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Workers' compensation -- HIPAA 835 Health care claim payment/remittance advice



5221.4051 Fee adjustments for physical medicine and rehabilitation services

Maximum fees for the physical medicine and rehabilitation modalities in the following list are determined according to the following payment schedule when more than one modality on the list is provided to the same patient on the same day:  100 percent of the fee calculated according to the formula in part 5221.4020 for the modality with the highest RVU and 75 percent of the fee calculated according to the formula in part 5221.4020 for each additional modality. All modalities after the first modality with the highest RVU shall be coded by adding modifier 51 to the applicable procedure code.

97012
Mechanical traction therapy
97014
Electrical stimulation therapy
97016
Vasopneumatic device therapy
97018
Paraffin bath therapy
97022
Whirlpool therapy
97024
Diathermy treatment
97026
Infrared therapy
97028
Ultraviolet therapy
97032
Electrical stimulation
97033
Electric current
97034
Contrast bath therapy
97035
Ultrasound therapy
97036
Hydrotherapy
97039
Unlisted therapy service

Statutory Authority:  MS s 14.38; 14.386; 14.388; 175.171; 176.101; 176.135; 176.1351; 176.136; 176.231; 176.83

History:  18 SR 1472; 20 SR 530; 25 SR 1142; 35 SR 227

Posted:  Sept. 30, 2010

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