G0283 — Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Documentation Required
- All documentation must be maintained in the patient's medical record, be legible, include appropriate patient identification (e.g., full name, dates of service), and be available to the contractor upon request.
- The medical record must identify the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- An updated and completed OASIS M2200 for the billing period must be in the patient's medical record and made available to the Medicare Administrative Contractor upon request to support medical necessity for therapy services.
- Medical records must document which modalities and specific procedures were performed for each therapy visit and be available to the MAC upon request.
- When multiple heating modalities are provided the same date of service, documentation of the medical necessity for multiple modalities must be present in the medical record.
Key Coverage Criteria
- Regional or local nerve blocks performed as part of an operative procedure (e.g., adjunct to or sole means of regional/local anesthesia for the procedure) are not affected by this non-coverage policy and may be billed as anesthesia for the operative procedure.
- Occupational therapy is covered for patients with migraine (G43.xx) who require training to reduce pain during basic and instrumental activities of daily living, typically completed in 3–4 sessions.
- Electrical stimulation (attended CPT 97032 or unattended HCPCS G0283) may be covered as part of a therapy plan of care to improve function when the nerve supply to the muscle is intact and atrophy is due to non-neurological disuse (e.g., post-casting, splinting, soft-tissue scarring).
- Wheelchair management training (CPT 97542) is covered for patient and/or caregiver training in transfers and propulsion when documentation ties the training to attainable functional goals.
- Therapeutic exercise (CPT 97110) is covered when used to address impairments of exercise tolerance due to cardiopulmonary impairments.
- Range of motion testing (CPT 95851) may be used for extremity ROM when every joint of the extremity is tested and documentation explains why such comprehensive assessment was warranted.
20 Active Policies
L35222 — Nerve Blocks for Peripheral Neuropathy
J05
A57589 — Billing and Coding: Nerve Blocks for Peripheral Neuropathy
J05
A56566 — Billing and Coding: Outpatient Physical and Occupational Therapy Services
J06
L33631 — Outpatient Physical and Occupational Therapy Services
J06
CGS-L35249 — Nerve Blocks for Peripheral Neuropathy
J18 MAC Part B
CGS-L34049 — Outpatient Physical and Occupational Therapy Services
J18 MAC Part B
WPS-L35222 — Nerve Blocks for Peripheral Neuropathy
J8 MAC Part B
NORIDIAN-L35456 — Nerve Blockade for Treatment of Chronic Pain and Neuropathy
JF Part B
PALMETTO-L37642 — Nerve Blocks and Electrostimulation for Peripheral Neuropathy
JJ Part B
NGS-L33631 — Outpatient Physical and Occupational Therapy Services
JK MAC Part B
A53057 — Billing and Coding: Home Health Occupational Therapy
A57067 — Billing and Coding: Outpatient Physical and Occupational Therapy Services
A57311 — Billing and Coding: Physical Therapy - Home Health
A56731 — Billing and Coding: Nerve Blocks and Electrostimulation for Peripheral Neuropathy
A52725 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
AETNA-CPB-0625 — Dysphagia Therapy
A56034 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
AETNA-CPB-0729 — Diabetic Neuropathy: Selected Treatments
L34560 — Home Health Occupational Therapy
L34428 — Outpatient Physical Therapy
Related Codes
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