Eli's Rehab Report

Question: Can you be reimbursed for other one-on-one codes on the same day you bill 95992 to the Medicare program?

Answer: Effective April 1, 2011, the Medicare program did create new CCI edits when billing 95992 on the same day as any combination of 97110 (therapeutic exercise), 97112 (neuromuscular re-education), 97140 (manual therapy) and 97530 (therapeutic activities). If a provider bills any one or combination of 97110, 97112, 97140 and 97530 on the same day, they are also billing 95992 [and] providers must append modifier-59 [distinct procedural service] to the one-on-one codes on the claim form in order to be reimbursed for all services provided. Documentation must support the need for each service billed and that the services were provided at separate and distinct times of each other.