98977
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
$51.44
Non-Facility
$51.44
Documentation Required
- The medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.
- Medical record must include relevant medical history, applicable comorbidities/medications, prior diagnostic imaging/testing results, prior therapy history for the same diagnosis, and results of pertinent tests/procedures.
- All services ordered or rendered must be signed and dated; a legible identifier (handwritten or electronic signature) of the person(s) who provided the service is required.
- Documentation must be legible, relevant, sufficient to justify medical necessity, and should paint a clear picture of impairments, functional limitations, prior functional level, and the skilled nature of treatment provided.
Key Coverage Criteria
- Therapy services are covered when the medical record and claim consistently and accurately document that the services are covered and medically necessary.
- Therapy is covered when the patient has impairments and functional limitations that require the unique skills of a clinician (therapist) to improve functioning.
- Coverage requires an initial evaluation performed by a clinician that documents objective findings, baseline functional testing using standardized scales, realistic goals, and expected rehabilitation potential.
- Services are covered when documentation provides objective measurements or assessment results that demonstrate clinical progress toward the patient's identified functional limitations.
- Therapy is covered when documentation justifies the type, frequency, and duration of skilled therapy as medically necessary for the individual patient's condition.
- Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
6 Active Policies
A57067 — Billing and Coding: Outpatient Physical and Occupational Therapy Services
A57311 — Billing and Coding: Physical Therapy - Home Health
L34049 — Outpatient Physical and Occupational Therapy Services
L33942 — Physical Therapy - Home Health
CIGNA-RPM — Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) - (0563)
Related Codes
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