Therapy CPT code list

Listing of the following codes does not imply that services are covered or applicable to all provider settings.

Underlined codes are “always therapy” services, regardless of who performs them. These codes always require therapy modifiers (GP, GO, GN).

+ These HCPCS/CPT codes sometimes represent therapy services. However, these codes always represent therapy services and require the use of a therapy modifier when performed by therapists. There are some circumstances when these codes will not be considered representative of therapy services and therapy limits (when they are in effect) will not apply. Codes marked + are not therapy services when:

• It is not appropriate to bill the service under a therapy plan of care, and
•  They are billed by practitioners/providers of services who are not therapists, i.e., physicians, clinical nurse specialists, nurse practitioners and psychologists; or they are billed to fiscal intermediaries by hospitals for outpatient services which are performed by non-therapists.
While the “+” designates that a particular HCPCS/CPT code will not of itself always indicate that a therapy service was rendered, these codes always represent therapy services when rendered by therapists or by practitioners who are not therapists in situations where the service provided is integral to an outpatient rehabilitation therapy plan of care. For these situations, these codes must always have a therapy modifier. For example, when the service is rendered by either a doctor of medicine or a nurse practitioner (acting within the scope of his or her license when performing such service), with the goal of rehabilitation, a modifier is required. When there is doubt about whether a service should be part of a therapy plan of care, WPS Medicare shall make that determination.

The underlined HCPCS codes on the above list do not have a + sign because they are considered “always therapy” codes and always require a therapy modifier. Therapy services, whether represented by “always therapy” codes, or + codes in the above list performed as outpatient rehabilitation therapy services, must follow all the policies for therapy services (e.g., Pub. 100-04, chapter 5; Pub. 100-02, chapters 12 and 15).

64550+ 95834+ 97032 97597+
90901+ 95851+ 97033 97598+
92506 95852+ 97034 97602+
92507 95992+ 97035 97605+
92508 96105+ 97036 97606+
92526 96110+ 97039 97550
92597 96111+ 97110 97755
92605 96125 97112 97760
92606 97001 97113 97761
92607 97002 97116 97762
92608 97003 97124 977799
92609 97004 97139 G0281
92610+ 97010 97140 G0283
92611+ 97012 97150 G0329
92612+ 97016 97530 0019T+
92614+ 97018 97532 0029T+
92616+ 97022 97533 0183T+
95831+ 97024 97535
95832+ 97026 97537

95833+ 97028 97542

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