 - 844.9SPRAIN OF OTHER SPECIFIED SITES OF KNEE AND LEG - SPRAIN OF UNSPECIFIED SITE OF KNEE AND LEG












848.5 PELVIC SPRAIN

848.8 OTHER SPECIFIED SITES OF SPRAINS AND STRAINS

851.00 - 851.06CORTEX (CEREBRAL) CONTUSION WITHOUT OPEN INTRACRANIAL WOUND STATE OF CONSCIOUSNESS UNSPECIFIED - CORTEX (CEREBRAL) CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

851.09 CORTEX (CEREBRAL) CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

851.10 - 851.16CORTEX (CEREBRAL) CONTUSION WITH OPEN INTRACRANIAL WOUND WITHOUT SPECIFIC STATE OF CONSCIOUSNESS - CORTEX (CEREBRAL) CONTUSION WITH OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

851.19CORTEX (CEREBRAL) CONTUSION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

851.20 - 851.26CORTEX (CEREBRAL) LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - CORTEX (CEREBRAL) LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

851.29 CORTEX (CEREBRAL) LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

851.30 - 851.36CORTEX (CEREBRAL) LACERATION WITH OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - CORTEX (CEREBRAL) LACERATION WITH OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

851.39CORTEX (CEREBRAL) LACERATION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

851.40 - 851.46CEREBELLAR OR BRAIN STEM CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - CEREBELLAR OR BRAIN STEM CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

851.49 CEREBELLAR OR BRAIN STEM CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

851.50 - 851.56CEREBELLAR OR BRAIN STEM CONTUSION WITH OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - CEREBELLAR OR BRAIN STEM CONTUSION WITH OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION



851.59 CEREBELLAR OR BRAIN STEM CONTUSION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

851.60 - 851.66CEREBELLAR OR BRAIN STEM LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - CEREBELLAR OR BRAIN STEM LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

851.69CEREBELLAR OR BRAIN STEM LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

851.70 - 851.76CEREBELLAR OR BRAIN STEM LACERATION WITH OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - CEREBELLAR OR BRAIN STEM LACERATION WITH OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

851.80 - 851.86

OTHER AND UNSPECIFIED CEREBRAL LACERATION AND CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER AND UNSPECIFIED CEREBRAL LACERATION AND CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

851.89 OTHER AND UNSPECIFIED CEREBRAL LACERATION AND CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

851.90 - 851.96

OTHER AND UNSPECIFIED CEREBRAL LACERATION AND CONTUSION WITH OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER AND UNSPECIFIED CEREBRAL LACERATION AND CONTUSION WITH OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

851.99OTHER AND UNSPECIFIED CEREBRAL LACERATION AND CONTUSION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

905.1 - 905.9 LATE EFFECT OF FRACTURE OF SPINE AND TRUNK WITHOUT SPINAL CORD LESION - LATE EFFECT OF TRAUMATIC AMPUTATION


























952.00 - 952.03 C1-C4 LEVEL SPINAL CORD INJURY UNSPECIFIED - C1-C4 LEVEL WITH CENTRAL CORD SYNDROME

952.04 C1-C4 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY




952.10 - 952.19 T1-T6 LEVEL SPINAL CORD INJURY UNSPECIFIED - T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY


952.8 - 952.9MULTIPLE SITES OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY - UNSPECIFIED SITE OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY













V54.01 - V54.02ENCOUNTER FOR REMOVAL OF INTERNAL FIXATION DEVICE - ENCOUNTER FOR LENGTHENING/ADJUSTMENT OF GROWTH ROD








Medicare is establishing the following limited coverage for CPT/HCPCS code 97535 – self care: Covered for:





333.0 OTHER DEGENERATIVE DISEASES OF THE BASAL GANGLIA

333.90 - 333.91 UNSPECIFIED EXTRAPYRAMIDAL DISEASE AND ABNORMAL MOVEMENT DISORDER - STIFF-MAN SYNDROME

334.0 - 334.2 FRIEDREICH'S ATAXIA - PRIMARY CEREBELLAR DEGENERATION

334.3 - 334.4 OTHER CEREBELLAR ATAXIA - CEREBELLAR ATAXIA IN DISEASES CLASSIFIED ELSEWHERE


















342.80 - 342.82OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE



343.8 OTHER SPECIFIED INFANTILE CEREBRAL PALSY

343.9 INFANTILE CEREBRAL PALSY UNSPECIFIED




















357.0 - 357.7 ACUTE INFECTIVE POLYNEURITIS - POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS

357.81 - 357.82 CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS - CRITICAL ILLNESS POLYNEUROPATHY

357.89 OTHER INFLAMMATORY AND TOXIC NEUROPATHY

357.9 UNSPECIFIED INFLAMMATORY AND TOXIC NEUROPATHIES

358.00 - 358.01MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION - MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION

358.2 TOXIC MYONEURAL DISORDERS






359.0 - 359.1CONGENITAL HEREDITARY MUSCULAR DYSTROPHY - HEREDITARY PROGRESSIVE MUSCULAR DYSTROPHY

359.3 - 359.6 PERIODIC PARALYSIS - SYMPTOMATIC INFLAMMATORY MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE




368.40 - 368.41 VISUAL FIELD DEFECT UNSPECIFIED - SCOTOMA INVOLVING CENTRAL AREA

368.45 - 368.47GENERALIZED VISUAL FIELD CONTRACTION OR CONSTRICTION - HETERONYMOUS BILATERAL FIELD DEFECTS


369.03 - 369.04BETTER EYE: NEAR-TOTAL VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT - BETTER EYE: NEAR-TOTAL VISION IMPAIRMENT; LESSER EYE: NEAR-TOTAL VISION IMPAIRMENT

369.06 - 369.08BETTER EYE: PROFOUND VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT - BETTER EYE: PROFOUND VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT
























696.0 PSORIATIC ARTHROPATHY

710.3 DERMATOMYOSITIS

710.4 POLYMYOSITIS








711.60 - 711.69ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH MYCOSES - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH MYCOSES



















715.10 - 715.18OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING OTHER SPECIFIED SITES














716.60 - 716.68 UNSPECIFIED MONOARTHRITIS SITE UNSPECIFIED - UNSPECIFIED MONOARTHRITIS INVOLVING OTHER SPECIFIED SITES

716.80 - 716.89OTHER SPECIFIED ARTHROPATHY NO SITE SPECIFIED - OTHER SPECIFIED ARTHROPATHY INVOLVING MULTIPLE SITES

716.90 - 716.99UNSPECIFIED ARTHROPATHY SITE UNSPECIFIED - UNSPECIFIED ARTHROPATHY INVOLVING MULTIPLE SITES






718.50 - 718.59 ANKYLOSIS OF JOINT SITE UNSPECIFIED - ANKYLOSIS OF JOINT OF MULTIPLE SITES

718.65 UNSPECIFIED INTRAPELVIC PROTRUSION OF ACETABULUM PELVIC REGION AND THIGH


718.97 - 718.99 UNSPECIFIED DERANGEMENT OF ANKLE AND FOOT JOINT - UNSPECIFIED DERANGEMENT OF JOINT OF MULTIPLE SITES







719.60 - 719.69 OTHER SYMPTOMS REFERABLE TO JOINT SITE UNSPECIFIED - OTHER SYMPTOMS REFERABLE TO JOINT OF MULTIPLE SITES


719.80 - 719.89 OTHER SPECIFIED DISORDERS OF JOINT SITE UNSPECIFIED - OTHER SPECIFIED DISORDERS OF JOINT OF MULTIPLE SITES

719.90 - 719.99UNSPECIFIED DISORDER OF JOINT SITE UNSPECIFIED - UNSPECIFIED JOINT DISORDER OF MULTIPLE SITES




720.9 UNSPECIFIED INFLAMMATORY SPONDYLOPATHY

723.0 - 723.9 SPINAL STENOSIS IN CERVICAL REGION - UNSPECIFIED MUSCULOSKELETAL DISORDERS AND SYMPTOMS REFERABLE TO NECK














799.3 DEBILITY UNSPECIFIED

799.4 CACHEXIA

799.51 ATTENTION OR CONCENTRATION DEFICIT

799.52 COGNITIVE COMMUNICATION DEFICIT

799.53 VISUOSPATIAL DEFICIT

799.55 FRONTAL LOBE AND EXECUTIVE FUNCTION DEFICIT




806.00 - 806.09 CLOSED FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY


806.20 - 806.29CLOSED FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY

806.30 - 806.39OPEN FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - OPEN FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY







806.9 OPEN FRACTURE OF UNSPECIFIED VERTEBRA WITH SPINAL CORD INJURY



807.2 - 807.6 CLOSED FRACTURE OF STERNUM - OPEN FRACTURE OF LARYNX AND TRACHEA
























812.50 - 812.54FRACTURE OF UNSPECIFIED PART OF LOWER END OF HUMERUS OPEN - FRACTURE OF UNSPECIFIED CONDYLE(S) OF HUMERUS OPEN


813.00 - 813.08CLOSED FRACTURE OF UPPER END OF FOREARM UNSPECIFIED - FRACTURE OF RADIUS WITH ULNA UPPER END (ANY PART) CLOSED














816.11 - 816.13OPEN FRACTURE OF MIDDLE OR PROXIMAL PHALANX OR PHALANGES OF HAND - OPEN FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND























823.90 - 823.92OPEN FRACTURE OF UNSPECIFIED PART OF TIBIA - OPEN FRACTURE OF UNSPECIFIED PART OF FIBULA WITH TIBIA


824.8 UNSPECIFIED FRACTURE OF ANKLE CLOSED

824.9 UNSPECIFIED FRACTURE OF ANKLE OPEN







827.0 - 827.1OTHER MULTIPLE AND ILL-DEFINED FRACTURES OF LOWER LIMB CLOSED - OTHER MULTIPLE AND ILL-DEFINED FRACTURES OF LOWER LIMB OPEN





851.20 - 851.25

CORTEX (CEREBRAL) LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - CORTEX (CEREBRAL) LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS WITHOUT RETURN TO PRE-EXISTING CONSCIOUS LEVEL

851.29CORTEX (CEREBRAL) LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED


851.39 CORTEX (CEREBRAL) LACERATION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED

851.40 - 851.45 CEREBELLAR OR BRAIN STEM CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - CEREBELLAR OR BRAIN STEM CONTUSION WITHOUT OPEN



INTRACRANIAL WOUND WITH PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS WITHOUT RETURN TO PRE-EXISTING CONSCIOUS LEVEL

851.49CEREBELLAR OR BRAIN STEM CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED






851.80 - 851.86



851.90 - 851.96


851.99 OTHER AND UNSPECIFIED CEREBRAL LACERATION AND CONTUSION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED


952.10 - 952.19 T1-T6 LEVEL SPINAL CORD INJURY UNSPECIFIED - T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY


952.8 MULTIPLE SITES OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY




Note: Use this code for patients who have become oxygen dependent following an illness. Medicare is establishing the following limited coverage for CPT/HCPCS code 97537 – community/work reintegration: Covered for:



















342.80 - 342.82OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE















368.41 SCOTOMA INVOLVING CENTRAL AREA

368.45 - 368.47 GENERALIZED VISUAL FIELD CONTRACTION OR CONSTRICTION - HETERONYMOUS BILATERAL FIELD DEFECTS


733.13 - 733.16 PATHOLOGICAL FRACTURE OF VERTEBRAE - PATHOLOGICAL FRACTURE OF TIBIA OR FIBULA

733.96 - 733.98 STRESS FRACTURE OF FEMORAL NECK - STRESS FRACTURE OF PELVIS

755.31 TRANSVERSE DEFICIENCY OF LOWER LIMB







820.30 - 820.32FRACTURE OF UNSPECIFIED TROCHANTERIC SECTION OF FEMUR OPEN - FRACTURE OF SUBTROCHANTERIC SECTION OF FEMUR OPEN













851.19 CORTEX (CEREBRAL) CONTUSION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED


851.29CORTEX (CEREBRAL) LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED


851.39 CORTEX (CEREBRAL) LACERATION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED


851.49CEREBELLAR OR BRAIN STEM CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED




851.69 CEREBELLAR OR BRAIN STEM LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED


851.80 - 851.86



851.90 - 851.96


851.99 OTHER AND UNSPECIFIED CEREBRAL LACERATION AND CONTUSION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED















929.0 CRUSHING INJURY OF MULTIPLE SITES NOT ELSEWHERE CLASSIFIED

943.30 - 943.36 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF UPPER LIMB - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF SCAPULAR REGION

943.39FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND

944.35 - 944.38FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF PALM OF HAND - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF WRIST(S) AND HAND(S)

945.32 - 945.36 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF FOOT - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF THIGH (ANY PART)

945.39 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF LOWER LIMB(S)

946.3 - 946.5FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SPECIFIED SITES - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SPECIFIED SITES WITH LOSS OF A BODY PART

997.01 CENTRAL NERVOUS SYSTEM COMPLICATION

V49.75 - V49.77 BELOW KNEE AMPUTATION STATUS - HIP AMPUTATION STATUS

V53.8 FITTING AND ADJUSTMENT OF WHEELCHAIR

Medicare is establishing the following limited coverage for CPT/HCPCS code 97542 – wheelchair management: Covered for:















342.00 - 342.02FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE



















733.13 - 733.16 PATHOLOGICAL FRACTURE OF VERTEBRAE - PATHOLOGICAL FRACTURE OF TIBIA OR FIBULA

733.96 - 733.98 STRESS FRACTURE OF FEMORAL NECK - STRESS FRACTURE OF PELVIS

755.31 TRANSVERSE DEFICIENCY OF LOWER LIMB




















851.29 CORTEX (CEREBRAL) LACERATION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED


851.39CORTEX (CEREBRAL) LACERATION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED




851.49 CEREBELLAR OR BRAIN STEM CONTUSION WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED






851.80 - 851.86



851.90 - 851.96


851.99OTHER AND UNSPECIFIED CEREBRAL LACERATION AND CONTUSION WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED




V49.75 - V49.77 BELOW KNEE AMPUTATION STATUS - HIP AMPUTATION STATUS

V53.8 FITTING AND ADJUSTMENT OF WHEELCHAIR

Medicare is establishing the following limited coverage for CPT/HCPCS code 97750 – physical performance test or measurement, with written report: Covered for:.


369.03 - 369.04BETTER EYE: NEAR-TOTAL VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT - BETTER EYE: NEAR-TOTAL VISION IMPAIRMENT; LESSER EYE: NEAR-TOTAL VISION IMPAIRMENT

369.06 - 369.08 BETTER EYE: PROFOUND VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT - BETTER EYE: PROFOUND VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT





























711.60 - 711.69ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH MYCOSES - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH MYCOSES































































































Note: Use this code for patients who have become oxygen dependent following an illness. Medicare is establishing the following limited coverage for CPT/HCPCS code 97762 – checkout for orthotic/prosthetic use: Covered for:

524.60 - 524.63 TEMPOROMANDIBULAR JOINT DISORDERS UNSPECIFIED - TEMPOROMANDIBULAR JOINT DISORDERS ARTICULAR DISC DISORDER (REDUCING OR NON-REDUCING)


V49.0 - V49.5 DEFICIENCIES OF LIMBS - OTHER PROBLEMS OF LIMBS





V52.0 - V52.1FITTING AND ADJUSTMENT OF ARTIFICIAL ARM (COMPLETE) (PARTIAL) - FITTING AND ADJUSTMENT OF ARTIFICIAL LEG (COMPLETE) (PARTIAL)

Medicare is establishing the following limited coverage for CPT/HCPCS code 95992 – canalith repositioning procedure(s): Covered for:

386.11 BENIGN PAROXYSMAL POSITIONAL VERTIGO

Diagnoses that Support Medical Necessity

N/A

ICD-9 Codes that DO NOT Support Medical Necessity

N/A

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

Diagnoses that DO NOT Support Medical Necessity

All diagnoses not listed in the “ICD-9-CM Codes That Support Medical Necessity” section of this LCD.

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Other Information

Documentation Requirements

Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon

request. This documentation should establish the variables that influence the patient’s condition, especially those factors that influence the

clinician’s decision to provide more services than are typical for the individual’s condition.

•

Documentation should establish through objective measurements that the patient is making progress toward goals. Results of one of the following

four measurements are recommended:

•

National Outcomes Measurement System (NOMS) by the American Speech-Language Hearing Association. ◦

Patient Inquiry by Focus on Therapeutic Outcomes, Inc. (FOTO). ◦

Activity Measure – Post Acute Care (AM-PAC). ◦

OPTIMAL by Cedaron through the American Physical Therapy Association. ◦

Note: If results of one of the four instruments listed above are not recorded, the medical record shall contain that information outlined in Pub.100-02, Chapter 15, Section 220.3.C.

The medical record must identify the physician responsible for the general medical care. •

Therapy services must be furnished according to a written treatment plan determined by the physician or by the therapist who will provide the

treatment after an appropriate assessment of the condition (illness or injury). All qualified professionals rendering therapy must document the

appropriate history, examination, diagnosis, functional assessment, type of treatment, the body areas to be treated, the date therapy was initiated,

and expected frequency and number of treatments.

•

Outpatient therapy MUST be under the care of a Physician/NPP. An order (sometimes called a referral) for therapy service, documented in the

medical record, provides evidence of both the need for care and that the patient is under the care of a physician. Payment is dependent on the

certification of the plan of care rather than the order, but the use of an order is prudent to determine that a physician is involved in care and

available to certify the plan.

•

Certification is the physician’s/NPP’s approval of the plan of care. Certification requires a dated signature on the plan of care or some other

document that indicates approval of the plan of care. A certification is timely when it is obtained within 30 calendar days of the initial treatment

under that plan of care.

•

Recertifications must be obtained within the duration of the initial plan of care or within 90 calendar days of the initial treatment under that plan,

whichever is less.

•

For CMS recommendations regarding progress reports and modifications to the plan of care, refer to the Medicare Benefit Policy Manual Pub. 100-

02, Chapter 15.

•

When a verbal order is used to certify the plan of care a dated notation should be made in the patient’s medical record. •

Evidence considered necessary to justify delayed certification should be maintained by the supplier of services. •

Signature and professional identity of the person who established the plan and the date it was established must be recorded with the plan. •

Documentation should indicate the prognosis for potential restoration of function in a reasonable and generally predictable period of time or the

need to establish a safe and effective maintenance program. Evaluation, re-evaluation and assessment documented in Progress Notes should

describe objective measurements that, when compared, show improvement in function or decrease in severity or rationalization for an optimistic

outlook to justify continued treatment.

•

When both a modality/procedure and an evaluation service are billed, the evaluation may be reimbursed if the medical necessity for the evaluation

is clearly documented. Allowed unit limitations (once per provider, per discipline, per date of service, per patient) by discipline for CPT codes

included in this LCD are described in the “Utilization Guidelines” section below.

•

When therapy services are billed as incident to a physician/NPP services, the requirement for direct supervision by the physician/NPP and other

“incident to” requirements must be met, even though the service is provided by a licensed therapist who may perform the services unsupervised in

other settings.

•

Documentation supporting the medical necessity for multiple heating modalities (codes 97018, 97024, 97034) on the same date of service must be

available for review and show that all were needed toward the restoration of function.

•

A dated notation of a verbal order to certify the plan of care should be made in the patient’s medical record. •

Evidence considered necessary to justify delayed certification should be maintained by the supplier of services. •

Signature and professional identity of the person who established the plan and the date it was established must be recorded with the plan. •

The total number of timed minutes must be documented in the medical record. •



Appendices

N/A

Utilization Guidelines

Medicare covers the following number of therapy services without routinely requiring medical review of records to determine medical necessity:

Five (15 minutes each) timed PT services per patient per day. •

Five (15 minutes each) timed OT services per patient per day. •

Sixty (15 minutes each) PT services per patient per month. •

Sixty (15 minutes each) OT services per patient, per month. •

Providers of PT/OT services must be aware, however, that any service reported to Medicare, even when reported at a frequency within the following stated covered guidelines, may be denied if done so in association with medical review of the patient’s record that demonstrates no medical necessity for the services. Similarly, services in addition to the above limits may be payable when done so in association with medical review of the patient’s record that demonstrates medical necessity for additional services. Likewise, providers of PT/OT services must understand that although Medicare will allow the following units of service, each service must be medically reasonable and necessary for the specific patient and his condition. Additionally, Medicare expects that the patient’s medical record will clearly demonstrate that medical necessity. Further, Medicare does not expect that maximum allowable services will be routinely necessary, necessary for multiple-week periods, or necessary for the entirety of the patient’s course of treatment. Any federally established financial limitations on outpatient therapy services’ coverage and coding rules will apply. Allowed units outlined in the table below may be billed no more than once per provider, per discipline, per date of service, per patient. The codes allowed zero 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). (See CMS Change Request 5253 for additional detail.)

CPT Code Code Description Timed/Untimed Allowed Units PT Allowed Units OT Allowed Units SLP Physician/NPP No t Under a Therapy POC

97001 PT evaluation Untimed 1 0 0 N/A

97002 PT re-evaluation Untimed 1 0 0 N/A

97003 OT evaluation Untimed 0 1 0 N/A

97004 OT re-evaluation Untimed 0 1 0 N/A

Notice: This LCD imposes utilization guideline limitations. Despite Medicare's allowing up to these maximums, each patient’s condition and response to treatment must medically warrant the number of services reported for payment. Medicare requires the medical necessity for each service reported to be clearly demonstrated in the patient’s medical record. Medicare expects that patients will not routinely require the maximum allowable number of services.Sources of Information and Basis for Decision

Medicare National Coverage Determinations Manual – Pub. 100-03, Chapter 1, Part 4, Section 270.6. Other Contractor Local Coverage Determinations “Outpatient Physical Medicine and Rehabilitation,” TrailBlazer LCD, (00400) L20286, (00900) L20290. “Physical Medicine and Rehabilitation,” Noridian Administrative Services, LLC LCD, (CO) L23914. “Physical Medicine and Rehabilitation,” Arkansas BlueCross BlueShield (Pinnacle) LCD, (OK, NM) L19574 and L19573. Novitas Solutions, Inc. – JH Local Coverage Determination (LCD) Consolidation

Narrative Justification – Most Clinically Appropriate LCD LCDs Compared: L26832, Therapy Services (PT, OT, SLP), TrailBlazer, CO, NM, OK, TX – A/B L19570, Physical Medicine and Rehabilitation, Pinnacle, Arkansas - A L18739, Physical Medicine and Rehabilitation, Pinnacle, Arkansas - B L19571, Physical Medicine and Rehabilitation, Pinnacle, LA - A L31062, Physical Medicine and Rehabilitation, Pinnacle, LA, MS - B CMD Rationale: LCD L26832 from Trailblazer has additional information in the Indications/Limitations sections than the other LCDs from Pinnacle. L26832 is a well written document. There is a good explanation of frequency and time billing increments in L26832. Therapies that are not covered are also well outlined in L26832 in more detail. The format and explanations of Specific Modality Guidelines have additional information and are well written. L26832 explains with additional detail the combination of CPT codes that should not be reported at the same time. L26832 did not have the full list of ICD-9 codes available for my review as this was part of another attachment. Sources of Information were also not available as L26832 from TrailBlazer was adopted from another TrailBlazer LCD during the J4 transition. L26832 is the most clinically appropriate LCD. Advisory Committee Meeting Notes

N/A

Start Date of Comment Period

N/AEnd Date of Comment Period:

N/A

Start Date of Notice Period

06/28/2012



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Revision History

Revision History Number

1

Revision History Explanation

Date Policy # Description

08/13/2012 LCD original effective date of 08/13/2012 for Arkansas Part B and Louisiana Part B. LCD posted for notice on 06/28/2012.

Reason for Change

CMS Requirement

Related Documents

This LCD has no Related Documents. LCD Attachments

There are no attachments for this LCD

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