Medicare Claims Processing Manual 
Chapter 5 - Part B Outpatient Rehabilitation  
and CORF/OPT Services 
 
Table of Contents 
(Rev. 11129, 11-22-21) 
 
Transmittals for Chapter 5 
 
10 - Part B Outpatient Rehabilitation and Comprehensive Outpatient Rehabilitation 
Facility (CORF) Services - General 
10.1 - New Payment Requirement for A/B MACs (A) 
10.2 - The Financial Limitation Legislation 
10.3 - Application of Financial Limitations 
10.3.1 - Exceptions to Therapy Caps  General 
10.3.2 - Exceptions Process 
10.3.3 - Use of the KX Modifier  
10.3.4 - Manual Review Threshold to Ensure Appropriate Therapy 
10.3.5 - Identifying the Certifying Physician 
10.3.6 - MSN Messages Regarding the Therapy Cap 
10.4 - Claims Processing Requirements for Financial Limitations 
10.5 - Notification for Beneficiaries Exceeding Financial Limitations 
10.6 - Functional Reporting 
10.7 - Multiple Procedure Payment Reductions for Outpatient Rehabilitation 
Services 
20 - HCPCS Coding Requirement 
20.1 - Discipline Specific Outpatient Rehabilitation Modifiers - All Claims 
20.2 - Reporting of Service Units With HCPCS 
20.3 - Determining What Time Counts Towards 15-Minute Timed Codes - 
All Claims 
20.4 - Coding Guidance for Certain CPT Codes  All Claims 
20.5 - CORF/OPT Edit for Billing Inappropriate Supplies 
30 - Special Claims Processing Rules for Outpatient Rehabilitation Claims - Form 
CMS-1500 
30.1 - Determining Payment Amounts  30.2 - Applicable A/B MAC (B) CWF Type of Service Codes 
40 - Special Claims Processing Rules for Institutional Outpatient Rehabilitation Claims 
40.1 - Determining Payment Amounts - Institutional Claims 
40.2 - Applicable Types of Bill 
40.3 - Applicable Revenue Codes 
40.4 - Edit Requirements for Revenue Codes 
40.5 - Line Item Date of Service Reporting 
40.6  Non-covered Charge Reporting 
40.7 - Billing for Biofeedback Training for the Treatment of Urinary Incontinence 
40.8  Rebilling Therapy Services for Hospital Inpatients 
50 - CWF and PS&R Requirements - A/B MAC (A) 
100 - Special Rules for Comprehensive Outpatient Rehabilitation Facilities (CORFs) 
100.1 - General 
100.1.1 - Allowable Revenue Codes on CORF 75X Bill Types 
100.2 - Obtaining Fee Schedule Amounts 
100.3 - Proper Reporting of Nursing Services by CORFs - A/B MAC (A) 
100.4 - Outpatient Mental Health Treatment Limitation 
100.5 - Off-Site CORF Services 
100.6 - Notifying Patient of Service Denial 
100.7 - Payment of Drugs, Biologicals, and Supplies in a CORF 
100.8 - Billing for DME, Prosthetic and Orthotic Devices, and Surgical 
Dressings 
100.10 - Group Therapy Services (Code 97150) 
100.10.1 - Therapy Students 
100.11 - Billing for Social Work and Psychological Services in a CORF 
100.12 - Billing for Respiratory Therapy Services in a CORF 
Exhibit 1 - Physician Fee Schedule Abstract File 
Addendum A - Chapter 5, Section 20.4  Coding Guidance for Certain CPT Codes  All 
Claims 
   
10 - Part B Outpatient Rehabilitation and Comprehensive Outpatient 
Rehabilitation Facility (CORF) Services - General 
(Rev. 3454, Issued: 02-04-16, Effective: 07-01-16, Implementation: 07-05-16) 
 
Language in this section is defined or described in Pub. 100-02, chapter 15, sections 220 
and 230. 
 
Section 1834(k)(5) to the Social Security Act (the Act), requires that all claims for 
outpatient rehabilitation services and comprehensive outpatient rehabilitation facility 
(CORF) services, be reported using a uniform coding system.  The CMS chose HCPCS 
(Healthcare Common Procedure Coding System) as the coding system to be used for the 
reporting of these services.  This coding requirement is effective for all claims for 
outpatient rehabilitation services and CORF services submitted on or after April 1, 1998. 
 
The Act also requires payment under a prospective payment system for outpatient 
rehabilitation services including CORF services.  Effective for claims with dates of 
service on or after January 1, 1999, the Medicare Physician Fee Schedule (MPFS) 
became the method of payment for outpatient therapy services furnished by: 
 
  Comprehensive outpatient rehabilitation facilities (CORFs); 
 
  Outpatient physical therapy providers (OPTs), also known as rehabilitation 
agencies; 
 
  Hospitals (to outpatients and inpatients who are not in a covered Part A stay); 
 
  Skilled nursing facilities (SNFs) (to residents not in a covered Part A stay and to 
nonresidents who receive outpatient rehabilitation services from the SNF); and 
 
  Home health agencies (HHAs) (to individuals who are not homebound or 
otherwise are not receiving services under a home health plan of care (POC)). 
 
NOTE:  No provider or supplier other than the SNF will be paid for therapy services 
during the time the beneficiary is in a covered SNF Part A stay.  For information 
regarding SNF consolidated billing see chapter 6, section 10 of this manual. 
 
Similarly, under the HH prospective payment system, HHAs are responsible to provide, 
either directly or under arrangements, all outpatient rehabilitation therapy services to 
beneficiaries receiving services under a home health POC.  No other provider or supplier 
will be paid for these services during the time the beneficiary is in a covered Part A stay. 
For information regarding HH consolidated billing see chapter10, section 20 of this 
manual. 
 
Section 143 of the Medicare Improvements for Patients and Providers Act of 2008 
(MIPPA) authorizes  the Centers for Medicare & Medicaid Services (CMS) to enroll 
speech-language pathologists (SLP) as suppliers of Medicare services and for SLPs to 
   
begin billing Medicare for outpatient speech-language pathology services furnished in 
private practice beginning July 1, 2009.  Enrollment will allow SLPs in private practice to 
bill Medicare and receive direct payment for their services.  Previously, the Medicare 
program could only pay SLP services if an institution, physician or nonphysician 
practitioner billed them. 
 
In Chapter 23, as part of the CY 2009 Medicare Physician Fee Schedule Database, the 
descriptor for PC/TC indicator 7, as applied to certain HCPCS/CPT codes, is described 
as specific to the services of privately practicing therapists.  Payment may not be made if 
the service is provided to either a hospital outpatient or a hospital inpatient by a physical 
therapist, occupational therapist, or speech-language pathologist in private practice. 
 
The MPFS is used as a method of payment for outpatient rehabilitation services furnished 
under arrangement with any of these providers. 
 
In addition, the MPFS is used as the payment system for CORF services identified by the 
HCPCS codes in 20.  Assignment is mandatory. 
 
Services that are paid subject to the MPFS are adjusted based on the applicable payment 
locality.  Rehabilitation agencies and CORFs with service locations in different payment 
localities shall follow the instructions for multiple service locations in chapter 1, section 
170.1.1. 
 
The Medicare allowed charge for the services is the lower of the actual charge or the 
MPFS amount.  The Medicare payment for the services is 80 percent of the allowed 
charge after the Part B deductible is met.  Coinsurance is made at 20 percent of the lower 
of the actual charge or the MPFS amount.  The general coinsurance rule (20 percent of 
the actual charges) does not apply when making payment under the MPFS.  This is a final 
payment. 
 
The MPFS does not apply to outpatient rehabilitation services furnished by critical access 
hospitals (CAHs) or hospitals in Maryland.  CAHs are to be paid on a reasonable cost 
basis. Maryland hospitals are paid under the Maryland All-Payer Model.  
 
Contractors process outpatient rehabilitation claims from hospitals, including CAHs, 
SNFs, HHAs, CORFs, outpatient rehabilitation agencies, and outpatient physical therapy 
providers for which they have received a tie in notice from the Regional Office (RO).  
These provider types submit their claims to the contractors using the ASC X12 837 
institutional claim format or the CMS-1450 paper form when permissible.  Contractors 
also process claims from physicians, certain nonphysician practitioners (NPPs),  
therapists in private practices (TPPs), (which are limited to physical and occupational 
therapists, and speech-language pathologists in private practices), and physician-directed 
clinics that bill for services furnished incident to a physicians service (see Pub. 100-02, 
Medicare Benefit Policy Manual, chapter 15, for a definition of incident to).  These 
provider types submit their claims to the contractor using the ASC X 12 837 professional 
claim format or the CMS-1500 paper form when permissible. 
   
 
There are different fee rates for nonfacility and facility services.  Chapter 23 describes the 
differences in these two rates.  (See fields 28 and 29 of the record therein described).  
Facility rates apply to professional services performed in a facility other than the 
professionals office.  Nonfacility rates apply when the service is performed in the 
professionals office.  The nonfacility rate (that is paid when the provider performs the 
services in its own facility) accommodates overhead and indirect expenses the provider 
incurs by operating its own facility.  Thus it is somewhat higher than the facility rate. 
 
Contractors pay the nonfacility rate on institutional claims for services performed in the 
providers facility.  Contractors may pay professional claims using the facility or 
nonfacility rate depending upon where the service is performed (place of service on the 
claim), and the provider specialty. 
 
Contractors pay the codes in 20 under the MPFS on professional claims regardless of 
whether they may be considered rehabilitation services.  However, contractors must use 
this list for institutional claims to determine whether to pay under outpatient 
rehabilitation rules or whether payment rules for other types of service may apply, e.g., 
OPPS for hospitals, reasonable costs for CAHs. 
 
Note that because a service is considered an outpatient rehabilitation service does not 
automatically imply payment for that service.  Additional criteria, including coverage, 
plan of care and physician certification must also be met.  These criteria are described in 
Pub. 100-02, Medicare Benefit Policy Manual, chapters 1 and 15. 
 
Payment for rehabilitation services provided to Part A inpatients of hospitals or SNFs is 
included in the respective PPS rate.  Also, for SNFs (but not hospitals), if the beneficiary 
has Part B, but not Part A coverage (e.g., Part A benefits are exhausted), the SNF must 
bill for any rehabilitation service. 
 
Payment for rehabilitation therapy services provided by home health agencies under a 
home health plan of care is included in the home health PPS rate.  HHAs may submit bill 
type 34X and be paid under the MPFS if there are no home health services billed under a 
home health plan of care at the same time, and there is a valid rehabilitation POC (e.g., 
the patient is not homebound). 
 
An institutional employer (other than a SNF) of the TPPs, or physician performing 
outpatient services, (e.g., hospital, CORF, etc.), or a clinic billing on behalf of the 
physician or therapist may bill the contractor on a professional claim. 
 
The MPFS is the basis of payment for outpatient rehabilitation services furnished by 
TPPs, physicians, and certain nonphysician practitioners or for diagnostic tests provided 
incident to the services of such physicians or nonphysician practitioners.  (See Pub. 100-
02, Medicare Benefit Policy Manual, Chapter 15, for a definition of incident to, 
therapist, therapy and related instructions.")  Such services are billed to the contractor on 
the professional claim format.  Assignment is mandatory. 
   
 
The following table identifies the provider and supplier types, and identifies which claim 
format they may use to submit claims for outpatient therapy services to the contractor. 
 
Provider/Supplier Service  Format  Bill Type  Comment 
Type 
Inpatient SNF Part A   Institutional  21X  Included in PPS 
Inpatient hospital Part B  Institutional  12X  Hospital may obtain services 
under arrangements and bill, or 
rendering provider may bill. 
Inpatient SNF Part B  Institutional  22X  SNF must provide and bill, or 
(audiology tests are not  obtain under arrangements and 
included)  bill. 
Outpatient hospital  Institutional  13X  Hospital may provide and bill 
or obtain under arrangements 
and bill. 
Outpatient SNF  Institutional  23X  SNF must provide and bill or 
obtain under arrangements and 
bill. 
HHA billing for services not  Institutional  34X  Service not under home health 
rendered under a Part A or  plan of care. 
Part B home health plan of 
care, but rendered under a 
therapy plan of care. 
Outpatient physical therapy  Institutional  74X  Paid MPFS for outpatient 
providers (OPTs), also known  rehabilitation services. 
as rehabilitation agencies 
 
Comprehensive Outpatient  Institutional  75X  Paid MPFS for outpatient 
Rehabilitation Facility  rehabilitation services and all 
(CORF)  other services except drugs.  
Drugs are paid 95% of the 
AWP. 
Physician, NPPs, TPPs,  Professional  See Chapter  Payment may not be made for 
(therapy services in hospital  26 for place  therapy services to Part A 
or SNF)  of service  inpatients of hospitals or SNFs, 
coding.  or for Part B SNF residents. 
 
NOTE:  Payment may be made 
to physicians and NPPs for 
their professional services 
defined as sometimes therapy 
(not part of a therapy plan) in 
certain situations; for example, 
when furnished to a beneficiary 
   
Provider/Supplier Service  Format  Bill Type  Comment 
Type 
registered as an outpatient of a 
hospital. 
 
Physician/NPP/TPPs office,  Professional  See Chapter  Paid via MPFS. 
or patients home   26 for place 
of service 
coding. 
Critical Access Hospital -  Institutional  12X  Rehabilitation services are paid 
inpatient Part B  at cost. 
Critical Access Hospital   Institutional  85X  Rehabilitation services are paid 
outpatient Part B  at cost. 
 
For a list of the outpatient rehabilitation HCPCS codes see 20. 
 
If a contractor receives an institutional claim for one of these HCPCS codes with dates of 
service on or after July 1, 2003, that does not appear on the supplemental file it currently 
uses to pay the therapy claims, it contacts its professional claims area to obtain the non-
facility price in order to pay the claim. 
 
NOTE: The list of codes in 20 contains commonly utilized codes for outpatient 
rehabilitation services.  Contractors may consider other codes on institutional claims for 
payment under the MPFS as outpatient rehabilitation services to the extent that such 
codes are determined to be medically reasonable and necessary and could be performed 
within the scope of practice of the therapist providing the service. 
 
10.1 - New Payment Requirement for A/B MACs (A) 
(Rev. 1, 10-01-03) 
 
Effective with claims with dates of service on or after July 1, 2003, OPTs/outpatient 
rehabilitation facilities (ORFs), (74X and 75X bill type) are required to report all their 
services utilizing HCPCS.  A/B MACs (A) are required to make payment for these 
services under the MPFS unless the item or service is currently being paid under the 
orthotic fee schedule or the item is a drug, biological, supply or vaccine (see below for an 
explanation of these services). 
 
The CMS currently provides A/B MACs (A) with a CORF supplemental file that 
contains all physician fee schedule services and their related prices.  A/B MACs (A) use 
this file to price and pay OPT claims.  The format of the record layout is provided in 
Attachment E of PM A-02-090, dated September 27, 2002.  This is located in Chapter 23, 
section 50.3. 
 
A/B MACs (A) will be notified in a one-time instruction of updates to this file and when 
it will be available for retrieval. 
 
   
If an A/B MAC (A) receives a claim for one of the above HCPCS codes with dates of 
service on or after July 1, 2003, that does not appear on the CORF supplemental file it 
currently uses to pay the CORF claims, it contacts its local A/B MAC (B) to obtain the 
price in order to pay the claim.  When requesting the pricing data, it advises the A/B 
MAC (B) to provide it with the nonfacility fee. 
 
10.2 - The Financial Limitation Legislation 
(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19) 
 
A.  Legislation on Limitations 
 
The dollar amount of the limitations (caps) on outpatient therapy services is established 
by statute.  The updated amount of the caps is released annually via Recurring Update 
Notifications and posted on the CMS Website www.cms.gov/TherapyServices, on 
contractor Websites, and on each beneficiarys Medicare Summary Notice.  Medicare 
contractors shall publish the financial limitation amount in educational articles.  It is also 
available at 1-800-Medicare. 
 
Section 4541(a)(2) of the Balanced Budget Act (BBA) (P.L. 105-33) of 1997, which added 
1834(k)(5) to the Act, required payment under a prospective payment system (PPS) for 
outpatient rehabilitation services (except those furnished by or under arrangements with a 
hospital).  Outpatient rehabilitation services include the following services: 
 
  Physical therapy 
  Speech-language pathology; and  
  Occupational therapy. 
 
Section 4541(c) of the BBA required application of financial limitations to all outpatient 
rehabilitation services (except those furnished by or under arrangements with a hospital).  
In 1999, an annual per beneficiary limit of $1,500 was applied, including all outpatient 
physical therapy services and speech-language pathology services.  A separate limit 
applied to all occupational therapy services.  The limits were based on incurred expenses 
and included applicable deductible and coinsurance.  The BBA provided that the limits be 
indexed by the Medicare Economic Index (MEI) each year beginning in 2002. 
 
Since the limitations apply to outpatient services, they do not apply to skilled nursing 
facility (SNF) residents in a covered Part A stay, including patients occupying swing 
beds.  Rehabilitation services are included within the global Part A per diem payment that 
the SNF receives under the prospective payment system (PPS) for the covered stay.  
Also, limitations do not apply to any therapy services covered under prospective payment 
systems for home health or inpatient hospitals, including critical access hospitals. 
 
The limitation is based on therapy services the Medicare beneficiary receives, not the 
type of practitioner who provides the service.  Physical therapists, speech-language 
pathologists, and occupational therapists, as well as physicians and certain nonphysician 
practitioners, could render a therapy service. 
   
 
B.  Moratoria and Exceptions for Therapy Claims 
 
Since the creation of therapy caps, Congress has enacted several moratoria.  The Deficit 
Reduction Act of 2005 directed CMS to develop exceptions to therapy caps for calendar 
year 2006 and the exceptions have been extended periodically.  The cap exception for 
therapy services billed by outpatient hospitals was part of the original legislation and 
applies as long as caps are in effect.  Exceptions to caps based on the medical necessity of 
the service are in effect only when Congress legislates the exceptions. 
 
C. Repeal of Original Legislation and Replacement with Thresholds to Ensure 
Appropriate Therapy. 
 
Section 50202 of the Bipartisan Budget Act of 2018 repeals application of the Medicare 
outpatient therapy caps but retains the former cap amounts as a threshold of incurred 
expenses above which claims must include a modifier as a confirmation that services are 
medically necessary as justified by appropriate documentation in the medical record. This 
is termed the KX modifier threshold. 
Along with this KX modifier threshold, the new law retains the targeted medical review  
process but at a lower threshold amount of $3,000. For more information about the 
medical review (MR) threshold see the below section 10.3.4.   
 
10.3 - Application of Financial Limitations 
(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19) 
 
(Additions, deletions or changes to the therapy code list are updated via a Recurring 
Update Notification) 
 
Financial limitations on outpatient therapy services, as described above, began for 
therapy services rendered on or after on January 1, 2006.  References and polices relevant 
to the exceptions process in this chapter apply only when exceptions to therapy caps are 
in effect.  For dates of service before October 1, 2012, limits apply to outpatient Part B 
therapy services furnished in all settings except outpatient hospitals, including hospital 
emergency departments.  These excluded hospital services are reported on types of bill 
12x or 13x, or 85x.  Effective for dates of service on or after October 1, 2012, the limits 
also apply to outpatient Part B therapy services furnished in outpatient hospitals other 
than CAHs and hospitals in Maryland.  During this period, only type of bill 12x claims 
with a CMS certification number in the CAH range, type of bill 12x and 13x claims with 
a CMS certification number beginning with the State code for Maryland, and type of bill 
85x claims are excluded.   
 
Effective for dates of service on or after January 1, 2014, the limits also apply to CAHs.  
Effective for dates of service on or after January 1, 2016, the limits also apply to hospitals 
in Maryland.  Effective for dates of service on or after January 1, 2018, the KX modifier 
threshold applies to all the therapy provider types to which the limits applied.  
   
 
Contractors apply the financial limitations or thresholds to the MPFS amount (or the 
amount charged if it is smaller) for therapy services for each beneficiary. 
 
As with any Medicare payment, beneficiaries pay the coinsurance (20 percent) and any 
deductible that may apply.  Medicare will pay the remaining 80 percent of the limit after 
the deductible is met.  These amounts will change each calendar year. 
 
Medicare shall apply these financial limitations or KX modifier thresholds in order, 
according to the dates when the claims were received.  When limitations or KX modifier 
thresholds apply, the Common Working File (CWF) tracks them.  Shared system 
maintainers are not responsible for tracking the dollar amounts of incurred expenses. 
 
In processing claims where Medicare is the secondary payer, the shared system takes the 
lowest secondary payment amount from MSPPAY and sends this amount on to CWF as 
the amount applied to therapy limits or KX modifier thresholds. 
 
10.3.1 - Exceptions to Therapy Caps  General 
(Rev. 3367 Issued: 10-07-15, Effective: 01-01-16, Implementation: 01-04-16) 
 
The following policies concerning exceptions to caps due to medical necessity apply only 
when the exceptions process is in effect.  Except for the requirement to use the KX 
modifier, the guidance in this section concerning medical necessity applies as well to 
services provided before caps are reached. 
 
Provider and supplier information concerning exceptions is in this chapter and in Pub. 
100-02, Chapter 15, section 220.3.  Exceptions shall be identified by a modifier on the 
claim and supported by documentation. 
 
The beneficiary may qualify for use of the cap exceptions process at any time during the 
episode when documented medically necessary services exceed caps.  All covered and 
medically necessary services qualify for exceptions to caps.  All requests for exception 
are in the form of a KX modifier added to claim lines.  (See subsection D. for use of the 
KX modifier.) 
 
Use of the exception process does not exempt services from manual or other medical 
review processes as described in Pub. 100-08.  Rather, atypical use of the exception 
process may invite contractor scrutiny, for example, when the KX modifier is applied to 
all services on claims that are below the therapy caps or when the KX modifier is used 
for all beneficiaries of a therapy provider.  To substantiate the medical necessity of the 
therapy services, document in the medical record (see Pub. 100-02, chapter 15, sections 
220.2, 220.3, and 230).  
 
The KX modifier, described in subsection D., is added to claim lines to indicate that the 
clinician attests that services at and above the therapy caps are medically necessary and 
justification is documented in the medical record. 
   
 
10.3.2 - Exceptions Process 
(Rev. 3670, Issued: 12-01-16, Effective: 01-01-17, Implementation: 01-03-17) 
 
An exception may be made when the patients condition is justified by documentation 
indicating that the beneficiary requires continued skilled therapy, i.e., therapy beyond the 
amount payable under the therapy cap, to achieve their prior functional status or 
maximum expected functional status within a reasonable amount of time. 
 
No special documentation is submitted to the contractor for exceptions.  The clinician is 
responsible for consulting guidance in the Medicare manuals and in the professional 
literature to determine if the beneficiary may qualify for the exception because 
documentation justifies medically necessary services above the caps.  The clinicians 
opinion is not binding on the Medicare contractor who makes the final determination 
concerning whether the claim is payable. 
 
Documentation justifying the services shall be submitted in response to any Additional 
Documentation Request (ADR) for claims that are selected for medical review.  Follow 
the documentation requirements in Pub. 100-02, chapter 15, section 220.3.  If medical 
records are requested for review, clinicians may include, at their discretion, a summary 
that specifically addresses the justification for therapy cap exception. 
 
In making a decision about whether to utilize the exception, clinicians shall consider, for 
example, whether services are appropriate to-- 
 
  The patients condition, including the diagnosis, complexities, and severity; 
  The services provided, including their type, frequency, and duration; 
 
The interaction of current active conditions and complexities that directly and 
significantly influence the treatment such that it causes services to exceed caps. 
 
In addition, the following should be considered before using the exception process: 
 
 
1.  Exceptions for Evaluation Services 
 
Evaluation.  The CMS will accept therapy evaluations from caps after the therapy caps 
are reached when evaluation is necessary, e.g., to determine if the current status of the 
beneficiary requires therapy services.  For example, the following CPT codes for 
evaluation procedures may be appropriate: 
 
92521, 92522, 92523, 92524, 92597, 92607, 92608, 92610, 92611, 92612, 92614, 
92616, 96105, 96125. 97161, 97162, 97163, 97164, 97165, 97166, 97167, and 
97168. 
 
   
These codes will continue to be reported as outpatient therapy procedures as listed in the 
Annual Therapy Update for the current year at: 
http://www.cms.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage. 
They are not diagnostic tests.  Definitions of evaluations and documentation are found in 
Pub. 100-02, chapter 15, sections 220 and 230. 
 
Other Services.  There are a number of sources that suggest the amount of certain 
services that may be typical, either per service, per episode, per condition, or per 
discipline.  For example, see the CSC - Therapy Cap Report, 3/21/2008, and CSC  
Therapy Edits Tables 4/14/2008 at www.cms.hhs.gov/TherapyServices (Studies and 
Reports), or more recent utilization reports.  Professional literature and guidelines from 
professional associations also provide a basis on which to estimate whether the type, 
frequency, and intensity of services are appropriate to an individual.  Clinicians and 
contractors should utilize available evidence related to the patients condition to justify 
provision of medically necessary services to individual beneficiaries, especially when 
they exceed caps.  Contractors shall not limit medically necessary services that are 
justified by scientific research applicable to the beneficiary.  Neither contractors nor 
clinicians shall utilize professional literature and scientific reports to justify payment for 
continued services after an individuals goals have been met earlier than is typical. 
Conversely, professional literature and scientific reports shall not be used as justification 
to deny payment to patients whose needs are greater than is typical or when the patients 
condition is not represented by the literature. 
 
2.  Exceptions for Medically Necessary Services 
 
Clinicians may utilize the process for exception for any diagnosis or condition for which 
they can justify services exceeding the cap.  Regardless of the diagnosis or condition, the 
patient must also meet other requirements for coverage. 
 
Bill the most relevant diagnosis.  As always, when billing for therapy services, the 
diagnosis code that best relates to the reason for the treatment shall be on the claim, 
unless there is a compelling reason to report another diagnosis code.  For example, when 
a patient with diabetes is being treated with therapy for gait training due to amputation, 
the preferred diagnosis is abnormality of gait (which characterizes the treatment).  Where 
it is possible in accordance with State and local laws and the contractors local coverage 
determinations, avoid using vague or general diagnoses.  When a claim includes several 
types of services, or where the physician/NPP must supply the diagnosis, it may not be 
possible to use the most relevant therapy diagnosis code in the primary position.  In that 
case, the relevant diagnosis code should, if possible, be on the claim in another position. 
 
Codes representing the medical condition that caused the treatment are used when there is 
no code representing the treatment.  Complicating conditions are preferably used in non-
primary positions on the claim and are billed in the primary position only in the rare 
circumstance that there is no more relevant code. 
 
   
The condition or complexity that caused treatment to exceed caps must be related to the 
therapy goals and must either be the condition that is being treated or a complexity that 
directly and significantly impacts the rate of recovery of the condition being treated such 
that it is appropriate to exceed the caps.  Documentation for an exception should indicate 
how the complexity (or combination of complexities) directly and significantly affects 
treatment for a therapy condition. 
 
If the contractor has determined that certain codes do not characterize patients who 
require medically necessary services, providers/suppliers may not use those codes, but 
must utilize a billable diagnosis code allowed by their contractor to describe the patients 
condition.  Contractors shall not apply therapy caps to services based on the patients 
condition, but only on the medical necessity of the service for the condition.  If a service 
would be payable before the cap is reached and is still medically necessary after the cap 
is reached, that service is excepted. 
 
Contact your contractor for interpretation if you are not sure that a service is applicable 
for exception. 
 
It is very important to recognize that most conditions would not ordinarily result in 
services exceeding the cap.  Use the KX modifier only in cases where the condition of 
the individual patient is such that services are APPROPRIATELY provided in an episode 
that exceeds the cap.  Routine use of the KX modifier for all patients with these 
conditions will likely show up on data analysis as aberrant and invite inquiry.  Be sure 
that documentation is sufficiently detailed to support the use of the modifier. 
 
In justifying exceptions for therapy caps, clinicians and contractors should not only 
consider the medical diagnoses and medical complications that might directly and 
significantly influence the amount of treatment required.  Other variables (such as the 
availability of a caregiver at home) that affect appropriate treatment shall also be 
considered.  Factors that influence the need for treatment should be supportable by 
published research, clinical guidelines from professional sources, and/or clinical or 
common sense.  See Pub. 100-02, chapter 15, section 220.3 for information related to 
documentation of the evaluation, and section 220.2 on medical necessity for some factors 
that complicate treatment. 
 
NOTE:  The patients lack of access to outpatient hospital therapy services alone, when 
outpatient hospital therapy services are excluded from the limitation, does not justify 
excepted services.  Residents of skilled nursing facilities prevented by consolidated 
billing from accessing hospital services, debilitated patients for whom transportation to 
the hospital is a physical hardship, or lack of therapy services at hospitals in the 
beneficiarys county may or may not qualify as justification for continued services above 
the caps.  The patients condition and complexities might justify extended services, but 
their location does not.  For dates of service on or after October 1, 2012, therapy services 
furnished in an outpatient hospital are not excluded from the limitation. 
 
 
   
10.3.3 - Use of the KX Modifier  
(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19) 
 
 
NOTE:  Effective for dates of service on or after January 1, 2018, the KX modifier 
continues to be used.  It no longer represents an exception request but serves as a 
confirmation that services are medically necessary after the beneficiary has exceeded the 
KX modifier threshold of incurred expenses.  Medicare claims systems process claims 
with and without the KX modifier in the same manner described below and in section 
10.4. 
 
When exceptions are in effect and the beneficiary qualifies for a therapy cap exception, 
the provider shall add a KX modifier to the therapy HCPCS code subject to the cap 
limits.  The KX modifier shall not be added to any line of service that is not a medically 
necessary service; this applies to services that, according to a local coverage 
determination by the contractor, are not medically necessary services. 
 
The codes subject to the therapy cap tracking requirements for a given calendar year are 
listed at: 
http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage. 
 
The GN, GO, or GP therapy modifiers are currently required to be appended to therapy 
services.  In addition to the KX modifier, the GN, GP and GO modifiers shall continue to 
be used.  Providers may report the modifiers on claims in any order.  If there is 
insufficient room on a claim line for multiple modifiers, additional modifiers may be 
reported in the remarks field.  Follow the routine procedure for placing HCPCS modifiers 
on a claim as described below. 
 
  For professional claims, sent to the A/B MAC(B), refer to: 
 
  Pub.100-04, Medicare Claims Processing Manual, chapter 26, for more 
o
detail regarding completing Form CMS 1500, including the placement of 
HCPCS modifiers.  NOTE:  The Form CMS 1500 currently has space for 
providing four modifiers in block 24D, but, if the provider has more than 
four to report, he/she can do so by placing the -99 modifier (which 
indicates multiple modifiers) in block 24D and placing the additional 
modifiers in block 19. 
 
  The ASC X12N 837 Health Care Claim: Professional Implementation 
o
Guide for more detail regarding how to electronically submit a health care 
claim transaction, including the placement of HCPCS modifiers.  The 
ASC X12N 837 implementation guides are the standards adopted under 
the Health Insurance Portability and Accountability Act of 1996 (HIPAA) 
for submitting health care claims electronically.  The 837 professional 
transaction currently permits the placement of up to four modifiers, in the 
2400 loop, SV1 segment, and data elements SV101-3, SV101-4, SV101-5, 
   
and SV101-6.  Copies of the ASC X12N 837 implementation guides may 
be obtained from the Washington Publishing Company. 
 
  For claims paid by a carrier or an A/B MAC(B), it is only appropriate to 
o
append the KX modifier to a service that reasonably may exceed the cap.  
Use of the KX modifier when there is no indication that the cap is likely to 
be exceeded is abusive.  For example, use of the KX modifier for low cost 
services early in an episode when there is no evidence of a previous 
episode that might have exceeded the cap is inappropriate. 
 
  For institutional claims, sent to the A/B MAC(A): 
 
  When the cap is exceeded by at least one line on the claim, use the KX 
o
modifier on all of the lines on that institutional claim that refer to the same 
therapy cap (PT/SLP or OT), regardless of whether the other services 
exceed the cap.  For example, if one PT service line exceeds the cap, use 
the KX modifier on all the PT and SLP service lines (also identified with 
the GP or GN modifier) for that claim.  When the PT/SLP cap is exceeded 
by PT services, the SLP lines on the claim may meet the requirements for 
an exception due to the complexity of two episodes of service. 
 
  Use the KX modifier on either all or none of the SLP lines on the claim, as 
o
appropriate.  In contrast, if all the OT lines on the claim are below the cap, 
do not use the KX modifier on any of the OT lines, even when the KX 
modifier is appropriately used on all of the PT lines.  Refer to Pub.100-04, 
Medicare Claims Processing Manual, chapter 25, for more detail. 
 
By appending the KX modifier, the provider is attesting that the services billed: 
 
  Are reasonable and necessary services that require the skills of a therapist; (See 
Pub. 100-02, chapter 15, section 220.2); and 
 
  Are justified by appropriate documentation in the medical record, (See Pub. 
100-02, chapter 15, section 220.3); and 
 
  Qualify for an exception using the automatic process exception. 
 
If this attestation is determined to be inaccurate, the provider/supplier is subject to 
sanctions resulting from providing inaccurate information on a claim. 
 
When the KX modifier is appended to a therapy HCPCS code, the contractor will 
override the CWF system reject for services that exceed the caps and pay the claim if it is 
otherwise payable. 
 
Providers and suppliers shall continue to append correct coding initiative (CCI) HCPCS 
modifiers under current instructions. 
   
 
If a claim is submitted without KX modifiers and the cap is exceeded, those services will 
be denied.  In cases where appending the KX modifier would have been appropriate, 
contractors may reopen and/or adjust the claim, if it is brought to their attention. 
 
Services billed after the cap has been exceeded which are not eligible for exceptions may 
be billed for the purpose of obtaining a denial using condition code 21. 
 
10.3.4 - Therapy Cap Manual Review Threshold to Ensure Appropriate 
Therapy  
(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19) 
 
Section 50202 of the Bipartisan Budget Act of 2018 retains the targeted medical review 
(MR) process (first established through Section 202 of the Medicare Access and CHIP 
Reauthorization Act of 2015 (MACRA)), but at a lower threshold amount of $3,000. For 
CY 2018 (and each calendar year until 2028 at which time it is indexed annually by the 
MEI), the MR threshold is $3,000 for PT and SLP services and $3,000 for OT services. 
The targeted MR process means that not all claims exceeding the MR threshold amount 
are subject to review as they once were. For a general overview of the MR process, go to 
the Medical Review and Education website at: https://www.cms.gov/Research-Statistics-
Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-
Review/index.html 
 
10.3.5 - Identifying the Certifying Physician 
(Rev. 3367 Issued: 10-07-15, Effective: 01-01-16, Implementation: 01-04-16) 
 
Therapy plans of care must be certified by a physician or non-physician practitioner 
(NPP), per the requirements in the Pub. 100-02, Medicare Benefit Policy Manual, chapter 
15, section 220.1.3.  Further, the National Provider Identifier (NPI) of the certifying 
physician/NPP identified for a therapy plan of care must be included on the therapy 
claim. 
 
For the purposes of processing professional claims, the certifying physician/NPP is 
considered a referring provider.  At the time the certifying physician/NPP is identified for 
a therapy plan of care, private practice therapists (PPTs), physicians or NPPs, as 
appropriate, submitting therapy claims, are to treat it as if a referral has occurred for 
purposes of completing the claim and to follow the instructions in the appropriate ASC 
X12 837 Professional Health Care Claim Technical Report 3 (TR3) for reporting a 
referring provider (for paper claims, they are to follow the instructions for identifying 
referring providers per chapter 26 of this manual).  These instructions include 
requirements for reporting NPIs. 
 
Currently, in the 5010 version of the ASC X12 837 Professional Health Care Claim TR3, 
referring providers are first reported at the claim level; additional referring providers are 
   
reported at the line level only when they are different from that identified at the claim 
level.  Therefore, there will be at least one referring provider identified at the claim level 
on the ASC X12 837 Professional claim for therapy services.  However, because of the 
hierarchical nature of the ASC X12 837 health care claim transaction, and the possibility 
of other types of referrals applying to the claim, the number of referring providers 
identified on a professional claim may vary.  For example, on a claim where one 
physician/NPP has certified all the therapy plans of care, and there are no other referrals, 
there would be only one referring provider identified at the claim level and none at the 
line levels.  Conversely, on a claim also containing a non-therapy referral made by a 
different physician/NPP than the one certifying the therapy plan of care, the billing 
provider may elect to identify either the nontherapy or the therapy referral at the claim 
level, with the other referral(s) at the line levels.  Similarly, on a claim having different 
certifying physician/NPPs for different therapy plans of care, only one of these 
physician/NPPs will be identified at the claim level, with the remainder identified at the 
line levels.  These scenarios are only examples:  there may be other patterns of 
representing referring providers at the claim and line levels depending upon the 
circumstances of the care and the manner in which the provider applies the requirements 
of the ASC X12 837 Professional Health Care Claim TR3. 
 
For situations where the physician/NPP is both the certifier of the plan of care and 
furnishes the therapy service, he/she supplies his/her own information, including the NPI, 
in the appropriate referring provider loop (or, appropriate block on Form CMS 1500).  
This is applicable to those therapy services that are personally furnished by the 
physician/NPP as well as to those services that are furnished incident to their own and 
delivered by qualified personnel (see section 230.5 of this manual for qualifications for 
incident to personnel). 
 
Contractors shall edit to ensure that there is at least one claim-level referring provider 
identified on professional therapy claims, and shall use the presence of the therapy 
modifiers (GN, GP, GO) to identify those claims subject to this requirement. 
 
For the purposes of processing institutional claims, the certifying physician/NPP and their 
NPI are reported in the Attending Provider fields on institutional claim formats.  Since 
the physician/NPP is certifying the therapy plan of care for the services on the claim, this 
is consistent with the National Uniform Billing Committee definition of the Attending 
Provider as the individual who has overall responsibility for the patients medical care 
and treatment that is reported on the claim.  In cases where a patient is receiving care 
under more than one therapy plan of care (OT, PT, or SLP) with different certifying 
physicians/NPPs, the second certifying physicians/NPP and their NPI are reported in the 
Referring Physician fields on institutional claim formats. 
 
10.3.6 - MSN Messages Regarding the Therapy Cap 
(Rev. 3367 Issued: 10-07-15, Effective: 01-01-16, Implementation: 01-04-16) 
 
Existing MSN messages 17.13, 17.18 and 17.19 shall be issued on all claims containing 
outpatient rehabilitation services.  Contractors add the applied amount for individual 
   
beneficiaries and the generic limit amount to all MSNs that require them.  For details of 
these MSNs, see: http://www.cms.gov/MSN/02_MSN%20Messages.asp. 
 
10.4 - Claims Processing Requirements for Financial Limitations 
(Rev. 3995, Issued: 03-09-18, Effective: 06-11- 18, Implementation: 06-11-18) 
 
A.  Requirements  Institutional Claims 
 
Regardless of financial limits on therapy services, CMS requires modifiers (See section 
20.1 of this chapter) on specific codes for the purpose of data analysis.  Beneficiaries may 
not be simultaneously covered by Medicare as an outpatient of a hospital and as a patient 
in another facility.  When outpatient hospital therapy services are excluded from the 
limitation, the beneficiary must be discharged from the other setting and registered as a 
hospital outpatient in order to receive payment for outpatient rehabilitation services in a 
hospital outpatient setting after the limitation has been reached. 
 
A hospital may bill for services of a facility as hospital outpatient services if that facility 
meets the requirements of a department of the provider (hospital) under 42 CFR 413.65.  
Facilities that do not meet those requirements are not considered to be part of the hospital 
and may not bill under the hospitals provider number, even if they are owned by the 
hospital.  For example, services of a Comprehensive Outpatient Rehabilitation Facility 
(CORF) must be billed as CORF services and not as hospital outpatient services, even if 
the CORF is owned by the hospital.   
 
The CWF applies the financial limitation to the following bill types 12X (with Critical 
Access Hospital CMS Certification Numbers), 22X, 23X, 34X, 74X, 75X and 85X using 
the lesser of the MPFS allowed amount (before adjustment for beneficiary liability) or the 
amount charged.   
 
For SNFs, the financial limitation does apply to rehabilitation services furnished to those 
SNF residents in noncovered stays (bill type 22X) who are in a Medicare-certified section 
of the facility, i.e., one that is either certified by Medicare alone, or is dually certified by 
Medicare as a SNF and by Medicaid as a nursing facility (NF).  For SNF residents, 
consolidated billing requires all outpatient rehabilitation services be billed to Part B by 
the SNF.  If a resident has reached the financial limitation, and remains in the Medicare-
certified section of the SNF, no further payment will be made to the SNF or any other 
entity.  Therefore, SNF residents who are subject to consolidated billing may not obtain 
services from an outpatient hospital after the cap has been exceeded. 
 
Once the financial limitation has been reached, services furnished to SNF residents who 
are in a non-Medicare certified section of the facility, i.e., one that is certified only by 
   
Medicaid as a NF or that is not certified at all by either program, use bill type 23X.  For 
SNF residents in non-Medicare certified portions of the facility and SNF nonresidents 
who go to the SNF for outpatient treatment (bill type 23X), medically necessary 
outpatient therapy may be covered at an outpatient hospital facility after the financial 
limitation has been exceeded when outpatient hospital therapy services are excluded from 
the limitation. 
 
B.  Requirements - Professional Claims 
 
Claims containing any of the always therapy codes must have one of the therapy 
modifiers appended (GN, GO, GP).  Contractors shall return claims for always therapy 
codes when they do not contain appropriate therapy modifiers for the applicable HCPCS 
codes. In addition, when any code on the list of therapy codes is submitted with specialty 
codes 65 (physical therapist in private practice), 67 (occupational therapist in private 
practice), or 15 (speech-language pathologist in private practice) they always represent 
therapy services, because they are provided by therapists. Contractors shall return claims 
for these services when they do not contain therapy modifiers for the applicable HCPCS 
codes.  
 
The contractor shall use the following remittance advice messages and associated codes 
when rejecting/denying claims under this policy.  This CARC/RARC combination is 
compliant with CAQH CORE Business Scenario 2. 
 
Group Code: CO 
CARC: 4 
RARC: N/A 
MSN: N/A 
 
The CMS identifies certain codes listed at: 
http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage 
as sometimes therapy services, regardless of the presence of a financial limitation.  
Claims from physicians (all specialty codes) and nonphysician practitioners, including 
specialty codes 50 (Nurse Practitioner), 89, (Clinical Nurse Specialist), and 97, 
(Physician Assistant) may be processed without therapy modifiers when they are not 
therapy services.  On review of these claims, sometimes therapy services that are not 
accompanied by a therapy modifier must be documented, reasonable and necessary, and 
payable as physician or nonphysician practitioner services, and not services that the 
contractor interprets as therapy services. 
 
The CWF will capture the amount and apply it to the limitation whenever a service is 
billed using the GN, GO, or GP modifier. 
 
   
C.  Contractor Action Based on CWF Trailer 
 
Upon receipt of the CWF error code/trailer, contractors are responsible for assuring that 
payment does not exceed the financial limitations, when the limits are in effect, except as 
noted below. 
 
In cases where a claim line partially exceeds the limit, the contractor must adjust the line 
based on information contained in the CWF trailer.  For example, where the MPFS 
allowed amount is greater than the financial limitation available, always report the MPFS 
allowed amount in the Financial Limitation field of the CWF record and include the 
CWF override code.  See example below for situations where the claim contains multiple 
lines that exceed the limit. 
 
EXAMPLE: 
 
Services received to date are $15 under the limit.  There is a $15 allowed amount 
remaining that Medicare will cover before the cap is reached. 
 
Incoming claim:  Line 1 MPFS allowed amount is $50. 
Line 2 MPFS allowed amount is $25. 
Line 3, MPFS allowed amount is $30. 
 
Based on this example, lines 1 and 3 are denied and line 2 is paid.  The contractor reports 
in the Financial Limitation" field of the CWF record $25.00 along with the CWF 
override code.  The contractor always applies the amount that would least exceed the 
limit.  Since institutional claims systems cannot split the payment on a line, CWF will 
allow payment on the line that least exceeds the limit and deny other lines. 
 
D.  Additional Information for Contractors During the Time Financial Limits Are 
in Effect With or Without Exceptions 
 
Once the limit is reached, if a claim is submitted, CWF returns an error code stating the 
financial limitation has been met.  Over applied lines will be identified at the line level.  
The outpatient rehabilitation therapy services that exceed the limit should be denied.  
 
The contractor shall use the following remittance advice messages and associated codes 
when rejecting/denying claims under this policy.  This CARC/RARC combination is 
compliant with CAQH CORE Business Scenario Three. 
   
 
Group Code: CO or PR (as defined by section 10.5) 
CARC: 119 
RARC: N/A 
MSN: 20.5 
 
In situations where a beneficiary is close to reaching the financial limitation and a 
particular claim might exceed the limitation, the provider/supplier should bill the usual 
and customary charges for the services furnished even though such charges might exceed 
the limit.  The CWF will return an error code/trailer that will identify the line that 
exceeds the limitation. 
 
Because CWF applies the financial limitation according to the date when the claim was 
received (when the date of service is within the effective date range for the limitation), it 
is possible that the financial limitation will have been met before the date of service of a 
given claim.  Such claims will prompt the CWF error code and subsequent contractor 
denial. 
 
When the provider/supplier knows that the limit has been reached, and exceptions are 
either not appropriate or not available, further billing should not occur.  The 
provider/supplier should inform the beneficiary of the limit and their option of receiving 
further covered services from an outpatient hospital when outpatient hospital therapy 
services are excluded from the limitation (unless consolidated billing rules prevent the 
use of the outpatient hospital setting).  If the beneficiary chooses to continue treatment at 
a setting other than the outpatient hospital where medically necessary services may be 
covered, the services may be billed at the rate the provider/supplier determines.  Services 
provided in a capped setting after the limitation has been reached are not Medicare 
benefits and are not governed by Medicare policies. 
 
If a beneficiary elects to receive services that exceed the cap limitation and a claim is 
submitted for such services, the resulting determination is subject to the administrative 
appeals process as described in subsection C. of section 10.3 and Pub. 100-04, Chapter 
29. 
 
10.5 - Notification for Beneficiaries Exceeding Financial Limitations 
(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13) 
 
A.  Notice to Beneficiaries 
 
Contractors will advise providers/suppliers to notify beneficiaries of the therapy financial 
limitations at their first therapy encounter with the beneficiary.  Prior to 2013, Medicare 
instructed providers/suppliers to inform beneficiaries that beneficiaries were responsible 
   
for 100 percent of the costs of therapy services above each respective therapy limit (cap), 
unless this outpatient care was furnished directly or under arrangements by a hospital 
when outpatient hospital therapy services were excluded from the limitation. The 
American Taxpayer Relief Act (ATRA) of 2012 amended 1833(g)(5) of the Social 
Security Act (the Act) providing limitation of liability protections (under 1879 of the 
Act) to beneficiaries with respect to outpatient therapy services that exceed therapy cap 
amounts, furnished on or after January 1, 2013. Thus, effective January 1, 2013, 
assignment of liability has changed for therapy services exceeding the cap that dont 
qualify for a coverage exception.  The provider/supplier is financially responsible when 
Medicare denies payment for therapy services above the cap that dont qualify for a 
coverage exception unless a valid Advance Beneficiary Notice of Noncoverage (ABN), 
Form CMS-R-131, was issued per CMS guidelines. 
 
Providers were previously encouraged to use either a form of their own design or a 
voluntary ABN when providing therapy above the cap where no exception was applied; 
however, this instruction is no longer valid.  When providing therapy services above the 
cap that dont qualify for the exceptions process, the provider/supplier must now issue a 
mandatory ABN in order to transfer financial responsibility to the beneficiary. When the 
ABN is used as a mandatory notice, providers must adhere to the ABN form instructions 
and guidance published  in Chapter 30, Section 50 of this manual. The ABN and 
instructions can be found at:  http://www.cms.gov/Medicare/Medicare-General-
Information/BNI/ABN.html. 
 
When issuing the ABN for therapy in excess of therapy caps, the following language is 
suggested for the Reason Medicare May Not Pay section: Medicare wont  pay for 
physical therapy and speech-language pathology services over (add the dollar amount of 
the cap) in (add the year or the dates of service to which it applies) unless you qualify for 
an exception to this cap amount. Your services dont qualify for an exception.  Providers 
should use similar language for occupational therapy services when appropriate.  A cost 
estimate for the services should be included per the ABN form instructions. Therapy cost 
estimates can be listed as a cost per service or as a projected total cost for a certain 
amount of therapy provided over a specified time period. 
 
ABN issuance remains mandatory before the cap is exceeded when services arent 
expected to be covered by Medicare because they are not medically reasonable and 
necessary. When the clinician determines that skilled services are not medically 
necessary, the clinical goals have been met, or there is no longer potential for the 
rehabilitation of health and/or function in a reasonable time, the beneficiary should be 
informed.  If the beneficiary will be getting services that dont meet the medical necessity 
requirements for Medicare payment, the ABN must be issued prior to delivering these 
services.  The ABN informs the beneficiary of his/her potential financial obligation to the 
provider, allows him/her to choose whether or not to get the services, and provides 
information regarding appeal rights. 
 
When a provider/supplier expects that Medicare will deny payment on a claim for 
therapy services because they are not medically reasonable and necessary, regardless of 
   
whether or not therapy limits are met, the ABN must be issued before providing the 
services in order to transfer financial responsibility to the beneficiary. 
 
10.6 - Functional Reporting 
(Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19) 
 
A.  General 
 
Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) 
amended Section 1833(g) of the Act to require a claims-based data collection system for 
outpatient therapy services, including physical therapy (PT), occupational therapy (OT) 
and speech-language pathology (SLP) services.  42 CFR 410.59, 410.60, 410.61, 410.62 
and 410.105 implement this requirement.  The system will collect data on beneficiary 
function during the course of therapy services in order to better understand beneficiary 
conditions, outcomes, and expenditures. 
 
Beneficiary function information is reported using 42 nonpayable functional G-codes and 
seven severity/complexity modifiers on claims for PT, OT, and SLP services.  Functional 
reporting on one functional limitation at a time is required periodically throughout an 
entire PT, OT, or SLP therapy episode of care. 
 
The nonpayable G-codes and severity modifiers provide information about the 
beneficiarys functional status at the outset of the therapy episode of care, including 
projected goal status, at specified points during treatment, and at the time of discharge.  
These G-codes, along with the associated modifiers, are required at specified intervals on 
all claims for outpatient therapy services  not just those over the cap. 
 
In the CY 2019 Physician Fee Schedule final rule, CMS-1693-F, after consideration of 
stakeholders requests for burden reduction, a review of all of the MCTRJCA requirements, 
and in light of the statutory amendments to section 1833(g) of the Act, via section 50202 of 
Bipartisan Budget Act of 2018 to repeal the therapy caps, CMS concluded that continued 
collection of functional reporting data through the same format would not yield additional 
information to inform future analyses or to serve as a basis for reforms to the payment system 
for therapy services.  The rule ended the functional reporting requirements to reduce burden 
of reporting for providers of therapy services and revised regulation text at 42 CFR 410.59, 
410.60, 410.61, 410.62, 410.105, accordingly.  
 
The instructions below apply only to dates of service when the reporting requirement was 
effective, January 1, 2013 through December 31, 2018.  
 
B.  Application of Coding Requirements 
 
This functional data reporting and collection system is effective for therapy services with 
dates of service on and after January 1, 2013 and before January 1, 2019.   
 
C.  Services Affected 
 
   
These requirements apply to all claims for services furnished under the Medicare Part B 
outpatient therapy benefit and the PT, OT, and SLP services furnished under the CORF 
benefit. They also apply to the therapy services furnished personally by and incident to 
the service of a physician or a nonphysician practitioner (NPP), including a nurse 
practitioner (NP), a certified nurse specialist (CNS), or a physician assistant (PA), as 
applicable. 
 
D.  Providers and Practitioners Affected. 
 
The functional reporting requirements apply to the therapy services furnished by the 
following providers:  hospitals, CAHs, SNFs, CORFs, rehabilitation agencies, and HHAs 
(when the beneficiary is not under a home health plan of care).  It applies to the following 
practitioners: physical therapists, occupational therapists, and speech-language 
pathologists in private practice (TPPs), physicians, and NPPs as noted above.  The term 
clinician is applied to these practitioners throughout this manual section.  (See 
definition section of Pub. 100-02, Chapter 15, section 220.) 
 
E.  Function-related G-codes 
 
There are 42 functional G-codes, 14 sets of three codes each.  Six of the G-code sets are 
generally for PT and OT functional limitations and eight sets of G-codes are for SLP 
functional limitations. 
 
The following G-codes are for functional limitations typically seen in beneficiaries 
receiving PT or OT services.  The first four of these sets describe categories of functional 
limitations and the final two sets describe other functional limitations, which are to be 
used for functional limitations not described by one of the four categories. 
 
NONPAYABLE G-CODES FOR FUNCTIONAL LIMITATIONS 
 
Code  Long Descriptor  Short Descriptor 
Mobility G-code Set 
G8978  Mobility: walking & moving around functional  Mobility current status 
limitation, current status, at therapy episode 
outset and at reporting intervals 
G8979  Mobility: walking & moving around functional  Mobility goal status 
limitation, projected goal status, at therapy 
episode outset, at reporting intervals, and at 
discharge or to end reporting 
G8980  Mobility: walking & moving around functional  Mobility D/C status 
limitation, discharge status, at discharge from 
therapy or to end reporting 
Changing & Maintaining Body Position G-code Set 
G8981  Changing & maintaining body position functional  Body pos current 
limitation, current status, at therapy episode  status 
outset and at reporting intervals 
   
G8982  Changing & maintaining body position functional  Body pos goal status 
limitation, projected goal status, at therapy 
episode outset, at reporting intervals, and at 
discharge or to end reporting  
G8983  Changing & maintaining body position functional  Body pos D/C status 
limitation, discharge status, at discharge from 
therapy or to end reporting 
Carrying, Moving & Handling Objects G-code Set 
G8984  Carrying, moving & handling objects functional  Carry current status 
limitation, current status, at therapy episode 
outset and at reporting intervals 
G8985  Carrying, moving & handling objects functional  Carry goal status 
limitation, projected goal status, at therapy 
episode outset, at reporting intervals, and at 
discharge or to end reporting  
G8986  Carrying, moving & handling objects functional  Carry D/C status 
limitation, discharge status, at discharge from 
therapy or to end reporting 
Self Care G-code Set 
G8987  Self care functional limitation, current status, at  Self care current status 
therapy episode outset and at reporting intervals 
G8988  Self care functional limitation, projected goal  Self care goal status 
status, at therapy episode outset, at reporting 
intervals, and at discharge or to end reporting 
G8989  Self care functional limitation, discharge status, at  Self care D/C status 
discharge from therapy or to end reporting 
 
The following other PT/OT functional G-codes are used to report: 
 
  a beneficiarys functional limitation that is not defined by one of the above four 
categories; 
 
  a beneficiary whose therapy services are not intended to treat a functional 
limitation; 
 
  or a beneficiarys functional limitation when an overall, composite or other score 
from a functional assessment too is used and it does not clearly represent a 
functional limitation defined by one of the above four code sets.  
 
Code  Long Descriptor  Short Descriptor 
Other PT/OT Primary G-code Set 
G8990  Other physical or occupational therapy primary  Other PT/OT current 
functional limitation, current status, at therapy  status 
episode outset and at reporting intervals 
   
Code  Long Descriptor  Short Descriptor 
G8991  Other physical or occupational therapy primary  Other PT/OT goal 
functional limitation, projected goal status, at  status 
therapy episode outset, at reporting intervals, and 
at discharge or to end reporting 
G8992  Other physical or occupational therapy primary  Other PT/OT D/C 
functional limitation, discharge status, at  status 
discharge from therapy or to end reporting 
Other PT/OT Subsequent G-code Set 
G8993  Other physical or occupational therapy  Sub PT/OT current 
subsequent functional limitation, current status, at  status 
therapy episode outset and at reporting intervals 
G8994  Other physical or occupational therapy  Sub PT/OT goal status 
subsequent functional limitation, projected goal 
status, at therapy episode outset, at reporting 
intervals, and at discharge or to end reporting 
G8995  Other physical or occupational subsequent  Sub PT/OT D/C status 
functional limitation, discharge from therapy or 
end reporting. 
 
The following G-codes are for functional limitations typically seen in beneficiaries 
receiving SLP services.  Seven are for specific functional communication measures, 
which are modeled after the National Outcomes Measurement System (NOMS), and one 
is for any other measure not described by one of the other seven. 
 
Code  Long Descriptor  Short Descriptor 
Swallowing G-code Set 
G8996  Swallowing functional limitation, current status,  Swallow current status 
at therapy episode outset and at reporting 
intervals  
G8997  Swallowing functional limitation, projected goal  Swallow goal status 
status, at therapy episode outset, at reporting 
intervals, and at discharge or to end reporting  
G8998  Swallowing functional limitation, discharge  Swallow D/C status 
status, at discharge from therapy or to end 
reporting  
Motor Speech G-code Set 
(Note: These codes are not sequentially numbered) 
G8999  Motor speech functional limitation, current status,  Motor speech current 
at therapy episode outset and at reporting  status 
intervals 
G9186  Motor speech functional limitation, projected goal  Motor speech goal 
status at therapy episode outset, at reporting  status 
intervals, and at discharge or to end reporting 
   
Code  Long Descriptor  Short Descriptor 
G9158  Motor speech functional limitation, discharge  Motor speech D/C 
status, at discharge from therapy or to end  status 
reporting  
Spoken Language Comprehension G-code Set 
G9159  Spoken language comprehension functional  Lang comp current 
limitation, current status, at therapy episode  status 
outset and at reporting intervals 
G9160  Spoken language comprehension functional  Lang comp goal status 
limitation, projected goal status, at therapy 
episode outset, at reporting intervals, and at 
discharge or to end reporting  
G9161  Spoken language comprehension functional  Lang comp D/C status 
limitation, discharge status, at discharge from 
therapy or to end reporting 
Spoken Language Expressive G-code Set 
G9162  Spoken language expression functional limitation,  Lang express current 
current status, at therapy episode outset and at  status 
reporting intervals  
G9163  Spoken language expression functional limitation,  Lang press goal status 
projected goal status, at therapy episode outset, at 
reporting intervals, and at discharge or to end 
reporting  
G9164  Spoken language expression functional limitation,  Lang express D/C 
discharge status, at discharge from therapy or to  status 
end reporting 
Attention G-code Set 
G9165  Attention functional limitation, current status, at  Atten current status 
therapy episode outset and at reporting intervals 
G9166  Attention functional limitation, projected goal  Atten goal status 
status, at therapy episode outset, at reporting 
intervals, and at discharge or to end reporting  
G9167  Attention functional limitation, discharge status,  Atten D/C status 
at discharge from therapy or to end reporting  
Memory G-code Set 
G9168  Memory functional limitation, current status, at  Memory current status 
therapy episode outset and at reporting intervals  
G9169  Memory functional limitation, projected goal  Memory goal status 
status, at therapy episode outset, at reporting 
intervals, and at discharge or to end reporting  
G9170  Memory functional limitation, discharge status, at  Memory D/C status 
discharge from therapy or to end reporting  
Voice G-code Set 
G9171  Voice functional limitation, current status, at  Voice current status 
therapy episode outset and at reporting intervals  
   
Code  Long Descriptor  Short Descriptor 
G9172  Voice functional limitation, projected goal status,  Voice goal status 
at therapy episode outset, at reporting intervals, 
and at discharge or to end reporting  
G9173  Voice functional limitation, discharge status, at  Voice D/C status 
discharge from therapy or to end reporting 
 
The following other SLP G-code set is used to report: 
 
  on one of the other eight NOMS-defined functional measures not described by the 
above code sets; or  
 
  to report an overall, composite or other score from assessment tool that does not 
clearly represent one of the above seven categorical SLP functional measures. 
 
Code  Long Descriptor  Short Descriptor 
Other Speech Language Pathology G-code Set 
G9174  Other speech language pathology functional  Speech lang current 
limitation, current status, at therapy episode  status 
outset and at reporting intervals  
G9175  Other speech language pathology functional  Speech lang goal 
limitation, projected goal status, at therapy  status 
episode outset, at reporting intervals, and at 
discharge or to end reporting  
G9176  Other speech language pathology functional  Speech lang D/C 
limitation, discharge status, at discharge from  status 
therapy or to end reporting 
 
F.  Severity/Complexity Modifiers 
 
For each nonpayable functional G-code, one of the modifiers listed below must be used 
to report the severity/complexity for that functional limitation. 
 
Modifier  Impairment Limitation Restriction  
CH  0 percent impaired, limited or restricted 
CI  At least 1 percent but less than 20 percent impaired, limited or restricted 
CJ  At least 20 percent but less than 40 percent impaired, limited or restricted 
CK  At least 40 percent but less than 60 percent impaired, limited or restricted 
CL  At least 60 percent but less than 80 percent impaired, limited or restricted 
CM  At least 80 percent but less than 100 percent impaired, limited or restricted 
CN  100 percent impaired, limited or restricted 
 
The severity modifiers reflect the beneficiarys percentage of functional impairment as 
determined by the clinician furnishing the therapy services. 
 
G.  Required Reporting of Functional G-codes and Severity Modifiers 
   
 
The functional G-codes and severity modifiers listed above are used in the required 
reporting on therapy claims at certain specified points during therapy episodes of care.   
Claims containing these functional G-codes must also contain another billable and 
separately payable (non-bundled) service.  Only one functional limitation shall be 
reported at a given time for each related therapy plan of care (POC). 
 
Functional reporting using the G-codes and corresponding severity modifiers is required 
reporting on specified therapy claims. Specifically, they are required on claims: 
 
  At the outset of a therapy episode of care (i.e., on the claim for the date of service 
(DOS) of the initial therapy service); 
 
  At least once every 10 treatment days, which corresponds with the progress 
reporting period; 
 
  When  an evaluative procedure, including a re-evaluative one, ( HCPCS/CPT 
codes  92521, 92522, 92523, 92524, 92597, 92607, 92608, 92610, 92611, 92612, 
92614, 92616, 96105, 96125, 97161, 97162 ,97163, 97164, 97165, 97166, 97167, 
97168) is furnished and billed; 
 
  At the time of discharge from the therapy episode of care(i.e., on the date 
services related to the discharge [progress] report are furnished); and 
 
  At the time reporting of a particular functional limitation is ended in cases where 
the need for further therapy is necessary.  
 
  At the time reporting is begun for a new or different functional limitation within 
the same episode of care (i.e., after the reporting of the prior functional limitation 
is ended)  
 
Functional reporting is required on claims throughout the entire episode of care.  When 
the beneficiary has reached his or her goal or progress has been maximized on the 
initially selected functional limitation, but the need for treatment continues, reporting is 
required for a second functional limitation using another set of G-codes.  In these 
situations two or more functional limitations will be reported for a beneficiary during the 
therapy episode of care.  Thus, reporting on more than one functional limitation may be 
required for some beneficiaries but not simultaneously. 
 
When the beneficiary stops coming to therapy prior to discharge, the clinician should 
report the functional information on the last claim.  If the clinician is unaware that the 
beneficiary is not returning for therapy until after the last claim is submitted, the clinician 
cannot report the discharge status. 
 
When functional reporting is required on a claim for therapy services, two G-codes will 
generally be required. 
   
 
Two exceptions exist: 
 
1.  Therapy services under more than one therapy POC--  Claims may contain more 
than two nonpayable functional G-codes when in cases where a beneficiary 
receives therapy services under multiple POCs (PT, OT, and/or SLP) from the 
same therapy provider. 
 
2.  One-Time Therapy Visit-- When a beneficiary is seen and future therapy services 
are either not medically indicated or  are going to be furnished by another 
provider, the clinician reports on the claim for the DOS of the visit, all three G-
codes in the appropriate code set (current status, goal status and discharge status), 
along with corresponding severity modifiers. 
 
Each reported functional G-code must also contain the following line of service 
information: 
 
  Functional severity modifier 
 
  Therapy modifier indicating the related discipline/POC -- GP, GO or GN -- for 
PT, OT, and SLP services, respectively 
 
  Date of the related therapy service 
 
  Nominal charge, e.g., a penny, for institutional claims submitted to the A/B 
MACs (A).  For professional claims, a zero charge is acceptable for the service 
line.  If provider billing software requires an amount for professional claims, a 
nominal charge, e.g., a penny, may be included.  
 
NOTE: The KX modifier is not required on the claim line for nonpayable G-codes, but 
would be required with the procedure code for medically necessary therapy services 
furnished once the beneficiarys annual cap has been reached. 
 
The following example demonstrates how the G-codes and modifiers are used.  In this 
example, the clinician determines that the beneficiarys mobility restriction is the most 
clinically relevant functional limitation and selects the Mobility G-code set (G8978  
G8980) to represent the beneficiarys functional limitation.  The clinician also determines 
the severity/complexity of the beneficiarys functional limitation and selects the 
appropriate modifier.  In this example, the clinician determines that the beneficiary has a 
75 percent mobility restriction for which the CL modifier is applicable.  The clinician 
expects that at the end of therapy the beneficiaries will have only a 15 percent mobility 
restriction for which the CI modifier is applicable.  When the beneficiary attains the 
mobility goal, therapy continues to be medically necessary to address a functional 
limitation for which there is no categorical G-code. The clinician reports this using 
(G8990  G8992). 
 
   
At the outset of therapy--  On the DOS for which the initial evaluative procedure is 
furnished or the initial treatment day of a therapy POC, the claim for the service will also 
include two G-codes  as shown below. 
 
  G8978-CL to report the functional limitation (Mobility with current mobility 
limitation of at least 60 percent but less than 80 percent impaired, limited or 
restricted) 
 
  G8979-CI to report the projected goal for a mobility restriction of at least 1 
percent but less than 20 percent impaired, limited or restricted.  
 
At the end of each progress reporting period--  On the claim for the DOS when the 
services related to the progress report (which must be done at least once each 10 
treatment days) are furnished, the clinician will report the same two G-codes but the 
modifier for the current status may be different. 
 
  G8978 with the appropriate modifier are reported to show the beneficiarys 
current status as of this DOS.  So if the beneficiary has made no progress, this 
claim will include G8978-CL.  If the beneficiary made progress and now has a 
mobility restriction of 65 percent CL would still be the appropriate modifier for 
65 percent, and G8978-CL would be reported in this case.  If the beneficiary now 
has a mobility restriction of 45 percent, G8978-CK would be reported. 
 
  G8979-CI would be reported to show the projected goal.  This severity modifier 
would not change unless the clinician adjusts the beneficiarys goal. 
 
This step is repeated as necessary and clinically appropriate, adjusting the current status 
modifier used as the beneficiary progresses through therapy.  
 
At the time the beneficiary is discharged from the therapy episode.  The final claim for 
therapy episode will include two G-codes. 
 
  G8979-CI would be reported to show the projected goal.  G8980-CI would be 
reported if the beneficiary attained the 15 percent mobility goal.   Alternatively, if 
the beneficiarys mobility restriction only reached 25 percent; G8980-CJ would 
be reported. 
 
To end reporting of one functional limitation--  As noted above, functional reporting is 
required to continue throughout the entire episode of care.  Accordingly, when further 
therapy is medically necessary after the beneficiary attains the goal for the first reported 
functional limitation, the clinician would end reporting of the first functional limitation 
by using the same G-codes and modifiers that would be used at the time of discharge. 
Using the mobility example, to end reporting of the mobility functional limitation, 
G8979-CI and G8980-CI would be reported on the same DOS that coincides with end of 
that progress reporting period. 
 
   
To begin reporting of a second functional limitation. At the time reporting is begun for a 
new and different functional limitation, within the same episode of care (i.e., after the 
reporting of the prior functional limitation is ended).  Reporting on the second functional 
limitation, however, is not begun until the DOS of the next treatment day -- which is day 
one of the new progress reporting period.  When the next functional limitation to be 
reported is NOT defined by one of the other three PT/OT categorical codes, the G-code 
set (G8990 - G8992) for the other PT/OT primary functional limitation is used, rather 
than the G-code set for the other PT/OT subsequent because it is the first reported 
other PT/OT functional limitation.  This reporting begins on the DOS of the first 
treatment day following the mobility discharge reporting, which is counted as the 
initial service for the other PT/OT primary functional limitation and the first treatment 
day of the new progress reporting period.  In this case, G8990 and G8991, along with the 
corresponding modifiers, are reported on the claim for therapy services. 
 
The table below illustrates when reporting is required using this example and what G-
codes would be used. 
 
Example of Required Reporting 
Key:  Reporting Period (RP)  Begin RP #1 for Mobility at Episode Outset   End RP#1for Mobility at Progress Report  Mobility RP #2 Begins  Next Treatment Day  End RP #2 for Mobility at Progress Report   Mobility RP #3 Begins Next Treatment Day   D/C or End Reporting for Mobility   Begin RP #1 for Other PT/OT Primary 
Mobility: Walking & Moving                      
Around 
G8978  Current Status  X  X    X       
G 8979 Goal Status  X  X    X    X   
G8980  Discharge Status            X   
Other PT/OT Primary               
G8990  Current Status              X 
G8991   Goal Status              X 
G8992  Discharge Status               
No Functional Reporting 
    X    X     
Required 
 
H.  Required Tracking and Documentation of Functional G-codes and Severity 
Modifiers 
 
The clinician who furnishes the services must not only report the functional information 
on the therapy claim, but, he/she must track and document the G-codes and severity 
modifiers used for this reporting in the beneficiarys medical record of therapy services. 
 
   
For details related to the documentation requirements, refer to, Medicare Benefit Policy 
Manual, Pub. 100-02, Chapter 15, section 220.4 - Functional Reporting.  For coverage 
rules related to MCTRJCA and therapy goals, refer to Pub. 100-02:  a) for outpatient 
therapy services, see Chapter 15, section 220.1.2 B and b) for instructions specific to PT, 
OT, and SLP services in the CORF, see Chapter 12, section 10. 
 
10.7 - Multiple Procedure Payment Reductions for Outpatient 
Rehabilitation Services 
(Rev. 3475, Issued: 03-04-16, Effective: 06-06-16, Implementation: 06-06-16) 
 
Medicare applies a multiple procedure payment reduction (MPPR) to the practice 
expense (PE) payment of select therapy services.  The reduction applies to the HCPCS 
codes contained on the list of always therapy services (see section 20), excluding A/B 
MAC (B)-priced, bundled and add-on codes, regardless of the type of provider or 
supplier that furnishes the services. 
 
Medicare applies an MPPR to the PE payment when more than one unit or procedure is 
provided to the same patient on the same day, i.e., the MPPR applies to multiple units as 
well as multiple procedures.  Many therapy services are time-based codes, i.e., multiple 
units may be billed for a single procedure.  The MPPR applies to all therapy services 
furnished to a patient on the same day, regardless of whether the services are provided in 
one therapy discipline or multiple disciplines, for example, physical therapy, 
occupational therapy, or speech-language pathology. 
 
Full payment is made for the unit or procedure with the highest PE payment. 
 
For subsequent units and procedures with dates of service prior to April 1, 2013, 
furnished to the same patient on the same day, full payment is made for work and 
malpractice and 80 percent payment is made for the PE for services submitted on 
professional claims (any claim submitted using the ASC X12 837 professional claim 
format or the CMS-1500 paper claim form) and 75 percent payment is made for the PE 
for services submitted on institutional claims (ASC X12 837 institutional claim format or 
Form CMS-1450). 
 
For subsequent units and procedures with dates of service on or after April 1, 2013, 
furnished to the same patient on the same day, full payment is made for work and 
malpractice and 50 percent payment is made for the PE for services submitted on either 
professional or institutional claims. 
 
To determine which services will receive the MPPR, contractors shall rank services 
according to the applicable PE relative value units (RVU) and price the service with the 
highest PE RVU at 100% and apply the appropriate MPPR to the remaining services. 
When the highest PE RVU applies to more than one of the identified services, contractors 
shall additionally sort and rank these services according to highest total fee schedule 
amount, and price the service with the highest total fee schedule amount at 100% and 
apply the appropriate MPPR to the remaining services. 
   
 
The therapy payment amount that has been reduced by the MPPR is applied toward the 
therapy caps described in section 10.2.  As a result, the MPPR may increase the amount 
of medically necessary therapy services a beneficiary may receive before exceeding the 
caps.  The reduced amount is also used to calculate the beneficiarys coinsurance and 
deductible amounts. 
 
The contractor shall use the following remittance advice messages and associated codes 
when adjusting payment under this policy.  The CARC below is not included in the 
CAQH CORE Business Scenarios. 
 
Group Code: CO  
CARC: 59 
RARC: N/A 
MSN: 30.1 
 
20 - HCPCS Coding Requirement 
(Rev. 1850, Issued: 11-13-09, Effective: 01-01-10, Implementation: 01-04-10) 
 
A.  Uniform Coding 
 
Section 1834(k)(5) of the Act requires that all claims for outpatient rehabilitation therapy 
services and all comprehensive outpatient rehabilitation facility (CORF) services be 
reported using a uniform coding system.  The current Healthcare Common Procedure 
Coding System/Current Procedural Terminology is used for the reporting of these 
services.  The uniform coding requirement in the Act is specific to payment for all CORF 
services and outpatient rehabilitation therapy services - including physical therapy, 
occupational therapy, and speech-language pathology - that is provided and billed to 
Medicare contractors.  The Medicare physician fee schedule (MPFS) is used to make 
payment for these therapy services at the non facility rate. 
 
Effective for claims submitted on or after April 1, 1998, providers that had not previously 
reported HCPCS/CPT for outpatient rehabilitation and CORF services began using 
HCPCS to report these services.  This requirement does not apply to outpatient 
rehabilitation services provided by: 
 
  Critical access hospitals, which are paid on a cost basis, not MPFS; 
 
  RHCs, and FQHCs for which therapy is included in the all-inclusive rate; or  
 
  Providers that do not furnish therapy services. 
 
The following providers of services must bill the A/B MAC (A) for outpatient 
rehabilitation services using HCPCS codes: 
 
  Hospitals (to outpatients and inpatients who are not in a covered Part A stay); 
   
 
  Skilled nursing facilities (SNFs) (to residents not in a covered Part A stay and to 
nonresidents who receive outpatient rehabilitation services from the SNF); 
 
  Home health agencies (HHAs) (to individuals who are not homebound or 
otherwise are not receiving services under a home health plan of care (POC).   
 
  Comprehensive outpatient rehabilitation facilities (CORFs); and 
 
  Providers of outpatient physical therapy and speech-language pathology services 
(OPTs), also known as rehabilitation agencies (previously termed outpatient 
physical therapy facilities in this instruction). 
 
Note 1. The requirements for hospitals and SNFs apply to inpatient Part B and outpatient 
services only.  Inpatient Part A services are bundled into the respective prospective 
payment system payment; no separate payment is made. 
 
Note 2.  For HHAs, HCPCS/CPT coding for outpatient rehabilitation services is required 
only when the HHA provides such service to individuals that are not homebound and, 
therefore, not under a home health plan of care. 
 
The following practitioners must bill the A/B MAC (B) for outpatient rehabilitation 
therapy services using HCPCS/CPT codes: 
 
  Physical therapists in private practice (PTPPs), 
 
  Occupational therapists in private practice (OTPPs), 
 
  Speech-language pathologists in private practice (SLPPs), 
 
  Physicians, including MDs, DOs, podiatrists and optometrists, and 
 
  Certain nonphysician practitioners (NPPs), acting within their State scope of 
practice, e.g., nurse practitioners and clinical nurse specialists. 
 
Providers billing to intermediaries shall report: 
 
  The date the therapy plan of care was either established or last reviewed (see 
220.1.3B) in Occurrence Code 17, 29, or 30. 
 
  The first day of treatment in Occurrence Code 35, 44, or 45. 
 
B.  Applicable Outpatient Rehabilitation HCPCS Codes 
 
The CMS identifies the codes listed at: 
http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage 
   
as therapy services, regardless of the presence of a financial limitation.  Therapy services 
include only physical therapy, occupational therapy and speech-language pathology 
services.  Therapist means only a physical therapist, occupational therapist or speech-
language pathologist. Therapy modifiers are GP for physical therapy, GO for 
occupational therapy, and GN for speech-language pathology. 
 
When in effect, any financial limitation will also apply to services represented unless 
otherwise noted on the therapy page on the CMS Web site. 
 
C.  Additional HCPCS Codes 
 
Some HCPCS/CPT codes that are not on the list of therapy services should not be billed 
with a modifier.  For example, outpatient non-rehabilitation HCPCS codes G0237, 
G0238, and G0239 should be billed without therapy modifiers.  These HCPCS codes 
describe services for the improvement of respiratory function and may represent either 
incident to services or respiratory therapy services that may be appropriately billed in 
the CORF setting.  When the services described by these G-codes are provided by 
physical therapists (PTs) or occupational therapists (OTs) treating respiratory conditions, 
they are considered therapy services and must meet the other conditions for physical and 
occupational therapy.  The PT or OT would use the appropriate HCPCS/CPT code(s) in 
the 97000 - 97799 series and the corresponding therapy modifier, GP or GO, must be 
used. 
 
Another example of codes that are not on the list of therapy services and should not be 
billed with a therapy modifier includes the following HCPCS codes:  95860, 95861, 
95863, 95864, 95867, 95869, 95870, 95900, 95903, 95904, and 95934.  These services 
represent diagnostic services - not therapy services; they must be appropriately billed and 
shall not include therapy modifiers. 
 
Other codes not on the therapy code list, and not paid under another fee schedule, are 
appropriately billed with therapy modifiers when the services are furnished by therapists 
or provided under a therapy plan of care and where the services are covered and 
appropriately delivered (e.g., the therapist is qualified to provide the service).  One 
example of non-listed codes where a therapy modifier is indicated regards the provision 
of services described in the CPT code series, 29000 through 29590, for the application of 
casts and strapping.  Some of these codes previously appeared on the therapy code list, 
but were deleted because we determined that they represented services that are most often 
performed outside a therapy plan of care. However, when these services are provided by 
therapists or as an integral part of a therapy plan of care, the CPT code must be 
accompanied with the appropriate therapy modifier. 
 
NOTE: The above lists of HCPCS/CPT codes are intended to facilitate the contractors 
ability to pay claims under the MPFS.  It is not intended to be an exhaustive list of 
covered services, imply applicability to provider settings, and does not assure coverage of 
these services. 
 
   
20.1 - Discipline Specific Outpatient Rehabilitation Modifiers - All 
Claims 
(Rev. 11129, Issued: 11-22-21, Effective: 01-01-22, Implementation: 01-03-22) 
 
Modifiers are used to identify therapy services whether or not financial limitations are in 
effect. When limitations are in effect, the CWF tracks the financial limitation based on 
the presence of therapy modifiers. Providers/suppliers must continue to report one of 
these modifiers for any therapy code on the list of applicable therapy codes except as 
noted in 20 of this chapter. Consult 20 for the list of codes to which modifiers must be 
applied. These modifiers do not allow a provider to deliver services that they are not 
qualified and recognized by Medicare to perform.  
 
The claim must include one of the following modifiers to distinguish the discipline of the 
plan of care under which the service is delivered:  
 
  GN Services delivered under an outpatient speech-language pathology plan of 
care;  
 
  GO Services delivered under an outpatient occupational therapy plan of care; or,  
 
  GP Services delivered under an outpatient physical therapy plan of care.  
 
This is applicable to all claims from physicians, nonphysician practitioners (NPPs), 
PTPPs, OTPPs, SLPPs, CORFs, OPTs, hospitals, SNFs, and any others billing for 
physical therapy, speech-language pathology or occupational therapy services as noted on 
the applicable code list in 20 of this chapter.  
 
Modifiers GN, GO, and GP refer only to services provided under plans of care for 
physical therapy, occupational therapy and speech-language pathology services. They 
should never be used with codes that are not on the list of applicable therapy services. For 
example, respiratory therapy services, or nutrition therapy services shall not be 
represented by therapy codes which require GN, GO, and GP modifiers.  
 
Contractors edit institutional claims to ensure the following: 
 
  that a GN, GO or GP modifier is present for all lines reporting revenue codes 
042X, 043X, or 044X. 
 
  that no more than one GN, GO or GP modifier is reported on the same service 
line. 
 
  that revenue codes and modifiers are reported only in the following combinations: 
  Revenue code 42x (physical therapy) lines may only contain modifier GP 
o
  Revenue code 43x (occupational therapy) lines may only contain modifier GO 
o
  Revenue code 44x (speech-language pathology) lines may only contain 
o
modifier GN. 
   
 
  that discipline-specific evaluation and re-evaluation HCPCS codes are always 
reported with the modifier for the associated discipline (e.g. modifier GP with a 
HCPCS code for a physical therapy evaluation). 
 
Contractors return to the provider institutional claims that do not meet one or more of 
these conditions. 
 
CMS has established two modifiers, CQ and CO, for services furnished in whole or in 
part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs). 
The modifiers are defined as follows: 
 
  CQ modifier:  Outpatient physical therapy services furnished in whole or in part 
by a physical therapist assistant 
 
  CO modifier:  Outpatient occupational therapy services furnished in whole or in 
part by an occupational therapy assistant 
 
Effective for claims with dates of service on and after January 1, 2020, the CQ and CO 
modifiers are required to be used, when applicable, for services furnished in whole or in 
part by PTAs and OTAs on the claim line of the service alongside the respective GP or 
GO therapy modifier, to identify those PTA and OTA services furnished under a PT or 
OT plan of care.   
 
For those practitioners submitting professional claims who are paid under the PFS, the 
CQ/CO modifiers apply only to services of physical and occupational therapists in private 
practice (PTPPs and OTPPs); and not to the therapy services furnished by or incident to 
the services of physicians or nonphysician practitioners (NPPs)  including nurse 
practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs)  
because PTAs and OTAs do not meet the qualifications and standards of physical or 
occupational therapists, as required by  410.60 and 410.59, respectively.  However, the 
CQ and CO modifiers do apply to claims from physician or NPP groups when a PTPP or 
OTPP has reassigned their benefits to the group and their NPI appears as the rendering 
provider of the therapy service(s) on the claim.  
 
For providers submitting institutional claims and paid at PFS rates for their outpatient PT 
and OT services, the CQ and CO modifiers apply to the following providers:  outpatient 
hospitals, rehabilitation agencies, skilled nursing facilities, home health agencies and 
CORFs.  However, the CQ and CO modifiers are not applicable to claims from critical 
access hospitals because they are paid on a reasonable cost basis, or from other providers 
for which payment for PT and OT services is not made under the PFS rates. 
 
The CQ modifier must be paired to the GP therapy modifier and the CO modifier with the 
GO therapy modifier. Claims not so paired will be rejected/returned as unprocessable. 
 
   
For dates of service, on and after January 1, 2022, claims billed with a CQ or CO 
modifier to indicate the services were furnished in whole or in part by a PTA or OTA are 
paid at an amount equal to 85 percent of the otherwise applicable Part B payment thats 
based on the MPFS.  The 15 percent reduction is taken last, e.g., after the MPPR (and 
other reductions where applicable) and right before sequestration. This reduction is 
taken from the paid amount, i.e., the actual amount paid not the MPFS allowed amount.  
 
Regulations for the payment of therapy claims and the policy for assigning the therapy 
assistant modifiers (CO and CQ) for services provided in whole or in part by OTAs and 
PTAs are found at  410.59(a)(4) and 410.60(a)(4) for outpatient occupational and 
physical therapy services, respectively and at  410.105(d) for CORF OT and PT 
services.   
 
20.2 - Reporting of Service Units With HCPCS 
(Rev. 3670, Issued: 12-01-16, Effective: 01-01-17, Implementation: 01-03-17) 
 
A.  General 
 
Effective with claims submitted on or after April 1, 1998, providers billing on the ASC 
X12 837 institutional claim format or Form CMS-1450 were required to report the 
number of units for outpatient rehabilitation services based on the procedure or service, 
e.g., based on the HCPCS code reported instead of the revenue code.  This was already in 
effect for billing on the Form CMS-1500, and CORFs were required to report their full 
range of CORF services on the institutional claim.  These unit-reporting requirements 
continue with the standards required for electronically submitting health care claims 
under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) - the 
currently adopted version of the ASC X12 837 transaction standards and implementation 
guides.  The Administrative Simplification Compliance Act mandates that claims be sent 
to Medicare electronically unless certain exceptions are met. 
 
B.  Timed and Untimed Codes 
 
When reporting service units for HCPCS codes where the procedure is not defined by a 
specific timeframe (untimed HCPCS), the provider enters 1 in the field labeled units.  
For timed codes, units are reported based on the number of times the procedure is 
performed, as described in the HCPCS code definition. 
 
EXAMPLE:  A beneficiary received a speech-language pathology evaluation 
represented by HCPCS untimed code 92521.  Regardless of the number of minutes 
spent providing this service only one unit of service is appropriately billed on the same 
day. 
 
Several CPT codes used for therapy modalities, procedures, and tests and measurements 
specify that the direct (one on one) time spent in patient contact is 15 minutes.  Providers 
report these timed procedure codes for services delivered on any single calendar day 
using CPT codes and the appropriate number of 15 minute units of service. 
   
 
EXAMPLE:  A beneficiary received a total of 60 minutes of occupational therapy, e.g., 
HCPCS timed code 97530 which is defined in 15 minute units, on a given date of 
service.  The provider would then report 4 units of 97530. 
 
C.  Counting Minutes for Timed Codes in 15 Minute Units 
 
When only one service is provided in a day, providers should not bill for services 
performed for less than 8 minutes.  For any single timed CPT code in the same day 
measured in 15 minute units, providers bill a single 15-minute unit for treatment greater 
than or equal to 8 minutes through and including 22 minutes.  If the duration of a single 
modality or procedure in a day is greater than or equal to 23 minutes, through and 
including 37 minutes, then 2 units should be billed.  Time intervals for 1 through 8 units 
are as follows: 
 
Units  Number of Minutes 
 
1 unit:   8 minutes through 22 minutes 
 
2 units:   23 minutes through 37 minutes 
 
3 units:   38 minutes through  52 minutes 
 
4 units:   53 minutes through 67 minutes 
 
5 units:   68 minutes through 82 minutes 
 
6 units:   83 minutes through 97 minutes 
 
7 units:   98 minutes through 112 minutes 
 
8 units:   113 minutes through 127 minutes 
 
The pattern remains the same for treatment times in excess of 2 hours. 
 
If a service represented by a 15 minute timed code is performed in a single day for at 
least 15 minutes, that service shall be billed for at least one unit.  If the service is 
performed for at least 30 minutes, that service shall be billed for at least two units, etc.  It 
is not appropriate to count all minutes of treatment in a day toward the units for one code 
if other services were performed for more than 15 minutes.  See examples 2 and 3 below. 
 
When more than one service represented by 15 minute timed codes is performed in a 
single day, the total number of minutes of service (as noted on the chart above) 
determines the number of timed units billed.  See example 1 below. 
 
   
If any 15 minute timed service that is performed for 7 minutes or less than 7 minutes on 
the same day as another 15 minute timed service that was also performed for 7 minutes or 
less and the total time of the two is 8 minutes or greater than 8 minutes, then bill one unit 
for the service performed for the most minutes.  This is correct because the total time is 
greater than the minimum time for one unit.  The same logic is applied when three or 
more different services are provided for 7 minutes or less than 7 minutes. See example 5 
below. 
 
The expectation (based on the work values for these codes) is that a providers direct 
patient contact time for each unit will average 15 minutes in length.  If a provider has a 
consistent practice of billing less than 15 minutes for a unit, these situations should be 
highlighted for review. 
 
If more than one 15 minute timed CPT code is billed during a single calendar day, then 
the total number of timed units that can be billed is constrained by the total treatment 
minutes for that day.  See all examples below. 
 
Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 220.3B, 
Documentation Requirements for Therapy Services, indicates that the amount of time for 
each specific intervention/modality provided to the patient is not required to be 
documented in the Treatment Note.  However, the total number of timed minutes must be 
documented.  These examples indicate how to count the appropriate number of units for 
the total therapy minutes provided. 
 
Example 1   
24 minutes of neuromuscular reeducation, code 97112, 
23 minutes of therapeutic exercise, code 97110, 
Total timed code treatment time was 47 minutes. 
 
See the chart above.  The 47 minutes falls within the range for 3 units = 38 to 52 minutes. 
 
Appropriate billing for 47 minutes is only 3 timed units. Each of the codes is performed 
for more than 15 minutes, so each shall be billed for at least 1 unit.  The correct coding is 
2 units of code 97112 and one unit of code 97110, assigning more timed units to the 
service that took the most time. 
 
Example 2   
20 minutes of neuromuscular reeducation (97112) 
20 minutes therapeutic exercise (97110), 
40 Total timed code minutes. 
 
Appropriate billing for 40 minutes is 3 units.  Each service was done at least 15 minutes 
and should be billed for at least one unit, but the total allows 3 units.  Since the time for 
each service is the same, choose either code for 2 units and bill the other for 1 unit.  Do 
not bill 3 units for either one of the codes. 
 
   
Example 3   
33 minutes of therapeutic exercise (97110), 
 7 minutes of manual therapy (97140), 
40 Total timed minutes 
 
Appropriate billing for 40 minutes is for 3 units.  Bill 2 units of 97110 and 1 unit of 
97140. Count the first 30 minutes of 97110 as two full units.  Compare the remaining 
time for 97110 (33-30 = 3 minutes) to the time spent on 97140 (7 minutes) and bill the 
larger, which is 97140. 
 
Example 4   
18 minutes of therapeutic exercise (97110), 
13 minutes of manual therapy (97140), 
10 minutes of gait training (97116), 
  8 minutes of ultrasound (97035), 
49 Total timed minutes 
 
Appropriate billing is for 3 units.  Bill the procedures you spent the most time providing.  
Bill 1 unit each of 97110, 97116, and 97140.  You are unable to bill for the ultrasound 
because the total time of timed units that can be billed is constrained by the total timed 
code treatment minutes (i.e., you may not bill 4 units for less than 53 minutes regardless 
of how many services were performed).  You would still document the ultrasound in the 
treatment notes. 
 
Example 5   
7  minutes of neuromuscular reeducation (97112) 
7  minutes therapeutic exercise (97110) 
7 minutes manual therapy (97140) 
  21 Total timed minutes 
 
Appropriate billing is for one unit.  The qualified professional (See definition in Pub. 
100-02, chapter 15, section 220) shall select one appropriate CPT code (97112, 97110, 
97140) to bill since each unit was performed for the same amount of time and only one 
unit is allowed. 
 
NOTE:  The above schedule of times is intended to provide assistance in rounding time 
into 15-minute increments.  It does not imply that any minute until the eighth should be 
excluded from the total count.  The total minutes of active treatment counted for all 15 
minute timed codes includes all direct treatment time for the timed codes.  Total 
treatment minutes - including minutes spent providing services represented by untimed 
codes - are also documented.  For documentation in the medical record of the services 
provided see Pub. 100-02, chapter 15, section 220.3. 
 
D.  Specific Limits for HCPCS 
 
   
The Deficit Reduction Act of 2005, section 5107 requires the implementation of 
clinically appropriate code edits to eliminate improper payments for outpatient therapy 
services.  The following codes may be billed, when covered, only at or below the number 
of units indicated on the chart per treatment day.  When higher amounts of units are 
billed than those indicated in the table below, the units on the claim line that exceed the 
limit shall be denied as medically unnecessary (according to 1862(a)(1)(A)).  Denied 
claims may be appealed and an ABN is appropriate to notify the beneficiary of liability.  
 
This chart does not include all of the codes identified as therapy codes; refer to section 20 
of this chapter for further detail on these and other therapy codes.  For example, therapy 
codes called always therapy must always be accompanied by therapy modifiers 
identifying the type of therapy plan of care under which the service is provided. 
 
Use the chart in the following manner: 
 
The codes that are allowed one unit for Allowed Units in the chart below may be billed 
no more than once per provider, per discipline, per date of service, per patient. 
 
The codes allowed 0 units in the column for Allowed Units, may not be billed under a 
plan of care indicated by the discipline in that column.  Some codes may be billed by one 
discipline (e.g., PT) and not by others (e.g., OT or SLP). 
 
When physicians/NPPs bill always therapy codes they must follow the policies of the 
type of therapy they are providing e.g., utilize a plan of care, bill with the appropriate 
therapy modifier (GP, GO, GN), bill the allowed units on the chart below for PT, OT or 
SLP depending on the plan.  A physician/NPP shall not bill an always therapy code 
unless the service is provided under a therapy plan of care.  Therefore, NA stands for 
Not Applicable in the chart below. 
 
When a sometimes therapy code is billed by a physician/NPP, but as a medical service, 
and not under a therapy plan of care, the therapy modifier shall not be used, but the 
number of units billed must not exceed the number of units indicated in the chart below 
per patient, per provider/supplier, per day. 
 
NOTE:  As of April 1, 2017, the chart below uses the CPT Consumer Friendly Code 
Descriptions which are intended only to assist the reader in identifying the service related 
to the CPT/HCPCS code.  The reader is reminded that these descriptions cannot be used 
in place of the CPT long descriptions which officially define each of the services.   The 
table below no longer contains a column noting whether a code is timed or untimed 
as this notation is not relevant to the number of units allowed per code on claims for the 
listed therapy services. We note that the official long descriptors for the CPT codes can 
be found in the latest CPT code book. 
 
CPT/  CPT Consumer Friendly  PT   OT   SLP   Physician/ 
HCPCS  Code Descriptions and  Allowed  Allowed  Allowed  NPP Not 
Code   Units  Units  Units  
   
Claim Line Outlier/Edit  Under 
Details  Therapy 
POC 
92521  Evaluation of speech  0  0  1  NA 
fluency 
92522  Evaluation of speech  0  0  1  NA 
sound production 
92523  Evaluation of speech  0  0  1  NA 
sound production with 
evaluation of language 
comprehension and 
expression 
92524  Behavioral and qualitative  0  0  1  NA 
analysis of voice and 
resonance 
92597  Evaluation for use and/or  0  0  1  NA 
fitting of voice prosthetic 
device to supplement oral 
speech 
92607  Evaluation of patient with  0  0  1  NA 
prescription of speech-
generating and alternative 
communication device 
92611  Fluoroscopic and video  0  1  1  1 
recorded motion 
evaluation of swallowing 
function 
92612  Evaluation and recording  0  1  1  1 
of swallowing using an 
endoscope Evaluation and 
recording of swallowing 
using an endoscope 
92614  Evaluation and recording  0  1  1  1 
of voice box sensory 
function using an 
endoscope 
92616  Evaluation and recording  0  1  1  1 
of swallowing and voice 
box sensory function using 
an endoscope 
95833  Manual muscle testing of  1  1  0  1 
whole body 
95834  Manual muscle testing of  1  1  0  1 
whole body including 
hands 
96110  Developmental screening  1  1  1  1 
   
96111  Developmental testing  1  1  1  1 
97161  Evaluation of physical  1  0  0  NA 
therapy, typically 20 
minutes 
97162  Evaluation of physical  1  0  0  NA 
therapy, typically 30 
minutes 
97163  Evaluation of physical  1  0  0  NA 
therapy, typically 45 
minutes 
 
97164  Re-evaluation of physical  1  0  0  NA 
therapy, typically 20 
minutes 
97165  Evaluation of occupational  0  1  0  NA 
therapy, typically 30 
minutes 
97166  Evaluation of occupational  0  1  0  NA 
therapy, typically 45 
minutes 
97167  Evaluation of occupational  0  1  0  NA 
therapy, typically 60 
minutes 
97168  Re-evaluation of  0  1  0  NA 
occupational therapy 
established plan of care, 
typically 30 minutes 
 
20.3 - Determining What Time Counts Towards 15-Minute Timed Codes - All 
Claims 
(Rev. 1, 10-01-03) 
 
Providers report the code for the time actually spent in the delivery of the modality 
requiring constant attendance and therapy services.  Pre- and post-delivery services are 
not to be counted in determining the treatment service time.  In other words, the time 
counted as intra-service care begins when the therapist or physician (or an assistant 
under the supervision of a physician or therapist) is directly working with the patient to 
deliver treatment services.  The patient should already be in the treatment area (e.g., on 
the treatment table or mat or in the gym) and prepared to begin treatment. 
 
The time counted is the time the patient is treated.  For example, if gait training in a 
patient with a recent stroke requires both a therapist and an assistant, or even two 
therapists, to manage in the parallel bars, each 15 minutes the patient is being treated can 
count as only one unit of code 97116.  The time the patient spends not being treated 
because of the need for toileting or resting should not be billed.  In addition, the time 
   
spent waiting to use a piece of equipment or for other treatment to begin is not considered 
treatment time. 
 
20.4 - Coding Guidance for Certain CPT Codes - All Claims 
(Rev. 3475, Issued: 03-04-16, Effective: 06-06-16, Implementation: 06-06-16) 
 
The following provides guidance about the use of codes 96105, 97026, 97150, 97545, 
97546, and G0128. 
 
  CPT Codes 96105, 97545, and 97546. 
 
Providers report code 96105, assessment of aphasia with interpretation and report in 1-
hour units.  This code represents formal evaluation of aphasia with an instrument such as 
the Boston Diagnostic Aphasia Examination.  If this formal assessment is performed 
during treatment, it is typically performed only once during treatment and its medical 
necessity should be documented.  If the test is repeated during treatment, the medical 
necessity of the repeat administration of the test must also be documented.  It is common 
practice for regular assessment of a patients progress in therapy to be documented in the 
chart, and this may be done using test items taken from the formal examinations.  This is 
considered to be part of the treatment and should not be billed as 96105 unless a full, 
formal assessment is completed. 
 
Other timed physical medicine codes are 97545 and 97546.  The interval for code 97545 
is 2 hours and for code 97546, 1 hour.  These are specialized codes to be used in the 
context of rehabilitating a worker to return to a job.  The expectation is that the entire 
time period specified in the codes 97545 or 97546 would be the treatment period, since a 
shorter period of treatment could be coded with another code such as codes 97110, 
97112, or 97537.  (Codes 97545 and 97546 were developed for reporting services to 
persons in the workers compensation program, thus CMS does not expect to see them 
reported for Medicare patients except under very unusual circumstances.  Further, CMS 
would not expect to see code 97546 without also seeing code 97545 on the same claim.  
Code 97546, when used, is used in conjunction with 97545.) 
 
  CPT Code 97026 
 
Effective for services performed on or after October 24, 2006, the Centers for Medicare 
& Medicaid Services announce a NCD stating the use of infrared and/or near-infrared 
light and/or heat, including monochromatic infrared energy (MIRE), is non-covered for 
the treatment, including symptoms such as pain arising from these conditions, of diabetic 
and/or non-diabetic peripheral sensory neuropathy, wounds and/or ulcers of the skin 
and/or subcutaneous tissues in Medicare beneficiaries.  Further coverage guidelines can 
be found in the National Coverage Determination Manual (Pub. 100-03), section 270.6. 
 
Contractors shall deny claims with CPT 97026 (infrared therapy incident to or as a 
PT/OT benefit) and HCPCS E0221 or A4639, if the claim contains any of the following 
diagnosis codes: 
   
 
ICD-9-CM 
 
250.60 - 250.63 
 
354.4, 354.5, 354.9 
 
355.1 - 355.4 
 
355.6 - 355.9 
 
356.0, 356.2-356.4, 356.8-356.9 
 
357.0 - 357.7 
 
674.10, 674.12, 674.14, 674.20, 674.22, 674.24 
 
707.00 -707.07, 707.09-707.15, 707.19 
 
870.0 - 879.9 
 
880.00 - 887.7 
 
890.0 - 897.7 
 
998.31 - 998.32 
 
ICD-10-CM 
 
See Addendum A Chapter 5, Section 20.4 (at end of this chapter) for the list of ICD 10-
CM diagnosis codes that require denial with the above HCPCD codes. 
 
The contractor shall use the following remittance advice messages and associated codes 
when rejecting/denying claims under this policy.  This CARC/RARC combination is 
compliant with CAQH CORE Business Scenario Three. 
 
Group Code: CO  
CARC: 50 
RARC: N/A 
MSN: 21.11 
 
Advanced Beneficiary Notice (ABN): 
 
Physicians, physical therapists, occupational therapists, outpatient rehabilitation facilities 
(ORFs), comprehensive outpatient rehabilitation facilities (CORFs), home health 
   
agencies (HHA), and hospital outpatient departments are liable if the service is 
performed, unless the beneficiary signs an ABN. 
 
Similarly, DME suppliers and HHA are liable for the devices when they are supplied, 
unless the beneficiary signs an ABN. 
 
20.5 - CORF/OPT Edit for Billing Inappropriate Supplies 
(Rev. 319, Issued: 10-22-04, Effective: 07-01-01, Implementation: 04-04-05) 
 
Supplies furnished by CORFs/OPTs are considered part of the practice expense. Under 
the Medicare Physician Fee Schedule (MPFS) these expenses are already taken into 
account in the practice expense relative values.  Therefore, CORFs/OPTs should not bill 
for the supplies they furnish except for the splint and cast, level II HCPCS Q codes 
associated with the level I HCPCS in the 29000 series. 
 
The shared system maintainer will return to CORFs/OPTs any claims that they receive 
that contain a supply revenue code 270 without the splint and cast Level II HCPCS Q 
codes and the related Level I applicable HCPCS codes in the 29000 series. 
 
The appropriate Level II HCPCS Q codes to be used are Q4001 thru Q4049. 
 
The appropriate Level I HCPCS codes associated with the Level II HCPCS Q codes are 
29000 thru 29085; 29105 thru 29131; and 29305 thru 29515. 
 
30 - Special Claims Processing Rules for Outpatient Rehabilitation 
Claims - Form CMS-1500 
(Rev. 1, 10-01-03) 
 
Rules for completing a Form CMS-1500 and electronic formats are in Chapter 26.  
Instructions in 10.1, 20.1, 20.2, 20.3 and 20.4 above also apply. 
 
30.1 - Determining Payment Amounts 
(Rev. 1, 10-01-03) 
 
A/B MACs (B) use the MPFS to determine payment for outpatient rehabilitation services.  
Payment rules are the same as those for other services paid on the MPFS. 
 
Assignment is mandatory. 
 
See chapter 23, for a description of the MPFS. 
 
30.2 - Applicable A/B MAC (B) CWF Type of Service Codes 
(Rev. 1, 10-01-03) 
 
The A/B MAC (B) assigns the type of service code before submitting the claim record to 
CWF. 
   
 
U = Occupational therapy 
W= Physical therapy 
 
40 - Special Claims Processing Rules for Institutional Outpatient 
Rehabilitation Claims  
(Rev. 1921, Issued: 02-19-10, Effective: 04-01-10, Implementation: 04-05-10) 
 
40.1 - Determining Payment Amounts  Institutional Claims 
(Rev. 3367 Issued: 10-07-15, Effective: 01-01-16, Implementation: 01-04-16) 
 
Institutional outpatient rehabilitation claims are paid under the Medicare Physician Fee 
Schedule (MPFS), except for claims from CAHs and hospitals in Maryland.  Medicare 
contractors should see 100.2 for details on obtaining the correct fee amounts. 
 
40.2 - Applicable Types of Bill 
(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13) 
 
The appropriate types of bill for submitting outpatient rehabilitation services are: 12X, 
13X, 22X, 23X, 34X, 74X, 75X, and 85X. 
 
40.3 - Applicable Revenue Codes 
(Rev. 2044, Issued: 09-03-10, Effective: 09-30-10, Implementation: 09-30-10) 
 
The appropriate revenue codes for reporting outpatient rehabilitation services are  
 
0420 - Physical Therapy Services 
0430 - Occupational Therapy Services 
0440  Speech-language pathology services 
 
The general classification of revenue codes is all that is needed for billing.  If, however, 
providers choose to use more specific revenue code classifications, the A/B MAC (A) 
should accept them.  Reporting of services is not limited to specific revenue codes; e.g., 
services other than therapy may be included on the same claim. 
 
Many therapy services may be provided by both physical and occupational therapists.  
Other services may be delivered by either occupational therapists or speech-language 
pathologists.  Therefore, providers report outpatient rehabilitation HCPCS codes in 
conjunction with the appropriate outpatient rehabilitation revenue code based on the type 
of therapist who delivered the service, or, if a therapist does not deliver the service, then 
on the type of therapy under the plan of care (POC) for which the service is delivered. 
 
40.4 - Edit Requirements for Revenue Codes 
(Rev. 1921, Issued: 02-19-10, Effective: 04-01-10, Implementation: 04-05-10) 
 
   
Medicare contractors edit to assure the presence of a HCPCS code when revenue codes 
0420, 0430, 0440, or 0470 are reported.  However, Medicare contractors do not edit the 
matching of revenue code to certain HCPCS codes or edit to limit provider reporting to 
only those HCPCS listed in section 20. 
 
40.5 - Line Item Date of Service Reporting 
(Rev. 2044, Issued: 09-03-10, Effective: 09-30-10, Implementation: 09-30-10) 
 
Providers are required to report line item dates of service per revenue code line for 
outpatient rehabilitation services.  CORFs are also required to report their full range of 
CORF services by line item date of service.  This means each service (revenue code) 
provided must be repeated on a separate line item along with the specific date the service 
was provided for every occurrence. 
 
Contractors will return claims that span two or more dates if a line item date of service is 
not entered for each HCPCS reported.  Line item date of service reporting became 
effective for claims with dates of service on or after October 1, 1998. 
 
Services that do not require line item date of service reporting may be reported before or 
after those services that require line item reporting. 
 
40.6 - Non-covered Charge Reporting 
(Rev. 1921, Issued: 02-19-10, Effective: 04-01-10, Implementation: 04-05-10) 
 
Institutional outpatient therapy claims may report non-covered charges when appropriate 
according to the instructions provided in of this manual. Outpatient therapies billed as 
non-covered charges are not counted toward the financial limitation described above, 
when that limitation is in effect, unless the charges are subject to review after they are 
submitted and found to be covered by Medicare.  Modifiers associated with non-covered 
charges that are presented in Chapter 1, section 60 can be used on claim lines for therapy 
services, in addition to the use of modifiers -GN, -GO and -GP. 
 
40.7 - Billing for Biofeedback Training for the Treatment of Urinary 
Incontinence 
(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13) 
 
Medicare covered biofeedback training for the treatment of urinary incontinence may be 
provided by physical therapists in facility settings. For information regarding the 
coverage of this service, see the Medicare National Coverage Determinations Manual, 
Chapter 1, Section 30.1.1. Medicare pays for this service under the Medicare Physician 
Fee Schedule. 
 
Providers bill this service on one of the types of bill listed in section 40.2 using revenue 
code 042X and one of the following HCPCS codes:  
 
  90901 - Biofeedback training by any modality 
   
 
  90911 - Biofeedback training, perineal muscles, anorectal or urethral sphincter, 
including EMG and/or manometry 
 
40.8  Rebilling Therapy Services for Hospital Inpatients 
(Rev. 2868, Issued: 02-06-14, Effective: 07-01-14, Implementation: 07-07-14) 
 
If a beneficiary receives therapy services during an inpatient hospital stay which was 
denied because the stay was not medically necessary, the therapy services may be rebilled 
under Medicare Part B coverage.  If the therapy would have been reasonable and 
necessary as hospital outpatient services, and provided the beneficiary has Part B 
entitlement, the services can be billed using Type of Bill 012x.  All payment and billing 
requirements for outpatient therapy (including therapy caps, functional reporting and 
other instructions in this chapter) apply to these claims. 
 
50 - CWF and PS&R Requirements - A/B MAC (A) 
(Rev. 2044, Issued: 09-03-10, Effective: 09-30-10, Implementation: 09-30-10) 
 
The A/B MAC (A) reports the procedure codes in the financial data section (field 65a-
65j) of the PS&R record.  It includes revenue code, HCPCS, units, and covered charges 
in the record.  Where more than one HCPCS procedure is applicable to a single revenue 
code, the provider reports each HCPCS and related charge on a separate line.  The A/B 
MAC (A) reports the payment amount before adjustment for beneficiary liability in field 
65g Rate and the actual charge in field 65h Covered Charges.  The PS&R system 
includes outpatient rehabilitation, and CORF services listed in subsections E and F on a 
separate report from cost based payments.  See the PS&R guidelines for specific 
information. 
 
100 - Special Rules for Comprehensive Outpatient Rehabilitation 
Facilities (CORFs) 
(Rev. 1, 10-01-03) 
 
100.1 - General 
(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10, 
ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of 
ICD-10 ASC X12: 09-16-14) 
 
The Omnibus Reconciliation Act of 1980 (Public Law 96-499, Section 933) defines 
CORFs (Comprehensive Outpatient Rehabilitation Facilities) as a distinct type of 
Medicare provider and adds CORF services as a benefit under Medicare Part B.  The 
Balance Budget Act (P.L.105-33) requires payment under a prospective system for all 
CORF services. 
 
See Chapter 1, for the policy on A/B MAC (A) designations governing CORFs. 
 
   
See the Medicare Benefit Policy Manual, Chapter 12, for a description of covered CORF 
services. 
 
Physicians diagnostic and therapeutic services furnished to a CORF patient are not 
considered CORF physicians services.  The physician must bill the area A/B MAC (B) 
for these services.  If they are covered, the A/B MAC (B) reimburses them via the MPFS. 
 
However, other services are considered CORF services to be billed by the CORF to the 
A/B MAC (A), and are also considered included in the fee amount under the MPFS.  
These services include such services as administrative services provided by the physician 
associated with the CORF, examinations for the purpose of establishing and reviewing 
the plan of care, consultation with and medical supervision of nonphysician staff, team 
conferences, case reviews, and other facility staff medical and facility administration 
activities relating to the services described in Medicare Benefit Policy Manual, chapter 
12.  Related supplies are also included in the MPFS fee amount. 
 
The CORFs bill Medicare with the ASC X12 837 institutional claim or Form CMS-1450 
using HCPCS codes and Revenue Codes.  Usually the zero level revenue code is used.  
Payment is based on the HCPCS code and related MPFS amount. 
 
Requirements in 10 - 50 apply to CORF billing.  In addition the following 
requirements apply. 
 
100.1.1 - Allowable Revenue Codes on CORF 75X Bill Types 
(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13) 
 
Effective October 1, 2012, the following revenue codes are allowable for reporting CORF 
services on 75X bill types: 
 
0270  0274  0279  029X 
0412  0419  042X  0410 
044X  0550  0559  043X 
0636  0771  0911  0569 
0942       
 
NOTE:  Billed revenue codes not listed in the above list will be returned to the provider 
by Medicare systems.  See Chapter 25, Completing and Processing the CMS-1450 Data 
Set, for revenue code descriptions. 
 
100.2 - Obtaining Fee Schedule Amounts 
(Rev. 1, 10-01-03) 
 
The CMS furnishes A/B MACs (A) with an annual therapy abstract file and a CORF 
supplemental file through the Medicare Telecommunications System.  The CMS notifies 
A/B MACs (A) when new files are available.  A/B MACs (A)  are responsible for 
informing CORFs of new fee schedule amounts. 
   
 
Payment is calculated at 80 percent of the allowed charge after deductible is met.  The 
allowed charge is the lower of billed charges or the fee schedule amount.  Unmet 
deductible is subtracted from the allowed charge, and payment is calculated at 80 percent 
of the result. 
 
EXAMPLE: 
 
$120 Provider charge; 
$100 MPFS amount. 
Payment is 80 percent of the lower of the actual charge or fee schedule amount, 
which in this case is $80.00.  ($100.00 (MPFS) X 80 percent.) 
 
The remaining 20 percent or $20 is the patient s coinsurance liability. 
 
These codes are updated as needed by CMS. 
 
If the A/B MAC (A) receives a claim for a Medicare covered CORF service with dates of 
service on or after July 1, 2000, that does not appear on its fee schedule abstract file, it 
has two options for obtaining pricing information: 
 
1.  It is provided with a therapy abstract file or CORF supplemental file that contains 
all therapy services and their related prices.  This supplemental file contains 
approximately a million records, and may be used as a resource to extract pricing 
data as needed.  The data in the supplemental file is in the same format as the 
MPFS abstract file in exhibit 1, but the fields defining the fee and outpatient 
hospital indicators are not populated, instead they are space-filled. 
 
2.  It can contact the local A/B MAC (B) to obtain the price.  When requesting the 
pricing data, it advises the A/B MAC (B) to provide the nonfacility fee from the 
MPFS.  The MPFS supplemental file of physician fee schedule services is 
available for retrieval through CMS Mainframe Telecommunications System.  
The A/B MAC (A) is notified yearly of the file retrieval names and dates by a 
program memorandum or other communication. 
 
100.3 - Proper Reporting of Nursing Services by CORFs - A/B MAC (A) 
(Rev. 1459; Issued:  02-22-08; Effective:  07-01-08; Implementation:  07-07-08) 
 
Nursing services performed in the CORF shall be billed utilizing the following HCPCS 
code: 
 
G0128  Direct (Face to Face w/ patient) skilled nursing services of a registered nurse 
provided in a CORF, each 10 minutes beyond the first 5 minutes. 
 
In addition, HCPCS G0128 is billable with revenue codes 0550 and 0559 only. 
 
   
100.4 - Outpatient Mental Health Treatment Limitation 
(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13) 
 
The Outpatient Mental Health Treatment Limitation (the limitation) is not applicable to 
CORF services because CORFs do not provide services to treat mental, psychoneurotic 
and personality disorders that are subject to the limitation in section 1833(c) of the Act.  
For dates of service on or after October 1, 2012, HCPCS code G0409 is the only code 
allowed for social work and psychological services furnished in a CORF.  This service is 
not subject to the limitation because it is not a psychiatric mental health treatment 
service. 
 
For additional information on the limitation, see Publication 100-01, Chapter 3, section 
30 and Publication 100-02, Chapter 12, sections 50-50.5. 
 
100.5 - Off-Site CORF Services 
(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10, 
ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of 
ICD-10 ASC X12: 09-16-14) 
 
The CORFs may provide physical therapy, speech-language pathology and occupational 
therapy off the CORFs premises in addition to the home evaluation.  Services provided 
offsite are billed separately and identified as offsite on the claim in remarks.  The 
charges for offsite visits include any additional charge for providing the services at a 
place other than the CORF premises.  There is no change in the payment method for 
offsite services. 
 
100.6 - Notifying Patient of Service Denial 
(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10, 
ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of 
ICD-10 ASC X12: 09-16-14) 
 
Services may be noncovered because they are statutorily excluded from coverage under 
Medicare, or because they are not medically reasonable and necessary. 
 
If a service is excluded by statute, the CORF may submit a claim for them to Medicare to 
obtain a denial prior to billing another insurance carrier.  It shows the charges as 
noncovered, and includes Condition Code 21. It may bill the beneficiary for the excluded 
services, and need not issue an advance beneficiary notice (ABN).  However, when 
providing therapy services under the financial limitations, the CORF should provide the 
beneficiary with the Notice of Exclusion of Medicare Benefits (NEMB). The Medicare 
Claims Processing Manual, Chapter 30, Limitation on Liability, discusses ABNs for 
A/B MAC (A) processed claims for Part B services. 
 
If, after reviewing the plan of care, the CORF determines that the services to be furnished 
to the patient are not medically reasonable or necessary, it immediately provides the 
beneficiary with an ABN.  If the patient signs an ABN, the claim includes occurrence 
   
code 32 Date Beneficiary Notified of Intent to Bill (Procedures or Treatments) along 
with the date the ABN was signed. 
 
If the beneficiary insists that a claim be submitted for payment, the CORF must indicate 
on the bill (billed separately from bills with covered charges) that it is being submitted at 
the beneficiarys request.  This is done by using condition code 20. 
 
If during the course of the patients treatment the A/B MAC (A) advises the CORF that 
covered care has ceased, the CORF must notify the beneficiary (or the beneficiarys 
representative) immediately. 
 
NOTE:  Information regarding the form locator numbers that correspond to these data 
element names is found in Chapter 25. 
 
100.7 - Payment of Drugs, Biologicals, and Supplies in a CORF 
(Rev. 1459; Issued:  02-22-08; Effective:  07-01-08; Implementation:  07-07-08) 
 
Drugs 
 
Drugs and biologicals generally do not apply in a CORF setting.  Therefore, contractors 
are to advise their CORFs not to bill for them. 
 
Supplies 
 
The CORFs should not bill for the supplies they furnish when such supplies are part of 
the practice expense for that service.  Under the MPFS, nearly all of these expenses are 
already taken into account in the practice expense relative values.  However, CORFs may 
bill separately for certain splint and cast supplies, represented by HCPCS codes Q4001 
through Q4051, when furnishing a cast/strapping application service in the CPT code 
series 29000 through 29750. 
 
Vaccines 
 
The CORFs should refer to Chapter 18, Preventive and Screening Services, for billing 
guidance on influenza, pneumococcal pneumonia, and Hepatitis B vaccines and their 
administration. 
 
100.8 - Billing for DME, Prosthetic and Orthotic Devices, and Surgical Dressings 
(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10, 
ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of 
ICD-10 ASC X12: 09-16-14) 
 
The CORFs bill DME to the DME MAC with the ASC X12 professional claim format or 
Form CMS-1500 except for claims for implanted DME, which are billed to the local A/B 
MAC (B).  If the CORF does not have a supplier billing number from the National 
Supplier Clearinghouse (NSC), it may contact the NSC to secure one.  If the local A/B 
   
MAC (B) has issued the CORF a provider number for billing physician services, the 
CORF may not use the same number when billing for DME. 
 
100.10 - Group Therapy Services (Code 97150) 
(Rev. 1145, Issued: 12-29-06, Effective: 01-01-07, Implementation: on or before 01-
29-07) 
 
Policies for group therapy services for CORF are the same as group therapy services for 
other Part B outpatient services.  See Pub 100-02, chapter 15, section 230. 
 
100.10.1 - Therapy Students 
(Rev. 1145, Issued: 12-29-06, Effective: 01-01-07, Implementation: on or before 01-
29-07) 
 
Policies for therapy students for CORF are the same as policies for therapy students for 
other Part B outpatient services.  See Pub. 100-02, chapter 15, section 230. 
 
100.11 - Billing for Social Work and Psychological Services in a CORF 
(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13) 
 
The CORF providers shall only bill social work and psychological services with the 
following HCPCS code: 
 
G0409  Social work and psychological services, directly relating to and/or the patient's 
rehabilitation goals, each 15 minutes, face-to-face; individual (services provided 
by a CORF-qualified social worker or psychologist in a CORF) 
 
In addition, HCPCS code G0409 shall only be billed with revenue code 0569 or 0911. 
 
100.12 - Billing for Respiratory Therapy Services in a CORF 
(Rev. 1459; Issued:  02-22-08; Effective:  07-01-08; Implementation:  07-07-08) 
 
The CORF providers shall only bill respiratory therapy services with revenue codes 0410, 
0412 and 0419.  See Chapter 25, Completing and Processing the CMS-1450 Data Set, for 
revenue code descriptions. 
 
Exhibit 1 - Physician Fee Schedule Abstract File 
(Rev. 515, Issued: 04-01-05, Effective: 01-03-05, Implementation: 07-05-05) 
 
This file contains nonfacility fee schedule payment amounts for the outpatient 
rehabilitation, and CORF HCPCS codes listed in 20.  These codes are identified in the 
abstract file by a value of R in the fee indicator field.  The file includes fee schedule 
payment amounts by locality and is available via the CMS Mainframe 
Telecommunications System (formerly referred to as the Network Data Mover). 
 
   
Record Length:  60 
Record Format:  FB 
Block size:  6000 
Character Code:  EBCDIC 
Sort Sequence:  A/B MAC (B), Locality HCPCS Code, Modifier 
 
Data Element Name  COBOL  Picture  Value 
Location 
1  HCPCS  1-5  X(05)   
2  Modifier  6-7  X(02)   
3  Filler  8-9  X(02)   
4 -- Non-Facility Fee  10-16  9(05)V99   
5  Filler  17-23  X(07)   
6  Filler  24-30  X(07)   
7 -- A/B MAC (B)  31-35  X(05)   
Number 
8  Locality  36-37  X(02)  Identical to the 
radiology/diagnostic fees 
9  Filler  38-40  X(03)   
10 -- Fee Indicator  41-41  X(1)  R - Rehab/Audiology/CORF 
services 
11 -- Outpatient  42-42  X(1)  0 - Fee applicable in hospital 
Hospital  outpatient setting 
indicator  1 - Fee not applicable in hospital 
outpatient setting 
12  Filler  43-60  X(18)   
 
Upon CMS notification, the contractor is responsible for retrieving this file and making 
payment based on 80 percent of the lower of the actual charge or fee schedule amount 
indicated on the file after the Part B deductible has been met.  The CMS will notify 
contractors of updates to the MPFS, file names and when the updated files will be 
available for retrieval.  Upon retrieval, contractors disseminate the fee schedules to their 
   
providers.  The file is also available on the CMS Web site in the Public Use Files (PUF) 
area. 
 
Addendum A - Chapter 5, Section 20.4  Coding Guidance for Certain CPT 
Codes  All Claims 
(Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10, 
ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of 
ICD-10 ASC X12: 09-16-14) 
 
ICD-10-CM - Code and Description 
A52.15 Late syphilitic neuropathy 
E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy, 
unspecified 
E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy 
E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy 
E09.40 Drug or chemical induced diabetes mellitus with neurological complications 
with diabetic neuropathy, unspecified 
E09.41 Drug or chemical induced diabetes mellitus with neurological complications 
with diabetic mononeuropathy 
E09.42 Drug or chemical induced diabetes mellitus with neurological complications 
with diabetic polyneuropathy 
E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified 
E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy 
E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy 
E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy 
E10.44 Type 1 diabetes mellitus with diabetic amyotrophy 
E10.49 Type 1 diabetes mellitus with other diabetic neurological complication 
E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy 
E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified 
E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy 
E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy 
E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy 
E11.44 Type 2 diabetes mellitus with diabetic amyotrophy 
E11.49 Type 2 diabetes mellitus with other diabetic neurological complication 
E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy 
E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified 
E13.41 Other specified diabetes mellitus with diabetic mononeuropathy 
E13.42 Other specified diabetes mellitus with diabetic polyneuropathy 
   
ICD-10-CM - Code and Description 
E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy 
E13.44 Other specified diabetes mellitus with diabetic amyotrophy 
E13.49 Other specified diabetes mellitus with other diabetic neurological complication 
E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy 
G13.0 Paraneoplastic neuromyopathy and neuropathy 
G13.1 Other systemic atrophy primarily affecting central nervous system in neoplastic 
disease 
G56.40 Causalgia of unspecified upper limb 
G56.41 Causalgia of right upper limb 
G56.42 Causalgia of left upper limb 
G56.90 Unspecified mononeuropathy of unspecified upper limb 
G56.91 Unspecified mononeuropathy of right upper limb 
G56.92 Unspecified mononeuropathy of left upper limb 
G57.10 Meralgia paresthetica, unspecified lower limb 
G57.11 Meralgia paresthetica, right lower limb 
G57.12 Meralgia paresthetica, left lower limb 
G57.20 Lesion of femoral nerve, unspecified lower limb 
G57.21 Lesion of femoral nerve, right lower limb 
G57.22 Lesion of femoral nerve, left lower limb 
G57.30 Lesion of lateral popliteal nerve, unspecified lower limb 
G57.31 Lesion of lateral popliteal nerve, right lower limb 
G57.32 Lesion of lateral popliteal nerve, left lower limb 
G57.40 Lesion of medial popliteal nerve, unspecified lower limb 
G57.41 Lesion of medial popliteal nerve, right lower limb 
G57.42 Lesion of medial popliteal nerve, left lower limb 
G57.60 Lesion of plantar nerve, unspecified lower limb 
G57.61 Lesion of plantar nerve, right lower limb 
G57.62 Lesion of plantar nerve, left lower limb 
G57.70 Causalgia of unspecified lower limb 
G57.71 Causalgia of right lower limb 
G57.72 Causalgia of left lower limb 
G57.80 Other specified mononeuropathies of unspecified lower limb 
G57.81 Other specified mononeuropathies of right lower limb 
G57.82 Other specified mononeuropathies of left lower limb 
G57.90 Unspecified mononeuropathy of unspecified lower limb 
   
ICD-10-CM - Code and Description 
G57.91 Unspecified mononeuropathy of right lower limb 
G57.92 Unspecified mononeuropathy of left lower limb 
G58.7 Mononeuritis multiplex 
G58.8 Other specified mononeuropathies 
G58.9 Mononeuropathy, unspecified 
G59 Mononeuropathy in diseases classified elsewhere 
G60.0 Hereditary motor and sensory neuropathy 
G60.1 Refsum's disease 
G60.2 Neuropathy in association with hereditary ataxia 
G60.3 Idiopathic progressive neuropathy 
G60.8 Other hereditary and idiopathic neuropathies 
G60.9 Hereditary and idiopathic neuropathy, unspecified 
G61.0 Guillain-Barre syndrome 
G61.1 Serum neuropathy 
G62.0 Drug-induced polyneuropathy 
G62.1 Alcoholic polyneuropathy 
G62.2 Polyneuropathy due to other toxic agents 
G62.82 Radiation-induced polyneuropathy 
G63 Polyneuropathy in diseases classified elsewhere 
G65.0 Sequelae of Guillain-Barre syndrome 
G65.1 Sequelae of other inflammatory polyneuropathy 
G65.2 Sequelae of toxic polyneuropathy 
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh 
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf 
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle 
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot 
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot 
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of 
lower right leg 
I70.239 Atherosclerosis of native arteries of right leg with ulceration of unspecified site 
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh 
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf 
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle 
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot 
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot 
   
ICD-10-CM - Code and Description 
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of 
lower left leg 
I70.249 Atherosclerosis of native arteries of left leg with ulceration of unspecified site 
I70.331 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with 
ulceration of thigh 
I70.332 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with 
ulceration of calf 
I70.333 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with 
ulceration of ankle 
I70.334 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with 
ulceration of heel and midfoot 
I70.335 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with 
ulceration of other part of foot 
I70.338 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with 
ulceration of other part of lower leg 
I70.339 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with 
ulceration of unspecified site 
I70.341 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with 
ulceration of thigh 
I70.342 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with 
ulceration of calf 
I70.343 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with 
ulceration of ankle 
I70.344 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with 
ulceration of heel and midfoot 
I70.345 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with 
ulceration of other part of foot 
I70.348 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with 
ulceration of other part of lower leg 
I70.349 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with 
ulceration of unspecified site 
I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with 
ulceration of thigh 
I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with 
ulceration of calf 
I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with 
ulceration of ankle 
I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with 
ulceration of heel and midfoot 
   
ICD-10-CM - Code and Description 
I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with 
ulceration of other part of foot 
I70.438 Atherosclerosis of autologous vein bypass graft(s) of the right leg with 
ulceration of other part of lower leg 
I70.439 Atherosclerosis of autologous vein bypass graft(s) of the right leg with 
ulceration of unspecified site 
I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration 
of thigh 
I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration 
of calf 
I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration 
of ankle 
I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration 
of heel and midfoot 
I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration 
of other part of foot 
I70.448 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration 
of other part of lower leg 
I70.449 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration 
of unspecified site 
I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with 
ulceration of thigh 
I70.532 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with 
ulceration of calf 
I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with 
ulceration of ankle 
I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with 
ulceration of heel and midfoot 
I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with 
ulceration of other part of foot 
I70.538 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with 
ulceration of other part of lower leg 
I70.539 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with 
ulceration of unspecified site 
I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with 
ulceration of thigh 
I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with 
ulceration of calf 
   
ICD-10-CM - Code and Description 
I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with 
ulceration of ankle 
I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with 
ulceration of heel and midfoot 
I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with 
ulceration of other part of foot 
I70.548 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with 
ulceration of other part of lower leg 
I70.549 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with 
ulceration of unspecified site 
I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration 
of thigh 
I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration 
of calf 
I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration 
of ankle 
I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration 
of heel and midfoot 
I70.635 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration 
of other part of foot 
I70.638 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration 
of other part of lower leg 
I70.639 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration 
of unspecified site 
I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of 
thigh 
I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of 
calf 
I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of 
ankle 
I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of 
heel and midfoot 
I70.645 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of 
other part of foot 
I70.648 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of 
other part of lower leg 
I70.649 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of 
unspecified site 
   
ICD-10-CM - Code and Description 
I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration 
of thigh 
I70.732 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration 
of calf 
I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration 
of ankle 
I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration 
of heel and midfoot 
I70.735 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration 
of other part of foot 
I70.738 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration 
of other part of lower leg 
I70.739 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration 
of unspecified site 
I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of 
thigh 
I70.742 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of 
calf 
I70.743 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of 
ankle 
I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of 
heel and midfoot 
I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of 
other part of foot 
I70.748 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of 
other part of lower leg 
I70.749 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of 
unspecified site 
L89.000 Pressure ulcer of unspecified elbow, unstageable 
L89.001 Pressure ulcer of unspecified elbow, stage 1 
L89.002 Pressure ulcer of unspecified elbow, stage 2 
L89.003 Pressure ulcer of unspecified elbow, stage 3 
L89.004 Pressure ulcer of unspecified elbow, stage 4 
L89.009 Pressure ulcer of unspecified elbow, unspecified stage 
L89.010 Pressure ulcer of right elbow, unstageable 
L89.011 Pressure ulcer of right elbow, stage 1 
L89.012 Pressure ulcer of right elbow, stage 2 
L89.013 Pressure ulcer of right elbow, stage 3 
   
ICD-10-CM - Code and Description 
L89.014 Pressure ulcer of right elbow, stage 4 
L89.019 Pressure ulcer of right elbow, unspecified stage 
L89.020 Pressure ulcer of left elbow, unstageable 
L89.021 Pressure ulcer of left elbow, stage 1 
L89.022 Pressure ulcer of left elbow, stage 2 
L89.023 Pressure ulcer of left elbow, stage 3 
L89.024 Pressure ulcer of left elbow, stage 4 
L89.029 Pressure ulcer of left elbow, unspecified stage 
L89.100 Pressure ulcer of unspecified part of back, unstageable 
L89.101 Pressure ulcer of unspecified part of back, stage 1 
L89.102 Pressure ulcer of unspecified part of back, stage 2 
L89.103 Pressure ulcer of unspecified part of back, stage 3 
L89.104 Pressure ulcer of unspecified part of back, stage 4 
L89.109 Pressure ulcer of unspecified part of back, unspecified stage 
L89.110 Pressure ulcer of right upper back, unstageable 
L89.111 Pressure ulcer of right upper back, stage 1 
L89.112 Pressure ulcer of right upper back, stage 2 
L89.113 Pressure ulcer of right upper back, stage 3 
L89.114 Pressure ulcer of right upper back, stage 4 
L89.119 Pressure ulcer of right upper back, unspecified stage 
L89.120 Pressure ulcer of left upper back, unstageable 
L89.121 Pressure ulcer of left upper back, stage 1 
L89.122 Pressure ulcer of left upper back, stage 2 
L89.123 Pressure ulcer of left upper back, stage 3 
L89.124 Pressure ulcer of left upper back, stage 4 
L89.129 Pressure ulcer of left upper back, unspecified stage 
L89.130 Pressure ulcer of right lower back, unstageable 
L89.131 Pressure ulcer of right lower back, stage 1 
L89.132 Pressure ulcer of right lower back, stage 2 
L89.133 Pressure ulcer of right lower back, stage 3 
L89.134 Pressure ulcer of right lower back, stage 4 
L89.139 Pressure ulcer of right lower back, unspecified stage 
L89.140 Pressure ulcer of left lower back, unstageable 
L89.141 Pressure ulcer of left lower back, stage 1 
   
ICD-10-CM - Code and Description 
L89.142 Pressure ulcer of left lower back, stage 2 
L89.143 Pressure ulcer of left lower back, stage 3 
L89.144 Pressure ulcer of left lower back, stage 4 
L89.149 Pressure ulcer of left lower back, unspecified stage 
L89.150 Pressure ulcer of sacral region, unstageable 
L89.151 Pressure ulcer of sacral region, stage 1 
L89.152 Pressure ulcer of sacral region, stage 2 
L89.153 Pressure ulcer of sacral region, stage 3 
L89.154 Pressure ulcer of sacral region, stage 4 
L89.159 Pressure ulcer of sacral region, unspecified stage 
L89.200 Pressure ulcer of unspecified hip, unstageable 
L89.201 Pressure ulcer of unspecified hip, stage 1 
L89.202 Pressure ulcer of unspecified hip, stage 2 
L89.203 Pressure ulcer of unspecified hip, stage 3 
L89.204 Pressure ulcer of unspecified hip, stage 4 
L89.209 Pressure ulcer of unspecified hip, unspecified stage 
L89.210 Pressure ulcer of right hip, unstageable 
L89.211 Pressure ulcer of right hip, stage 1 
L89.212 Pressure ulcer of right hip, stage 2 
L89.213 Pressure ulcer of right hip, stage 3 
L89.214 Pressure ulcer of right hip, stage 4 
L89.219 Pressure ulcer of right hip, unspecified stage 
L89.220 Pressure ulcer of left hip, unstageable 
L89.221 Pressure ulcer of left hip, stage 1 
L89.222 Pressure ulcer of left hip, stage 2 
L89.223 Pressure ulcer of left hip, stage 3 
L89.224 Pressure ulcer of left hip, stage 4 
L89.229 Pressure ulcer of left hip, unspecified stage 
L89.300 Pressure ulcer of unspecified buttock, unstageable 
L89.301 Pressure ulcer of unspecified buttock, stage 1 
L89.302 Pressure ulcer of unspecified buttock, stage 2 
L89.303 Pressure ulcer of unspecified buttock, stage 3 
L89.304 Pressure ulcer of unspecified buttock, stage 4 
L89.309 Pressure ulcer of unspecified buttock, unspecified stage 
   
ICD-10-CM - Code and Description 
L89.310 Pressure ulcer of right buttock, unstageable 
L89.311 Pressure ulcer of right buttock, stage 1 
L89.312 Pressure ulcer of right buttock, stage 2 
L89.313 Pressure ulcer of right buttock, stage 3 
L89.314 Pressure ulcer of right buttock, stage 4 
L89.319 Pressure ulcer of right buttock, unspecified stage 
L89.320 Pressure ulcer of left buttock, unstageable 
L89.321 Pressure ulcer of left buttock, stage 1 
L89.322 Pressure ulcer of left buttock, stage 2 
L89.323 Pressure ulcer of left buttock, stage 3 
L89.324 Pressure ulcer of left buttock, stage 4 
L89.329 Pressure ulcer of left buttock, unspecified stage 
L89.40 Pressure ulcer of contiguous site of back, buttock and hip, unspecified stage 
L89.41 Pressure ulcer of contiguous site of back, buttock and hip, stage 1 
L89.42 Pressure ulcer of contiguous site of back, buttock and hip, stage 2 
L89.43 Pressure ulcer of contiguous site of back, buttock and hip, stage 3 
L89.44 Pressure ulcer of contiguous site of back, buttock and hip, stage 4 
L89.45 Pressure ulcer of contiguous site of back, buttock and hip, unstageable 
L89.500 Pressure ulcer of unspecified ankle, unstageable 
L89.501 Pressure ulcer of unspecified ankle, stage 1 
L89.502 Pressure ulcer of unspecified ankle, stage 2 
L89.503 Pressure ulcer of unspecified ankle, stage 3 
L89.504 Pressure ulcer of unspecified ankle, stage 4 
L89.509 Pressure ulcer of unspecified ankle, unspecified stage 
L89.510 Pressure ulcer of right ankle, unstageable 
L89.511 Pressure ulcer of right ankle, stage 1 
L89.512 Pressure ulcer of right ankle, stage 2 
L89.513 Pressure ulcer of right ankle, stage 3 
L89.514 Pressure ulcer of right ankle, stage 4 
L89.519 Pressure ulcer of right ankle, unspecified stage 
L89.520 Pressure ulcer of left ankle, unstageable 
L89.521 Pressure ulcer of left ankle, stage 1 
L89.522 Pressure ulcer of left ankle, stage 2 
L89.523 Pressure ulcer of left ankle, stage 3 
   
ICD-10-CM - Code and Description 
L89.524 Pressure ulcer of left ankle, stage 4 
L89.529 Pressure ulcer of left ankle, unspecified stage 
L89.600 Pressure ulcer of unspecified heel, unstageable 
L89.601 Pressure ulcer of unspecified heel, stage 1 
L89.602 Pressure ulcer of unspecified heel, stage 2 
L89.603 Pressure ulcer of unspecified heel, stage 3 
L89.604 Pressure ulcer of unspecified heel, stage 4 
L89.609 Pressure ulcer of unspecified heel, unspecified stage 
L89.610 Pressure ulcer of right heel, unstageable 
L89.611 Pressure ulcer of right heel, stage 1 
L89.612 Pressure ulcer of right heel, stage 2 
L89.613 Pressure ulcer of right heel, stage 3 
L89.614 Pressure ulcer of right heel, stage 4 
L89.619 Pressure ulcer of right heel, unspecified stage 
L89.620 Pressure ulcer of left heel, unstageable 
L89.621 Pressure ulcer of left heel, stage 1 
L89.622 Pressure ulcer of left heel, stage 2 
L89.623 Pressure ulcer of left heel, stage 3 
L89.624 Pressure ulcer of left heel, stage 4 
L89.629 Pressure ulcer of left heel, unspecified stage 
L89.810 Pressure ulcer of head, unstageable 
L89.811 Pressure ulcer of head, stage 1 
L89.812 Pressure ulcer of head, stage 2 
L89.813 Pressure ulcer of head, stage 3 
L89.814 Pressure ulcer of head, stage 4 
L89.819 Pressure ulcer of head, unspecified stage 
L89.890 Pressure ulcer of other site, unstageable 
L89.891 Pressure ulcer of other site, stage 1 
L89.892 Pressure ulcer of other site, stage 2 
L89.893 Pressure ulcer of other site, stage 3 
L89.894 Pressure ulcer of other site, stage 4 
L89.899 Pressure ulcer of other site, unspecified stage 
L89.90 Pressure ulcer of unspecified site, unspecified stage 
L89.91 Pressure ulcer of unspecified site, stage 1 
   
ICD-10-CM - Code and Description 
L89.92 Pressure ulcer of unspecified site, stage 2 
L89.93 Pressure ulcer of unspecified site, stage 3 
L89.94 Pressure ulcer of unspecified site, stage 4 
L89.95 Pressure ulcer of unspecified site, unstageable 
L97.101 Non-pressure chronic ulcer of unspecified thigh limited to breakdown of skin 
L97.102 Non-pressure chronic ulcer of unspecified thigh with fat layer exposed 
L97.103 Non-pressure chronic ulcer of unspecified thigh with necrosis of muscle 
L97.104 Non-pressure chronic ulcer of unspecified thigh with necrosis of bone 
L97.109 Non-pressure chronic ulcer of unspecified thigh with unspecified severity 
L97.111 Non-pressure chronic ulcer of right thigh limited to breakdown of skin 
L97.112 Non-pressure chronic ulcer of right thigh with fat layer exposed 
L97.113 Non-pressure chronic ulcer of right thigh with necrosis of muscle 
L97.114 Non-pressure chronic ulcer of right thigh with necrosis of bone 
L97.119 Non-pressure chronic ulcer of right thigh with unspecified severity 
L97.121 Non-pressure chronic ulcer of left thigh limited to breakdown of skin 
L97.122 Non-pressure chronic ulcer of left thigh with fat layer exposed 
L97.123 Non-pressure chronic ulcer of left thigh with necrosis of muscle 
L97.124 Non-pressure chronic ulcer of left thigh with necrosis of bone 
L97.129 Non-pressure chronic ulcer of left thigh with unspecified severity 
L97.201 Non-pressure chronic ulcer of unspecified calf limited to breakdown of skin 
L97.202 Non-pressure chronic ulcer of unspecified calf with fat layer exposed 
L97.203 Non-pressure chronic ulcer of unspecified calf with necrosis of muscle 
L97.204 Non-pressure chronic ulcer of unspecified calf with necrosis of bone 
L97.209 Non-pressure chronic ulcer of unspecified calf with unspecified severity 
L97.211 Non-pressure chronic ulcer of right calf limited to breakdown of skin 
L97.212 Non-pressure chronic ulcer of right calf with fat layer exposed 
L97.213 Non-pressure chronic ulcer of right calf with necrosis of muscle 
L97.214 Non-pressure chronic ulcer of right calf with necrosis of bone 
L97.219 Non-pressure chronic ulcer of right calf with unspecified severity 
L97.221 Non-pressure chronic ulcer of left calf limited to breakdown of skin 
L97.222 Non-pressure chronic ulcer of left calf with fat layer exposed 
L97.223 Non-pressure chronic ulcer of left calf with necrosis of muscle 
L97.224 Non-pressure chronic ulcer of left calf with necrosis of bone 
L97.229 Non-pressure chronic ulcer of left calf with unspecified severity 
   
ICD-10-CM - Code and Description 
L97.301 Non-pressure chronic ulcer of unspecified ankle limited to breakdown of skin 
L97.302 Non-pressure chronic ulcer of unspecified ankle with fat layer exposed 
L97.303 Non-pressure chronic ulcer of unspecified ankle with necrosis of muscle 
L97.304 Non-pressure chronic ulcer of unspecified ankle with necrosis of bone 
L97.309 Non-pressure chronic ulcer of unspecified ankle with unspecified severity 
L97.311 Non-pressure chronic ulcer of right ankle limited to breakdown of skin 
L97.312 Non-pressure chronic ulcer of right ankle with fat layer exposed 
L97.313 Non-pressure chronic ulcer of right ankle with necrosis of muscle 
L97.314 Non-pressure chronic ulcer of right ankle with necrosis of bone 
L97.319 Non-pressure chronic ulcer of right ankle with unspecified severity 
L97.321 Non-pressure chronic ulcer of left ankle limited to breakdown of skin 
L97.322 Non-pressure chronic ulcer of left ankle with fat layer exposed 
L97.323 Non-pressure chronic ulcer of left ankle with necrosis of muscle 
L97.324 Non-pressure chronic ulcer of left ankle with necrosis of bone 
L97.329 Non-pressure chronic ulcer of left ankle with unspecified severity 
L97.401 Non-pressure chronic ulcer of unspecified heel and midfoot limited to 
breakdown of skin 
L97.402 Non-pressure chronic ulcer of unspecified heel and midfoot with fat layer 
exposed 
L97.403 Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of 
muscle 
L97.404 Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of 
bone 
L97.409 Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified 
severity 
L97.411 Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of 
skin 
L97.412 Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed 
L97.413 Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle 
L97.414 Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone 
L97.419 Non-pressure chronic ulcer of right heel and midfoot with unspecified severity 
L97.421 Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of 
skin 
L97.422 Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed 
L97.423 Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle 
L97.424 Non-pressure chronic ulcer of left heel and midfoot with necrosis of bone 
   
ICD-10-CM - Code and Description 
L97.429 Non-pressure chronic ulcer of left heel and midfoot with unspecified severity 
L97.501 Non-pressure chronic ulcer of other part of unspecified foot limited to 
breakdown of skin 
L97.502 Non-pressure chronic ulcer of other part of unspecified foot with fat layer 
exposed 
L97.503 Non-pressure chronic ulcer of other part of unspecified foot with necrosis of 
muscle 
L97.504 Non-pressure chronic ulcer of other part of unspecified foot with necrosis of 
bone 
L97.509 Non-pressure chronic ulcer of other part of unspecified foot with unspecified 
severity 
L97.511 Non-pressure chronic ulcer of other part of right foot limited to breakdown of 
skin 
L97.512 Non-pressure chronic ulcer of other part of right foot with fat layer exposed 
L97.513 Non-pressure chronic ulcer of other part of right foot with necrosis of muscle 
L97.514 Non-pressure chronic ulcer of other part of right foot with necrosis of bone 
L97.519 Non-pressure chronic ulcer of other part of right foot with unspecified severity 
L97.521 Non-pressure chronic ulcer of other part of left foot limited to breakdown of 
skin 
L97.522 Non-pressure chronic ulcer of other part of left foot with fat layer exposed 
L97.523 Non-pressure chronic ulcer of other part of left foot with necrosis of muscle 
L97.524 Non-pressure chronic ulcer of other part of left foot with necrosis of bone 
L97.529 Non-pressure chronic ulcer of other part of left foot with unspecified severity 
L97.801 Non-pressure chronic ulcer of other part of unspecified lower leg limited to 
breakdown of skin 
L97.802 Non-pressure chronic ulcer of other part of unspecified lower leg with fat layer 
exposed 
L97.803 Non-pressure chronic ulcer of other part of unspecified lower leg with necrosis 
of muscle 
L97.804 Non-pressure chronic ulcer of other part of unspecified lower leg with necrosis 
of bone 
L97.809 Non-pressure chronic ulcer of other part of unspecified lower leg with 
unspecified severity 
L97.811 Non-pressure chronic ulcer of other part of right lower leg limited to 
breakdown of skin 
L97.812 Non-pressure chronic ulcer of other part of right lower leg with fat layer 
exposed 
   
ICD-10-CM - Code and Description 
L97.813 Non-pressure chronic ulcer of other part of right lower leg with necrosis of 
muscle 
L97.814 Non-pressure chronic ulcer of other part of right lower leg with necrosis of 
bone 
L97.819 Non-pressure chronic ulcer of other part of right lower leg with unspecified 
severity 
L97.821 Non-pressure chronic ulcer of other part of left lower leg limited to breakdown 
of skin 
L97.822 Non-pressure chronic ulcer of other part of left lower leg with fat layer exposed 
L97.823 Non-pressure chronic ulcer of other part of left lower leg with necrosis of 
muscle 
L97.824 Non-pressure chronic ulcer of other part of left lower leg with necrosis of bone 
L97.829 Non-pressure chronic ulcer of other part of left lower leg with unspecified 
severity 
L97.901 Non-pressure chronic ulcer of unspecified part of unspecified lower leg limited 
to breakdown of skin 
L97.902 Non-pressure chronic ulcer of unspecified part of unspecified lower leg with fat 
layer exposed 
L97.903 Non-pressure chronic ulcer of unspecified part of unspecified lower leg with 
necrosis of muscle 
L97.904 Non-pressure chronic ulcer of unspecified part of unspecified lower leg with 
necrosis of bone 
L97.909 Non-pressure chronic ulcer of unspecified part of unspecified lower leg with 
unspecified severity 
L97.911 Non-pressure chronic ulcer of unspecified part of right lower leg limited to 
breakdown of skin 
L97.912 Non-pressure chronic ulcer of unspecified part of right lower leg with fat layer 
exposed 
L97.913 Non-pressure chronic ulcer of unspecified part of right lower leg with necrosis 
of muscle 
L97.914 Non-pressure chronic ulcer of unspecified part of right lower leg with necrosis 
of bone 
L97.919 Non-pressure chronic ulcer of unspecified part of right lower leg with 
unspecified severity 
L97.921 Non-pressure chronic ulcer of unspecified part of left lower leg limited to 
breakdown of skin 
L97.922 Non-pressure chronic ulcer of unspecified part of left lower leg with fat layer 
exposed 
   
ICD-10-CM - Code and Description 
L97.923 Non-pressure chronic ulcer of unspecified part of left lower leg with necrosis of 
muscle 
L97.924 Non-pressure chronic ulcer of unspecified part of left lower leg with necrosis of 
bone 
L97.929 Non-pressure chronic ulcer of unspecified part of left lower leg with 
unspecified severity 
M05.50 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site 
M05.511 Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder 
M05.512 Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder 
M05.519 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified shoulder 
M05.521 Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow 
M05.522 Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow 
M05.529 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified elbow 
M05.531 Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist 
M05.532 Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist 
M05.539 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified wrist 
M05.541 Rheumatoid polyneuropathy with rheumatoid arthritis of right hand 
M05.542 Rheumatoid polyneuropathy with rheumatoid arthritis of left hand 
M05.549 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hand 
M05.551 Rheumatoid polyneuropathy with rheumatoid arthritis of right hip 
M05.552 Rheumatoid polyneuropathy with rheumatoid arthritis of left hip 
M05.559 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hip 
M05.561 Rheumatoid polyneuropathy with rheumatoid arthritis of right knee 
M05.562 Rheumatoid polyneuropathy with rheumatoid arthritis of left knee 
M05.569 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee 
M05.571 Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot 
M05.572 Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot 
M05.579 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified ankle and 
foot 
M05.59 Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites 
M34.83 Systemic sclerosis with polyneuropathy 
O90.0 Disruption of cesarean delivery wound 
O90.1 Disruption of perineal obstetric wound 
S01.00XA Unspecified open wound of scalp, initial encounter 
S01.01XA Laceration without foreign body of scalp, initial encounter 
   
ICD-10-CM - Code and Description 
S01.02XA Laceration with foreign body of scalp, initial encounter 
S01.03XA Puncture wound without foreign body of scalp, initial encounter 
S01.04XA Puncture wound with foreign body of scalp, initial encounter 
S01.05XA Open bite of scalp, initial encounter 
S01.101A Unspecified open wound of right eyelid and periocular area, initial encounter 
S01.102A Unspecified open wound of left eyelid and periocular area, initial encounter 
S01.109A Unspecified open wound of unspecified eyelid and periocular area, initial 
encounter 
S01.111A Laceration without foreign body of right eyelid and periocular area, initial 
encounter 
S01.112A Laceration without foreign body of left eyelid and periocular area, initial 
encounter 
S01.119A Laceration without foreign body of unspecified eyelid and periocular area, 
initial encounter 
S01.119A Laceration without foreign body of unspecified eyelid and periocular area, 
initial encounter 
S01.121A Laceration with foreign body of right eyelid and periocular area, initial 
encounter 
S01.122A Laceration with foreign body of left eyelid and periocular area, initial 
encounter 
S01.129A Laceration with foreign body of unspecified eyelid and periocular area, initial 
encounter 
S01.129A Laceration with foreign body of unspecified eyelid and periocular area, initial 
encounter 
S01.131A Puncture wound without foreign body of right eyelid and periocular area, 
initial encounter 
S01.132A Puncture wound without foreign body of left eyelid and periocular area, initial 
encounter 
S01.139A Puncture wound without foreign body of unspecified eyelid and periocular 
area, initial encounter 
S01.141A Puncture wound with foreign body of right eyelid and periocular area, initial 
encounter 
S01.142A Puncture wound with foreign body of left eyelid and periocular area, initial 
encounter 
S01.149A Puncture wound with foreign body of unspecified eyelid and periocular area, 
initial encounter 
S01.151A Open bite of right eyelid and periocular area, initial encounter 
S01.152A Open bite of left eyelid and periocular area, initial encounter 
   
ICD-10-CM - Code and Description 
S01.159A Open bite of unspecified eyelid and periocular area, initial encounter 
S01.20XA Unspecified open wound of nose, initial encounter 
S01.21XA Laceration without foreign body of nose, initial encounter 
S01.22XA Laceration with foreign body of nose, initial encounter 
S01.23XA Puncture wound without foreign body of nose, initial encounter 
S01.24XA Puncture wound with foreign body of nose, initial encounter 
S01.25XA Open bite of nose, initial encounter 
S01.301A Unspecified open wound of right ear, initial encounter 
S01.302A Unspecified open wound of left ear, initial encounter 
S01.309A Unspecified open wound of unspecified ear, initial encounter 
S01.311A Laceration without foreign body of right ear, initial encounter 
S01.312A Laceration without foreign body of left ear, initial encounter 
S01.319A Laceration without foreign body of unspecified ear, initial encounter 
S01.321A Laceration with foreign body of right ear, initial encounter 
S01.322A Laceration with foreign body of left ear, initial encounter 
S01.329A Laceration with foreign body of unspecified ear, initial encounter 
S01.331A Puncture wound without foreign body of right ear, initial encounter 
S01.332A Puncture wound without foreign body of left ear, initial encounter 
S01.339A Puncture wound without foreign body of unspecified ear, initial encounter 
S01.341A Puncture wound with foreign body of right ear, initial encounter 
S01.342A Puncture wound with foreign body of left ear, initial encounter 
S01.349A Puncture wound with foreign body of unspecified ear, initial encounter 
S01.351A Open bite of right ear, initial encounter 
S01.352A Open bite of left ear, initial encounter 
S01.359A Open bite of unspecified ear, initial encounter 
S01.401A Unspecified open wound of right cheek and temporomandibular area, initial 
encounter 
S01.402A Unspecified open wound of left cheek and temporomandibular area, initial 
encounter 
S01.409A Unspecified open wound of unspecified cheek and temporomandibular area, 
initial encounter 
S01.411A Laceration without foreign body of right cheek and temporomandibular area, 
initial encounter 
S01.412A Laceration without foreign body of left cheek and temporomandibular area, 
initial encounter 
   
ICD-10-CM - Code and Description 
S01.419A Laceration without foreign body of unspecified cheek and temporomandibular 
area, initial encounter 
S01.421A Laceration with foreign body of right cheek and temporomandibular area, 
initial encounter 
S01.422A Laceration with foreign body of left cheek and temporomandibular area, 
initial encounter 
S01.429A Laceration with foreign body of unspecified cheek and temporomandibular 
area, initial encounter 
S01.431A Puncture wound without foreign body of right cheek and temporomandibular 
area, initial encounter 
S01.432A Puncture wound without foreign body of left cheek and temporomandibular 
area, initial encounter 
S01.439A Puncture wound without foreign body of unspecified cheek and 
temporomandibular area, initial encounter 
S01.441A Puncture wound with foreign body of right cheek and temporomandibular 
area, initial encounter 
S01.442A Puncture wound with foreign body of left cheek and temporomandibular area, 
initial encounter 
S01.449A Puncture wound with foreign body of unspecified cheek and 
temporomandibular area, initial encounter 
S01.451A Open bite of right cheek and temporomandibular area, initial encounter 
S01.452A Open bite of left cheek and temporomandibular area, initial encounter 
S01.459A Open bite of unspecified cheek and temporomandibular area, initial encounter 
S01.501A Unspecified open wound of lip, initial encounter 
S01.502A Unspecified open wound of oral cavity, initial encounter 
S01.511A Laceration without foreign body of lip, initial encounter 
S01.512A Laceration without foreign body of oral cavity, initial encounter 
S01.521A Laceration with foreign body of lip, initial encounter 
S01.522A Laceration with foreign body of oral cavity, initial encounter 
S01.531A Puncture wound without foreign body of lip, initial encounter 
S01.532A Puncture wound without foreign body of oral cavity, initial encounter 
S01.541A Puncture wound with foreign body of lip, initial encounter 
S01.542A Puncture wound with foreign body of oral cavity, initial encounter 
S01.551A Open bite of lip, initial encounter 
S01.552A Open bite of oral cavity, initial encounter 
S01.80XA Unspecified open wound of other part of head, initial encounter 
S01.81XA Laceration without foreign body of other part of head, initial encounter 
   
ICD-10-CM - Code and Description 
S01.82XA Laceration with foreign body of other part of head, initial encounter 
S01.83XA Puncture wound without foreign body of other part of head, initial encounter 
S01.84XA Puncture wound with foreign body of other part of head, initial encounter 
S01.85XA Open bite of other part of head, initial encounter 
S01.90XA Unspecified open wound of unspecified part of head, initial encounter 
S01.91XA Laceration without foreign body of unspecified part of head, initial encounter 
S01.92XA Laceration with foreign body of unspecified part of head, initial encounter 
S01.93XA Puncture wound without foreign body of unspecified part of head, initial 
encounter 
S01.94XA Puncture wound with foreign body of unspecified part of head, initial 
encounter 
S01.95XA Open bite of unspecified part of head, initial encounter 
S02.5XXA Fracture of tooth (traumatic), initial encounter for closed fracture 
S02.5XXB Fracture of tooth (traumatic), initial encounter for open fracture 
S03.2XXA Dislocation of tooth, initial encounter 
S05.20XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, 
unspecified eye, initial encounter 
S05.21XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, right 
eye, initial encounter 
S05.22XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, left 
eye, initial encounter 
S05.30XA Ocular laceration without prolapse or loss of intraocular tissue, unspecified 
eye, initial encounter 
S05.31XA Ocular laceration without prolapse or loss of intraocular tissue, right eye, 
initial encounter 
S05.32XA Ocular laceration without prolapse or loss of intraocular tissue, left eye, 
initial encounter 
S05.40XA Penetrating wound of orbit with or without foreign body, unspecified eye, 
initial encounter 
S05.41XA Penetrating wound of orbit with or without foreign body, right eye, initial 
encounter 
S05.42XA Penetrating wound of orbit with or without foreign body, left eye, initial 
encounter 
S05.50XA Penetrating wound with foreign body of unspecified eyeball, initial encounter 
S05.51XA Penetrating wound with foreign body of right eyeball, initial encounter 
S05.52XA Penetrating wound with foreign body of left eyeball, initial encounter 
   
ICD-10-CM - Code and Description 
S05.60XA Penetrating wound without foreign body of unspecified eyeball, initial 
encounter 
S05.61XA Penetrating wound without foreign body of right eyeball, initial encounter 
S05.62XA Penetrating wound without foreign body of left eyeball, initial encounter 
S05.70XA Avulsion of unspecified eye, initial encounter 
S05.71XA Avulsion of right eye, initial encounter 
S05.72XA Avulsion of left eye, initial encounter 
S05.8X1A Other injuries of right eye and orbit, initial encounter 
S05.8X2A Other injuries of left eye and orbit, initial encounter 
S05.8X9A Other injuries of unspecified eye and orbit, initial encounter 
S05.90XA Unspecified injury of unspecified eye and orbit, initial encounter 
S05.91XA Unspecified injury of right eye and orbit, initial encounter 
S05.92XA Unspecified injury of left eye and orbit, initial encounter 
S08.0XXA Avulsion of scalp, initial encounter 
S08.111A Complete traumatic amputation of right ear, initial encounter 
S08.112A Complete traumatic amputation of left ear, initial encounter 
S08.119A Complete traumatic amputation of unspecified ear, initial encounter 
S08.121A Partial traumatic amputation of right ear, initial encounter 
S08.122A Partial traumatic amputation of left ear, initial encounter 
S08.129A Partial traumatic amputation of unspecified ear, initial encounter 
S08.811A Complete traumatic amputation of nose, initial encounter 
S08.812A Partial traumatic amputation of nose, initial encounter 
S08.89XA Traumatic amputation of other parts of head, initial encounter 
S09.12XA Laceration of muscle and tendon of head, initial encounter 
S09.20XA Traumatic rupture of unspecified ear drum, initial encounter 
S09.21XA Traumatic rupture of right ear drum, initial encounter 
S09.22XA Traumatic rupture of left ear drum, initial encounter 
S09.301A Unspecified injury of right middle and inner ear, initial encounter 
S09.302A Unspecified injury of left middle and inner ear, initial encounter 
S09.309A Unspecified injury of unspecified middle and inner ear, initial encounter 
S09.311A Primary blast injury of right ear, initial encounter 
S09.312A Primary blast injury of left ear, initial encounter 
S09.313A Primary blast injury of ear, bilateral, initial encounter 
S09.319A Primary blast injury of unspecified ear, initial encounter 
S09.391A Other specified injury of right middle and inner ear, initial encounter 
   
ICD-10-CM - Code and Description 
S09.392A Other specified injury of left middle and inner ear, initial encounter 
S09.399A Other specified injury of unspecified middle and inner ear, initial encounter 
S09.8XXA Other specified injuries of head, initial encounter 
S09.90XA Unspecified injury of head, initial encounter 
S09.91XA Unspecified injury of ear, initial encounter 
S09.93XA Unspecified injury of face, initial encounter 
S11.011A Laceration without foreign body of larynx, initial encounter 
S11.012A Laceration with foreign body of larynx, initial encounter 
S11.013A Puncture wound without foreign body of larynx, initial encounter 
S11.014A Puncture wound with foreign body of larynx, initial encounter 
S11.015A Open bite of larynx, initial encounter 
S11.019A Unspecified open wound of larynx, initial encounter 
S11.021A Laceration without foreign body of trachea, initial encounter 
S11.022A Laceration with foreign body of trachea, initial encounter 
S11.023A Puncture wound without foreign body of trachea, initial encounter 
S11.024A Puncture wound with foreign body of trachea, initial encounter 
S11.025A Open bite of trachea, initial encounter 
S11.029A Unspecified open wound of trachea, initial encounter 
S11.031A Laceration without foreign body of vocal cord, initial encounter 
S11.032A Laceration with foreign body of vocal cord, initial encounter 
S11.033A Puncture wound without foreign body of vocal cord, initial encounter 
S11.034A Puncture wound with foreign body of vocal cord, initial encounter 
S11.035A Open bite of vocal cord, initial encounter 
S11.039A Unspecified open wound of vocal cord, initial encounter 
S11.10XA Unspecified open wound of thyroid gland, initial encounter 
S11.11XA Laceration without foreign body of thyroid gland, initial encounter 
S11.12XA Laceration with foreign body of thyroid gland, initial encounter 
S11.13XA Puncture wound without foreign body of thyroid gland, initial encounter 
S11.14XA Puncture wound with foreign body of thyroid gland, initial encounter 
S11.15XA Open bite of thyroid gland, initial encounter 
S11.20XA Unspecified open wound of pharynx and cervical esophagus, initial encounter 
S11.21XA Laceration without foreign body of pharynx and cervical esophagus, initial 
encounter 
S11.22XA Laceration with foreign body of pharynx and cervical esophagus, initial 
encounter 
   
ICD-10-CM - Code and Description 
S11.23XA Puncture wound without foreign body of pharynx and cervical esophagus, 
initial encounter 
S11.24XA Puncture wound with foreign body of pharynx and cervical esophagus, initial 
encounter 
S11.25XA Open bite of pharynx and cervical esophagus, initial encounter 
S11.80XA Unspecified open wound of other specified part of neck, initial encounter 
S11.81XA Laceration without foreign body of other specified part of neck, initial 
encounter 
S11.82XA Laceration with foreign body of other specified part of neck, initial encounter 
S11.83XA Puncture wound without foreign body of other specified part of neck, initial 
encounter 
S11.84XA Puncture wound with foreign body of other specified part of neck, initial 
encounter 
S11.85XA Open bite of other specified part of neck, initial encounter 
S11.89XA Other open wound of other specified part of neck, initial encounter 
S11.90XA Unspecified open wound of unspecified part of neck, initial encounter 
S11.91XA Laceration without foreign body of unspecified part of neck, initial encounter 
S11.92XA Laceration with foreign body of unspecified part of neck, initial encounter 
S11.93XA Puncture wound without foreign body of unspecified part of neck, initial 
encounter 
S11.94XA Puncture wound with foreign body of unspecified part of neck, initial 
encounter 
S11.95XA Open bite of unspecified part of neck, initial encounter 
S16.2XXA Laceration of muscle, fascia and tendon at neck level, initial encounter 
S21.001A Unspecified open wound of right breast, initial encounter 
S21.002A Unspecified open wound of left breast, initial encounter 
S21.009A Unspecified open wound of unspecified breast, initial encounter 
S21.011A Laceration without foreign body of right breast, initial encounter 
S21.012A Laceration without foreign body of left breast, initial encounter 
S21.019A Laceration without foreign body of unspecified breast, initial encounter 
S21.021A Laceration with foreign body of right breast, initial encounter 
S21.022A Laceration with foreign body of left breast, initial encounter 
S21.029A Laceration with foreign body of unspecified breast, initial encounter 
S21.031A Puncture wound without foreign body of right breast, initial encounter 
S21.032A Puncture wound without foreign body of left breast, initial encounter 
S21.039A Puncture wound without foreign body of unspecified breast, initial encounter 
   
ICD-10-CM - Code and Description 
S21.041A Puncture wound with foreign body of right breast, initial encounter 
S21.042A Puncture wound with foreign body of left breast, initial encounter 
S21.049A Puncture wound with foreign body of unspecified breast, initial encounter 
S21.051A Open bite of right breast, initial encounter 
S21.052A Open bite of left breast, initial encounter 
S21.059A Open bite of unspecified breast, initial encounter 
S21.101A Unspecified open wound of right front wall of thorax without penetration into 
thoracic cavity, initial encounter 
S21.102A Unspecified open wound of left front wall of thorax without penetration into 
thoracic cavity, initial encounter 
S21.109A Unspecified open wound of unspecified front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.111A Laceration without foreign body of right front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.112A Laceration without foreign body of left front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.119A Laceration without foreign body of unspecified front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.121A Laceration with foreign body of right front wall of thorax without penetration 
into thoracic cavity, initial encounter 
S21.122A Laceration with foreign body of left front wall of thorax without penetration 
into thoracic cavity, initial encounter 
S21.129A Laceration with foreign body of unspecified front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.131A Puncture wound without foreign body of right front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.132A Puncture wound without foreign body of left front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.139A Puncture wound without foreign body of unspecified front wall of thorax 
without penetration into thoracic cavity, initial encounter 
S21.141A Puncture wound with foreign body of right front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.142A Puncture wound with foreign body of left front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.149A Puncture wound with foreign body of unspecified front wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.151A Open bite of right front wall of thorax without penetration into thoracic 
cavity, initial encounter 
   
ICD-10-CM - Code and Description 
S21.152A Open bite of left front wall of thorax without penetration into thoracic cavity, 
initial encounter 
S21.159A Open bite of unspecified front wall of thorax without penetration into thoracic 
cavity, initial encounter 
S21.201A Unspecified open wound of right back wall of thorax without penetration into 
thoracic cavity, initial encounter 
S21.202A Unspecified open wound of left back wall of thorax without penetration into 
thoracic cavity, initial encounter 
S21.209A Unspecified open wound of unspecified back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.211A Laceration without foreign body of right back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.212A Laceration without foreign body of left back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.219A Laceration without foreign body of unspecified back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.221A Laceration with foreign body of right back wall of thorax without penetration 
into thoracic cavity, initial encounter 
S21.222A Laceration with foreign body of left back wall of thorax without penetration 
into thoracic cavity, initial encounter 
S21.229A Laceration with foreign body of unspecified back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.231A Puncture wound without foreign body of right back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.232A Puncture wound without foreign body of left back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.239A Puncture wound without foreign body of unspecified back wall of thorax 
without penetration into thoracic cavity, initial encounter 
S21.241A Puncture wound with foreign body of right back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.242A Puncture wound with foreign body of left back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.249A Puncture wound with foreign body of unspecified back wall of thorax without 
penetration into thoracic cavity, initial encounter 
S21.251A Open bite of right back wall of thorax without penetration into thoracic 
cavity, initial encounter 
S21.252A Open bite of left back wall of thorax without penetration into thoracic cavity, 
initial encounter 
   
ICD-10-CM - Code and Description 
S21.259A Open bite of unspecified back wall of thorax without penetration into thoracic 
cavity, initial encounter 
S21.90XA Unspecified open wound of unspecified part of thorax, initial encounter 
S21.91XA Laceration without foreign body of unspecified part of thorax, initial 
encounter 
S21.92XA Laceration with foreign body of unspecified part of thorax, initial encounter 
S21.93XA Puncture wound without foreign body of unspecified part of thorax, initial 
encounter 
S21.94XA Puncture wound with foreign body of unspecified part of thorax, initial 
encounter 
S21.95XA Open bite of unspecified part of thorax, initial encounter 
S28.1XXA Traumatic amputation (partial) of part of thorax, except breast, initial 
encounter 
S28.211A Complete traumatic amputation of right breast, initial encounter 
S28.212A Complete traumatic amputation of left breast, initial encounter 
S28.219A Complete traumatic amputation of unspecified breast, initial encounter 
S28.221A Partial traumatic amputation of right breast, initial encounter 
S28.222A Partial traumatic amputation of left breast, initial encounter 
S28.229A Partial traumatic amputation of unspecified breast, initial encounter 
S29.021A Laceration of muscle and tendon of front wall of thorax, initial encounter 
S29.022A Laceration of muscle and tendon of back wall of thorax, initial encounter 
S29.029A Laceration of muscle and tendon of unspecified wall of thorax, initial 
encounter 
S31.000A Unspecified open wound of lower back and pelvis without penetration into 
retroperitoneum, initial encounter 
S31.010A Laceration without foreign body of lower back and pelvis without penetration 
into retroperitoneum, initial encounter 
S31.020A Laceration with foreign body of lower back and pelvis without penetration 
into retroperitoneum, initial encounter 
S31.030A Puncture wound without foreign body of lower back and pelvis without 
penetration into retroperitoneum, initial encounter 
S31.040A Puncture wound with foreign body of lower back and pelvis without 
penetration into retroperitoneum, initial encounter 
S31.050A Open bite of lower back and pelvis without penetration into retroperitoneum, 
initial encounter 
S31.100A Unspecified open wound of abdominal wall, right upper quadrant without 
penetration into peritoneal cavity, initial encounter 
   
ICD-10-CM - Code and Description 
S31.101A Unspecified open wound of abdominal wall, left upper quadrant without 
penetration into peritoneal cavity, initial encounter 
S31.102A Unspecified open wound of abdominal wall, epigastric region without 
penetration into peritoneal cavity, initial encounter 
S31.103A Unspecified open wound of abdominal wall, right lower quadrant without 
penetration into peritoneal cavity, initial encounter 
S31.104A Unspecified open wound of abdominal wall, left lower quadrant without 
penetration into peritoneal cavity, initial encounter 
S31.105A Unspecified open wound of abdominal wall, periumbilic region without 
penetration into peritoneal cavity, initial encounter 
S31.109A Unspecified open wound of abdominal wall, unspecified quadrant without 
penetration into peritoneal cavity, initial encounter 
S31.110A Laceration without foreign body of abdominal wall, right upper quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.111A Laceration without foreign body of abdominal wall, left upper quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.112A Laceration without foreign body of abdominal wall, epigastric region without 
penetration into peritoneal cavity, initial encounter 
S31.113A Laceration without foreign body of abdominal wall, right lower quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.114A Laceration without foreign body of abdominal wall, left lower quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.115A Laceration without foreign body of abdominal wall, periumbilic region 
without penetration into peritoneal cavity, initial encounter 
S31.119A Laceration without foreign body of abdominal wall, unspecified quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.120A Laceration of abdominal wall with foreign body, right upper quadrant without 
penetration into peritoneal cavity, initial encounter 
S31.121A Laceration of abdominal wall with foreign body, left upper quadrant without 
penetration into peritoneal cavity, initial encounter 
S31.122A Laceration of abdominal wall with foreign body, epigastric region without 
penetration into peritoneal cavity, initial encounter 
S31.123A Laceration of abdominal wall with foreign body, right lower quadrant without 
penetration into peritoneal cavity, initial encounter 
S31.124A Laceration of abdominal wall with foreign body, left lower quadrant without 
penetration into peritoneal cavity, initial encounter 
S31.125A Laceration of abdominal wall with foreign body, periumbilic region without 
penetration into peritoneal cavity, initial encounter 
   
ICD-10-CM - Code and Description 
S31.129A Laceration of abdominal wall with foreign body, unspecified quadrant without 
penetration into peritoneal cavity, initial encounter 
S31.130A Puncture wound of abdominal wall without foreign body, right upper 
quadrant without penetration into peritoneal cavity, initial encounter 
S31.131A Puncture wound of abdominal wall without foreign body, left upper quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.132A Puncture wound of abdominal wall without foreign body, epigastric region 
without penetration into peritoneal cavity, initial encounter 
S31.133A Puncture wound of abdominal wall without foreign body, right lower 
quadrant without penetration into peritoneal cavity, initial encounter 
S31.134A Puncture wound of abdominal wall without foreign body, left lower quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.135A Puncture wound of abdominal wall without foreign body, periumbilic region 
without penetration into peritoneal cavity, initial encounter 
S31.139A Puncture wound of abdominal wall without foreign body, unspecified 
quadrant without penetration into peritoneal cavity, initial encounter 
S31.140A Puncture wound of abdominal wall with foreign body, right upper quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.141A Puncture wound of abdominal wall with foreign body, left upper quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.142A Puncture wound of abdominal wall with foreign body, epigastric region 
without penetration into peritoneal cavity, initial encounter 
S31.143A Puncture wound of abdominal wall with foreign body, right lower quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.144A Puncture wound of abdominal wall with foreign body, left lower quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.145A Puncture wound of abdominal wall with foreign body, periumbilic region 
without penetration into peritoneal cavity, initial encounter 
S31.149A Puncture wound of abdominal wall with foreign body, unspecified quadrant 
without penetration into peritoneal cavity, initial encounter 
S31.150A Open bite of abdominal wall, right upper quadrant without penetration into 
peritoneal cavity, initial encounter 
S31.151A Open bite of abdominal wall, left upper quadrant without penetration into 
peritoneal cavity, initial encounter 
S31.152A Open bite of abdominal wall, epigastric region without penetration into 
peritoneal cavity, initial encounter 
S31.153A Open bite of abdominal wall, right lower quadrant without penetration into 
peritoneal cavity, initial encounter 
   
ICD-10-CM - Code and Description 
S31.154A Open bite of abdominal wall, left lower quadrant without penetration into 
peritoneal cavity, initial encounter 
S31.155A Open bite of abdominal wall, periumbilic region without penetration into 
peritoneal cavity, initial encounter 
S31.159A Open bite of abdominal wall, unspecified quadrant without penetration into 
peritoneal cavity, initial encounter 
S31.20XA Unspecified open wound of penis, initial encounter 
S31.21XA Laceration without foreign body of penis, initial encounter 
S31.22XA Laceration with foreign body of penis, initial encounter 
S31.23XA Puncture wound without foreign body of penis, initial encounter 
S31.24XA Puncture wound with foreign body of penis, initial encounter 
S31.25XA Open bite of penis, initial encounter 
S31.30XA Unspecified open wound of scrotum and testes, initial encounter 
S31.31XA Laceration without foreign body of scrotum and testes, initial encounter 
S31.32XA Laceration with foreign body of scrotum and testes, initial encounter 
S31.33XA Puncture wound without foreign body of scrotum and testes, initial encounter 
S31.34XA Puncture wound with foreign body of scrotum and testes, initial encounter 
S31.35XA Open bite of scrotum and testes, initial encounter 
S31.40XA Unspecified open wound of vagina and vulva, initial encounter 
S31.41XA Laceration without foreign body of vagina and vulva, initial encounter 
S31.42XA Laceration with foreign body of vagina and vulva, initial encounter 
S31.43XA Puncture wound without foreign body of vagina and vulva, initial encounter 
S31.44XA Puncture wound with foreign body of vagina and vulva, initial encounter 
S31.45XA Open bite of vagina and vulva, initial encounter 
S31.501A Unspecified open wound of unspecified external genital organs, male, initial 
encounter 
S31.502A Unspecified open wound of unspecified external genital organs, female, initial 
encounter 
S31.511A Laceration without foreign body of unspecified external genital organs, male, 
initial encounter 
S31.512A Laceration without foreign body of unspecified external genital organs, 
female, initial encounter 
S31.521A Laceration with foreign body of unspecified external genital organs, male, 
initial encounter 
S31.522A Laceration with foreign body of unspecified external genital organs, female, 
initial encounter 
   
ICD-10-CM - Code and Description 
S31.531A Puncture wound without foreign body of unspecified external genital organs, 
male, initial encounter 
S31.532A Puncture wound without foreign body of unspecified external genital organs, 
female, initial encounter 
S31.541A Puncture wound with foreign body of unspecified external genital organs, 
male, initial encounter 
S31.542A Puncture wound with foreign body of unspecified external genital organs, 
female, initial encounter 
S31.551A Open bite of unspecified external genital organs, male, initial encounter 
S31.552A Open bite of unspecified external genital organs, female, initial encounter 
S31.801A Laceration without foreign body of unspecified buttock, initial encounter 
S31.802A Laceration with foreign body of unspecified buttock, initial encounter 
S31.803A Puncture wound without foreign body of unspecified buttock, initial 
encounter 
S31.804A Puncture wound with foreign body of unspecified buttock, initial encounter 
S31.805A Open bite of unspecified buttock, initial encounter 
S31.809A Unspecified open wound of unspecified buttock, initial encounter 
S31.811A Laceration without foreign body of right buttock, initial encounter 
S31.812A Laceration with foreign body of right buttock, initial encounter 
S31.813A Puncture wound without foreign body of right buttock, initial encounter 
S31.814A Puncture wound with foreign body of right buttock, initial encounter 
S31.815A Open bite of right buttock, initial encounter 
S31.819A Unspecified open wound of right buttock, initial encounter 
S31.821A Laceration without foreign body of left buttock, initial encounter 
S31.822A Laceration with foreign body of left buttock, initial encounter 
S31.823A Puncture wound without foreign body of left buttock, initial encounter 
S31.824A Puncture wound with foreign body of left buttock, initial encounter 
S31.825A Open bite of left buttock, initial encounter 
S31.829A Unspecified open wound of left buttock, initial encounter 
S31.831A Laceration without foreign body of anus, initial encounter 
S31.832A Laceration with foreign body of anus, initial encounter 
S31.833A Puncture wound without foreign body of anus, initial encounter 
S31.834A Puncture wound with foreign body of anus, initial encounter 
S31.835A Open bite of anus, initial encounter 
S31.839A Unspecified open wound of anus, initial encounter 
   
ICD-10-CM - Code and Description 
S38.211A Complete traumatic amputation of female external genital organs, initial 
encounter 
S38.212A Partial traumatic amputation of female external genital organs, initial 
encounter 
S38.221A Complete traumatic amputation of penis, initial encounter 
S38.222A Partial traumatic amputation of penis, initial encounter 
S38.231A Complete traumatic amputation of scrotum and testis, initial encounter 
S38.232A Partial traumatic amputation of scrotum and testis, initial encounter 
S38.3XXA Transection (partial) of abdomen, initial encounter 
S39.021A Laceration of muscle, fascia and tendon of abdomen, initial encounter 
S39.022A Laceration of muscle, fascia and tendon of lower back, initial encounter 
S39.023A Laceration of muscle, fascia and tendon of pelvis, initial encounter 
S41.001A Unspecified open wound of right shoulder, initial encounter 
S41.002A Unspecified open wound of left shoulder, initial encounter 
S41.009A Unspecified open wound of unspecified shoulder, initial encounter 
S41.011A Laceration without foreign body of right shoulder, initial encounter 
S41.012A Laceration without foreign body of left shoulder, initial encounter 
S41.019A Laceration without foreign body of unspecified shoulder, initial encounter 
S41.021A Laceration with foreign body of right shoulder, initial encounter 
S41.022A Laceration with foreign body of left shoulder, initial encounter 
S41.029A Laceration with foreign body of unspecified shoulder, initial encounter 
S41.031A Puncture wound without foreign body of right shoulder, initial encounter 
S41.032A Puncture wound without foreign body of left shoulder, initial encounter 
S41.039A Puncture wound without foreign body of unspecified shoulder, initial 
encounter 
S41.041A Puncture wound with foreign body of right shoulder, initial encounter 
S41.042A Puncture wound with foreign body of left shoulder, initial encounter 
S41.049A Puncture wound with foreign body of unspecified shoulder, initial encounter 
S41.051A Open bite of right shoulder, initial encounter 
S41.052A Open bite of left shoulder, initial encounter 
S41.059A Open bite of unspecified shoulder, initial encounter 
S41.101A Unspecified open wound of right upper arm, initial encounter 
S41.102A Unspecified open wound of left upper arm, initial encounter 
S41.109A Unspecified open wound of unspecified upper arm, initial encounter 
S41.111A Laceration without foreign body of right upper arm, initial encounter 
   
ICD-10-CM - Code and Description 
S41.112A Laceration without foreign body of left upper arm, initial encounter 
S41.119A Laceration without foreign body of unspecified upper arm, initial encounter 
S41.121A Laceration with foreign body of right upper arm, initial encounter 
S41.122A Laceration with foreign body of left upper arm, initial encounter 
S41.129A Laceration with foreign body of unspecified upper arm, initial encounter 
S41.131A Puncture wound without foreign body of right upper arm, initial encounter 
S41.132A Puncture wound without foreign body of left upper arm, initial encounter 
S41.139A Puncture wound without foreign body of unspecified upper arm, initial 
encounter 
S41.141A Puncture wound with foreign body of right upper arm, initial encounter 
S41.142A Puncture wound with foreign body of left upper arm, initial encounter 
S41.149A Puncture wound with foreign body of unspecified upper arm, initial encounter 
S41.151A Open bite of right upper arm, initial encounter 
S41.152A Open bite of left upper arm, initial encounter 
S41.159A Open bite of unspecified upper arm, initial encounter 
S46.021A Laceration of muscle(s) and tendon(s) of the rotator cuff of right shoulder, 
initial encounter 
S46.022A Laceration of muscle(s) and tendon(s) of the rotator cuff of left shoulder, 
initial encounter 
S46.029A Laceration of muscle(s) and tendon(s) of the rotator cuff of unspecified 
shoulder, initial encounter 
S46.121A Laceration of muscle, fascia and tendon of long head of biceps, right arm, 
initial encounter 
S46.122A Laceration of muscle, fascia and tendon of long head of biceps, left arm, 
initial encounter 
S46.129A Laceration of muscle, fascia and tendon of long head of biceps, unspecified 
arm, initial encounter 
S46.221A Laceration of muscle, fascia and tendon of other parts of biceps, right arm, 
initial encounter 
S46.222A Laceration of muscle, fascia and tendon of other parts of biceps, left arm, 
initial encounter 
S46.229A Laceration of muscle, fascia and tendon of other parts of biceps, unspecified 
arm, initial encounter 
S46.321A Laceration of muscle, fascia and tendon of triceps, right arm, initial encounter 
S46.322A Laceration of muscle, fascia and tendon of triceps, left arm, initial encounter 
S46.329A Laceration of muscle, fascia and tendon of triceps, unspecified arm, initial 
encounter 
   
ICD-10-CM - Code and Description 
S46.821A Laceration of other muscles, fascia and tendons at shoulder and upper arm 
level, right arm, initial encounter 
S46.822A Laceration of other muscles, fascia and tendons at shoulder and upper arm 
level, left arm, initial encounter 
S46.829A Laceration of other muscles, fascia and tendons at shoulder and upper arm 
level, unspecified arm, initial encounter 
S46.921A Laceration of unspecified muscle, fascia and tendon at shoulder and upper 
arm level, right arm, initial encounter 
S46.922A Laceration of unspecified muscle, fascia and tendon at shoulder and upper 
arm level, left arm, initial encounter 
S46.929A Laceration of unspecified muscle, fascia and tendon at shoulder and upper 
arm level, unspecified arm, initial encounter 
S48.011A Complete traumatic amputation at right shoulder joint, initial encounter 
S48.012A Complete traumatic amputation at left shoulder joint, initial encounter 
S48.019A Complete traumatic amputation at unspecified shoulder joint, initial encounter 
S48.021A Partial traumatic amputation at right shoulder joint, initial encounter 
S48.022A Partial traumatic amputation at left shoulder joint, initial encounter 
S48.029A Partial traumatic amputation at unspecified shoulder joint, initial encounter 
S48.111A Complete traumatic amputation at level between right shoulder and elbow, 
initial encounter 
S48.112A Complete traumatic amputation at level between left shoulder and elbow, 
initial encounter 
S48.119A Complete traumatic amputation at level between unspecified shoulder and 
elbow, initial encounter 
S48.121A Partial traumatic amputation at level between right shoulder and elbow, initial 
encounter 
S48.122A Partial traumatic amputation at level between left shoulder and elbow, initial 
encounter 
S48.129A Partial traumatic amputation at level between unspecified shoulder and elbow, 
initial encounter 
S48.911A Complete traumatic amputation of right shoulder and upper arm, level 
unspecified, initial encounter 
S48.912A Complete traumatic amputation of left shoulder and upper arm, level 
unspecified, initial encounter 
S48.919A Complete traumatic amputation of unspecified shoulder and upper arm, level 
unspecified, initial encounter 
S48.921A Partial traumatic amputation of right shoulder and upper arm, level 
unspecified, initial encounter 
   
ICD-10-CM - Code and Description 
S48.922A Partial traumatic amputation of left shoulder and upper arm, level unspecified, 
initial encounter 
S48.929A Partial traumatic amputation of unspecified shoulder and upper arm, level 
unspecified, initial encounter 
S51.001A Unspecified open wound of right elbow, initial encounter 
S51.002A Unspecified open wound of left elbow, initial encounter 
S51.009A Unspecified open wound of unspecified elbow, initial encounter 
S51.011A Laceration without foreign body of right elbow, initial encounter 
S51.012A Laceration without foreign body of left elbow, initial encounter 
S51.019A Laceration without foreign body of unspecified elbow, initial encounter 
S51.021A Laceration with foreign body of right elbow, initial encounter 
S51.022A Laceration with foreign body of left elbow, initial encounter 
S51.029A Laceration with foreign body of unspecified elbow, initial encounter 
S51.031A Puncture wound without foreign body of right elbow, initial encounter 
S51.032A Puncture wound without foreign body of left elbow, initial encounter 
S51.039A Puncture wound without foreign body of unspecified elbow, initial encounter 
S51.041A Puncture wound with foreign body of right elbow, initial encounter 
S51.042A Puncture wound with foreign body of left elbow, initial encounter 
S51.049A Puncture wound with foreign body of unspecified elbow, initial encounter 
S51.051A Open bite, right elbow, initial encounter 
S51.052A Open bite, left elbow, initial encounter 
S51.059A Open bite, unspecified elbow, initial encounter 
S51.801A Unspecified open wound of right forearm, initial encounter 
S51.802A Unspecified open wound of left forearm, initial encounter 
S51.809A Unspecified open wound of unspecified forearm, initial encounter 
S51.811A Laceration without foreign body of right forearm, initial encounter 
S51.812A Laceration without foreign body of left forearm, initial encounter 
S51.819A Laceration without foreign body of unspecified forearm, initial encounter 
S51.821A Laceration with foreign body of right forearm, initial encounter 
S51.822A Laceration with foreign body of left forearm, initial encounter 
S51.829A Laceration with foreign body of unspecified forearm, initial encounter 
S51.831A Puncture wound without foreign body of right forearm, initial encounter 
S51.832A Puncture wound without foreign body of left forearm, initial encounter 
S51.839A Puncture wound without foreign body of unspecified forearm, initial 
encounter 
   
ICD-10-CM - Code and Description 
S51.841A Puncture wound with foreign body of right forearm, initial encounter 
S51.842A Puncture wound with foreign body of left forearm, initial encounter 
S51.849A Puncture wound with foreign body of unspecified forearm, initial encounter 
S51.851A Open bite of right forearm, initial encounter 
S51.852A Open bite of left forearm, initial encounter 
S51.859A Open bite of unspecified forearm, initial encounter 
S56.021A Laceration of flexor muscle, fascia and tendon of right thumb at forearm 
level, initial encounter 
S56.022A Laceration of flexor muscle, fascia and tendon of left thumb at forearm level, 
initial encounter 
S56.029A Laceration of flexor muscle, fascia and tendon of unspecified thumb at 
forearm level, initial encounter 
S56.121A Laceration of flexor muscle, fascia and tendon of right index finger at forearm 
level, initial encounter 
S56.122A Laceration of flexor muscle, fascia and tendon of left index finger at forearm 
level, initial encounter 
S56.123A Laceration of flexor muscle, fascia and tendon of right middle finger at 
forearm level, initial encounter 
S56.124A Laceration of flexor muscle, fascia and tendon of left middle finger at forearm 
level, initial encounter 
S56.125A Laceration of flexor muscle, fascia and tendon of right ring finger at forearm 
level, initial encounter 
S56.126A Laceration of flexor muscle, fascia and tendon of left ring finger at forearm 
level, initial encounter 
S56.127A Laceration of flexor muscle, fascia and tendon of right little finger at forearm 
level, initial encounter 
S56.128A Laceration of flexor muscle, fascia and tendon of left little finger at forearm 
level, initial encounter 
S56.129A Laceration of flexor muscle, fascia and tendon of unspecified finger at 
forearm level, initial encounter 
S56.221A Laceration of other flexor muscle, fascia and tendon at forearm level, right 
arm, initial encounter 
S56.222A Laceration of other flexor muscle, fascia and tendon at forearm level, left arm, 
initial encounter 
S56.229A Laceration of other flexor muscle, fascia and tendon at forearm level, 
unspecified arm, initial encounter 
S56.321A Laceration of extensor or abductor muscles, fascia and tendons of right thumb 
at forearm level, initial encounter 
   
ICD-10-CM - Code and Description 
S56.322A Laceration of extensor or abductor muscles, fascia and tendons of left thumb 
at forearm level, initial encounter 
S56.329A Laceration of extensor or abductor muscles, fascia and tendons of unspecified 
thumb at forearm level, initial encounter 
S56.421A Laceration of extensor muscle, fascia and tendon of right index finger at 
forearm level, initial encounter 
S56.422A Laceration of extensor muscle, fascia and tendon of left index finger at 
forearm level, initial encounter 
S56.423A Laceration of extensor muscle, fascia and tendon of right middle finger at 
forearm level, initial encounter 
S56.424A Laceration of extensor muscle, fascia and tendon of left middle finger at 
forearm level, initial encounter 
S56.425A Laceration of extensor muscle, fascia and tendon of right ring finger at 
forearm level, initial encounter 
S56.426A Laceration of extensor muscle, fascia and tendon of left ring finger at forearm 
level, initial encounter 
S56.427A Laceration of extensor muscle, fascia and tendon of right little finger at 
forearm level, initial encounter 
S56.428A Laceration of extensor muscle, fascia and tendon of left little finger at forearm 
level, initial encounter 
S56.429A Laceration of extensor muscle, fascia and tendon of unspecified finger at 
forearm level, initial encounter 
S56.521A Laceration of other extensor muscle, fascia and tendon at forearm level, right 
arm, initial encounter 
S56.522A Laceration of other extensor muscle, fascia and tendon at forearm level, left 
arm, initial encounter 
S56.529A Laceration of other extensor muscle, fascia and tendon at forearm level, 
unspecified arm, initial encounter 
S56.821A Laceration of other muscles, fascia and tendons at forearm level, right arm, 
initial encounter 
S56.822A Laceration of other muscles, fascia and tendons at forearm level, left arm, 
initial encounter 
S56.829A Laceration of other muscles, fascia and tendons at forearm level, unspecified 
arm, initial encounter 
S56.921A Laceration of unspecified muscles, fascia and tendons at forearm level, right 
arm, initial encounter 
S56.922A Laceration of unspecified muscles, fascia and tendons at forearm level, left 
arm, initial encounter 
   
ICD-10-CM - Code and Description 
S56.929A Laceration of unspecified muscles, fascia and tendons at forearm level, 
unspecified arm, initial encounter 
S58.011A Complete traumatic amputation at elbow level, right arm, initial encounter 
S58.012A Complete traumatic amputation at elbow level, left arm, initial encounter 
S58.019A Complete traumatic amputation at elbow level, unspecified arm, initial 
encounter 
S58.021A Partial traumatic amputation at elbow level, right arm, initial encounter 
S58.022A Partial traumatic amputation at elbow level, left arm, initial encounter 
S58.029A Partial traumatic amputation at elbow level, unspecified arm, initial encounter 
S58.111A Complete traumatic amputation at level between elbow and wrist, right arm, 
initial encounter 
S58.112A Complete traumatic amputation at level between elbow and wrist, left arm, 
initial encounter 
S58.119A Complete traumatic amputation at level between elbow and wrist, unspecified 
arm, initial encounter 
S58.121A Partial traumatic amputation at level between elbow and wrist, right arm, 
initial encounter 
S58.122A Partial traumatic amputation at level between elbow and wrist, left arm, initial 
encounter 
S58.129A Partial traumatic amputation at level between elbow and wrist, unspecified 
arm, initial encounter 
S58.911A Complete traumatic amputation of right forearm, level unspecified, initial 
encounter 
S58.912A Complete traumatic amputation of left forearm, level unspecified, initial 
encounter 
S58.919A Complete traumatic amputation of unspecified forearm, level unspecified, 
initial encounter 
S58.921A Partial traumatic amputation of right forearm, level unspecified, initial 
encounter 
S58.922A Partial traumatic amputation of left forearm, level unspecified, initial 
encounter 
S58.929A Partial traumatic amputation of unspecified forearm, level unspecified, initial 
encounter 
S61.001A Unspecified open wound of right thumb without damage to nail, initial 
encounter 
S61.002A Unspecified open wound of left thumb without damage to nail, initial 
encounter 
   
ICD-10-CM - Code and Description 
S61.009A Unspecified open wound of unspecified thumb without damage to nail, initial 
encounter 
S61.011A Laceration without foreign body of right thumb without damage to nail, initial 
encounter 
S61.012A Laceration without foreign body of left thumb without damage to nail, initial 
encounter 
S61.019A Laceration without foreign body of unspecified thumb without damage to 
nail, initial encounter 
S61.021A Laceration with foreign body of right thumb without damage to nail, initial 
encounter 
S61.022A Laceration with foreign body of left thumb without damage to nail, initial 
encounter 
S61.029A Laceration with foreign body of unspecified thumb without damage to nail, 
initial encounter 
S61.031A Puncture wound without foreign body of right thumb without damage to nail, 
initial encounter 
S61.032A Puncture wound without foreign body of left thumb without damage to nail, 
initial encounter 
S61.039A Puncture wound without foreign body of unspecified thumb without damage 
to nail, initial encounter 
S61.041A Puncture wound with foreign body of right thumb without damage to nail, 
initial encounter 
S61.042A Puncture wound with foreign body of left thumb without damage to nail, 
initial encounter 
S61.049A Puncture wound with foreign body of unspecified thumb without damage to 
nail, initial encounter 
S61.051A Open bite of right thumb without damage to nail, initial encounter 
S61.052A Open bite of left thumb without damage to nail, initial encounter 
S61.059A Open bite of unspecified thumb without damage to nail, initial encounter 
S61.101A Unspecified open wound of right thumb with damage to nail, initial encounter 
S61.102A Unspecified open wound of left thumb with damage to nail, initial encounter 
S61.109A Unspecified open wound of unspecified thumb with damage to nail, initial 
encounter 
S61.109A Unspecified open wound of unspecified thumb with damage to nail, initial 
encounter 
S61.111A Laceration without foreign body of right thumb with damage to nail, initial 
encounter 
   
ICD-10-CM - Code and Description 
S61.112A Laceration without foreign body of left thumb with damage to nail, initial 
encounter 
S61.119A Laceration without foreign body of unspecified thumb with damage to nail, 
initial encounter 
S61.121A Laceration with foreign body of right thumb with damage to nail, initial 
encounter 
S61.122A Laceration with foreign body of left thumb with damage to nail, initial 
encounter 
S61.129A Laceration with foreign body of unspecified thumb with damage to nail, 
initial encounter 
S61.131A Puncture wound without foreign body of right thumb with damage to nail, 
initial encounter 
S61.132A Puncture wound without foreign body of left thumb with damage to nail, 
initial encounter 
S61.139A Puncture wound without foreign body of unspecified thumb with damage to 
nail, initial encounter 
S61.141A Puncture wound with foreign body of right thumb with damage to nail, initial 
encounter 
S61.142A Puncture wound with foreign body of left thumb with damage to nail, initial 
encounter 
S61.149A Puncture wound with foreign body of unspecified thumb with damage to nail, 
initial encounter 
S61.151A Open bite of right thumb with damage to nail, initial encounter 
S61.152A Open bite of left thumb with damage to nail, initial encounter 
S61.159A Open bite of unspecified thumb with damage to nail, initial encounter 
S61.200A Unspecified open wound of right index finger without damage to nail, initial 
encounter 
S61.201A Unspecified open wound of left index finger without damage to nail, initial 
encounter 
S61.202A Unspecified open wound of right middle finger without damage to nail, initial 
encounter 
S61.203A Unspecified open wound of left middle finger without damage to nail, initial 
encounter 
S61.204A Unspecified open wound of right ring finger without damage to nail, initial 
encounter 
S61.205A Unspecified open wound of left ring finger without damage to nail, initial 
encounter 
S61.206A Unspecified open wound of right little finger without damage to nail, initial 
encounter 
   
ICD-10-CM - Code and Description 
S61.207A Unspecified open wound of left little finger without damage to nail, initial 
encounter 
S61.208A Unspecified open wound of other finger without damage to nail, initial 
encounter 
S61.209A Unspecified open wound of unspecified finger without damage to nail, initial 
encounter 
S61.209A Unspecified open wound of unspecified finger without damage to nail, initial 
encounter 
S61.210A Laceration without foreign body of right index finger without damage to nail, 
initial encounter 
S61.211A Laceration without foreign body of left index finger without damage to nail, 
initial encounter 
S61.212A Laceration without foreign body of right middle finger without damage to 
nail, initial encounter 
S61.213A Laceration without foreign body of left middle finger without damage to nail, 
initial encounter 
S61.214A Laceration without foreign body of right ring finger without damage to nail, 
initial encounter 
S61.215A Laceration without foreign body of left ring finger without damage to nail, 
initial encounter 
S61.216A Laceration without foreign body of right little finger without damage to nail, 
initial encounter 
S61.217A Laceration without foreign body of left little finger without damage to nail, 
initial encounter 
S61.218A Laceration without foreign body of other finger without damage to nail, initial 
encounter 
S61.219A Laceration without foreign body of unspecified finger without damage to nail, 
initial encounter 
S61.220A Laceration with foreign body of right index finger without damage to nail, 
initial encounter 
S61.221A Laceration with foreign body of left index finger without damage to nail, 
initial encounter 
S61.222A Laceration with foreign body of right middle finger without damage to nail, 
initial encounter 
S61.223A Laceration with foreign body of left middle finger without damage to nail, 
initial encounter 
S61.224A Laceration with foreign body of right ring finger without damage to nail, 
initial encounter 
   
ICD-10-CM - Code and Description 
S61.225A Laceration with foreign body of left ring finger without damage to nail, initial 
encounter 
S61.226A Laceration with foreign body of right little finger without damage to nail, 
initial encounter 
S61.227A Laceration with foreign body of left little finger without damage to nail, initial 
encounter 
S61.228A Laceration with foreign body of other finger without damage to nail, initial 
encounter 
S61.229A Laceration with foreign body of unspecified finger without damage to nail, 
initial encounter 
S61.230A Puncture wound without foreign body of right index finger without damage to 
nail, initial encounter 
S61.231A Puncture wound without foreign body of left index finger without damage to 
nail, initial encounter 
S61.232A Puncture wound without foreign body of right middle finger without damage 
to nail, initial encounter 
S61.233A Puncture wound without foreign body of left middle finger without damage to 
nail, initial encounter 
S61.234A Puncture wound without foreign body of right ring finger without damage to 
nail, initial encounter 
S61.235A Puncture wound without foreign body of left ring finger without damage to 
nail, initial encounter 
S61.236A Puncture wound without foreign body of right little finger without damage to 
nail, initial encounter 
S61.237A Puncture wound without foreign body of left little finger without damage to 
nail, initial encounter 
S61.238A Puncture wound without foreign body of other finger without damage to nail, 
initial encounter 
S61.239A Puncture wound without foreign body of unspecified finger without damage 
to nail, initial encounter 
S61.240A Puncture wound with foreign body of right index finger without damage to 
nail, initial encounter 
S61.241A Puncture wound with foreign body of left index finger without damage to 
nail, initial encounter 
S61.242A Puncture wound with foreign body of right middle finger without damage to 
nail, initial encounter 
S61.243A Puncture wound with foreign body of left middle finger without damage to 
nail, initial encounter 
   
ICD-10-CM - Code and Description 
S61.244A Puncture wound with foreign body of right ring finger without damage to nail, 
initial encounter 
S61.245A Puncture wound with foreign body of left ring finger without damage to nail, 
initial encounter 
S61.246A Puncture wound with foreign body of right little finger without damage to 
nail, initial encounter 
S61.247A Puncture wound with foreign body of left little finger without damage to nail, 
initial encounter 
S61.248A Puncture wound with foreign body of other finger without damage to nail, 
initial encounter 
S61.249A Puncture wound with foreign body of unspecified finger without damage to 
nail, initial encounter 
S61.250A Open bite of right index finger without damage to nail, initial encounter 
S61.251A Open bite of left index finger without damage to nail, initial encounter 
S61.252A Open bite of right middle finger without damage to nail, initial encounter 
S61.253A Open bite of left middle finger without damage to nail, initial encounter 
S61.254A Open bite of right ring finger without damage to nail, initial encounter 
S61.255A Open bite of left ring finger without damage to nail, initial encounter 
S61.256A Open bite of right little finger without damage to nail, initial encounter 
S61.257A Open bite of left little finger without damage to nail, initial encounter 
S61.258A Open bite of other finger without damage to nail, initial encounter 
S61.259A Open bite of unspecified finger without damage to nail, initial encounter 
S61.300A Unspecified open wound of right index finger with damage to nail, initial 
encounter 
S61.301A Unspecified open wound of left index finger with damage to nail, initial 
encounter 
S61.302A Unspecified open wound of right middle finger with damage to nail, initial 
encounter 
S61.303A Unspecified open wound of left middle finger with damage to nail, initial 
encounter 
S61.304A Unspecified open wound of right ring finger with damage to nail, initial 
encounter 
S61.305A Unspecified open wound of left ring finger with damage to nail, initial 
encounter 
S61.306A Unspecified open wound of right little finger with damage to nail, initial 
encounter 
S61.307A Unspecified open wound of left little finger with damage to nail, initial 
encounter 
   
ICD-10-CM - Code and Description 
S61.308A Unspecified open wound of other finger with damage to nail, initial encounter 
S61.309A Unspecified open wound of unspecified finger with damage to nail, initial 
encounter 
S61.310A Laceration without foreign body of right index finger with damage to nail, 
initial encounter 
S61.311A Laceration without foreign body of left index finger with damage to nail, 
initial encounter 
S61.312A Laceration without foreign body of right middle finger with damage to nail, 
initial encounter 
S61.313A Laceration without foreign body of left middle finger with damage to nail, 
initial encounter 
S61.314A Laceration without foreign body of right ring finger with damage to nail, 
initial encounter 
S61.315A Laceration without foreign body of left ring finger with damage to nail, initial 
encounter 
S61.316A Laceration without foreign body of right little finger with damage to nail, 
initial encounter 
S61.317A Laceration without foreign body of left little finger with damage to nail, initial 
encounter 
S61.318A Laceration without foreign body of other finger with damage to nail, initial 
encounter 
S61.319A Laceration without foreign body of unspecified finger with damage to nail, 
initial encounter 
S61.320A Laceration with foreign body of right index finger with damage to nail, initial 
encounter 
S61.321A Laceration with foreign body of left index finger with damage to nail, initial 
encounter 
S61.322A Laceration with foreign body of right middle finger with damage to nail, 
initial encounter 
S61.323A Laceration with foreign body of left middle finger with damage to nail, initial 
encounter 
S61.324A Laceration with foreign body of right ring finger with damage to nail, initial 
encounter 
S61.325A Laceration with foreign body of left ring finger with damage to nail, initial 
encounter 
S61.326A Laceration with foreign body of right little finger with damage to nail, initial 
encounter 
S61.327A Laceration with foreign body of left little finger with damage to nail, initial 
encounter 
   
ICD-10-CM - Code and Description 
S61.328A Laceration with foreign body of other finger with damage to nail, initial 
encounter 
S61.329A Laceration with foreign body of unspecified finger with damage to nail, initial 
encounter 
S61.330A Puncture wound without foreign body of right index finger with damage to 
nail, initial encounter 
S61.331A Puncture wound without foreign body of left index finger with damage to 
nail, initial encounter 
S61.340A Puncture wound with foreign body of right index finger with damage to nail, 
initial encounter 
S61.341A Puncture wound with foreign body of left index finger with damage to nail, 
initial encounter 
S61.342A Puncture wound with foreign body of right middle finger with damage to nail, 
initial encounter 
S61.343A Puncture wound with foreign body of left middle finger with damage to nail, 
initial encounter 
S61.344A Puncture wound with foreign body of right ring finger with damage to nail, 
initial encounter 
S61.345A Puncture wound with foreign body of left ring finger with damage to nail, 
initial encounter 
S61.346A Puncture wound with foreign body of right little finger with damage to nail, 
initial encounter 
S61.347A Puncture wound with foreign body of left little finger with damage to nail, 
initial encounter 
S61.348A Puncture wound with foreign body of other finger with damage to nail, initial 
encounter 
S61.349A Puncture wound with foreign body of unspecified finger with damage to nail, 
initial encounter 
S61.401A Unspecified open wound of right hand, initial encounter 
S61.402A Unspecified open wound of left hand, initial encounter 
S61.409A Unspecified open wound of unspecified hand, initial encounter 
S61.411A Laceration without foreign body of right hand, initial encounter 
S61.412A Laceration without foreign body of left hand, initial encounter 
S61.419A Laceration without foreign body of unspecified hand, initial encounter 
S61.421A Laceration with foreign body of right hand, initial encounter 
S61.422A Laceration with foreign body of left hand, initial encounter 
S61.429A Laceration with foreign body of unspecified hand, initial encounter 
S61.431A Puncture wound without foreign body of right hand, initial encounter 
   
ICD-10-CM - Code and Description 
S61.432A Puncture wound without foreign body of left hand, initial encounter 
S61.439A Puncture wound without foreign body of unspecified hand, initial encounter 
S61.441A Puncture wound with foreign body of right hand, initial encounter 
S61.442A Puncture wound with foreign body of left hand, initial encounter 
S61.449A Puncture wound with foreign body of unspecified hand, initial encounter 
S61.451A Open bite of right hand, initial encounter 
S61.452A Open bite of left hand, initial encounter 
S61.459A Open bite of unspecified hand, initial encounter 
S61.501A Unspecified open wound of right wrist, initial encounter 
S61.502A Unspecified open wound of left wrist, initial encounter 
S61.509A Unspecified open wound of unspecified wrist, initial encounter 
S61.511A Laceration without foreign body of right wrist, initial encounter 
S61.512A Laceration without foreign body of left wrist, initial encounter 
S61.519A Laceration without foreign body of unspecified wrist, initial encounter 
S61.521A Laceration with foreign body of right wrist, initial encounter 
S61.522A Laceration with foreign body of left wrist, initial encounter 
S61.529A Laceration with foreign body of unspecified wrist, initial encounter 
S61.531A Puncture wound without foreign body of right wrist, initial encounter 
S61.532A Puncture wound without foreign body of left wrist, initial encounter 
S61.539A Puncture wound without foreign body of unspecified wrist, initial encounter 
S61.541A Puncture wound with foreign body of right wrist, initial encounter 
S61.542A Puncture wound with foreign body of left wrist, initial encounter 
S61.549A Puncture wound with foreign body of unspecified wrist, initial encounter 
S61.551A Open bite of right wrist, initial encounter 
S61.552A Open bite of left wrist, initial encounter 
S61.559A Open bite of unspecified wrist, initial encounter 
S66.021A Laceration of long flexor muscle, fascia and tendon of right thumb at wrist 
and hand level, initial encounter 
S66.022A Laceration of long flexor muscle, fascia and tendon of left thumb at wrist and 
hand level, initial encounter 
S66.029A Laceration of long flexor muscle, fascia and tendon of unspecified thumb at 
wrist and hand level, initial encounter 
S66.120A Laceration of flexor muscle, fascia and tendon of right index finger at wrist 
and hand level, initial encounter 
   
ICD-10-CM - Code and Description 
S66.121A Laceration of flexor muscle, fascia and tendon of left index finger at wrist and 
hand level, initial encounter 
S66.122A Laceration of flexor muscle, fascia and tendon of right middle finger at wrist 
and hand level, initial encounter 
S66.123A Laceration of flexor muscle, fascia and tendon of left middle finger at wrist 
and hand level, initial encounter 
S66.124A Laceration of flexor muscle, fascia and tendon of right ring finger at wrist and 
hand level, initial encounter 
S66.125A Laceration of flexor muscle, fascia and tendon of left ring finger at wrist and 
hand level, initial encounter 
S66.126A Laceration of flexor muscle, fascia and tendon of right little finger at wrist 
and hand level, initial encounter 
S66.127A Laceration of flexor muscle, fascia and tendon of left little finger at wrist and 
hand level, initial encounter 
S66.128A Laceration of flexor muscle, fascia and tendon of other finger at wrist and 
hand level, initial encounter 
S66.129A Laceration of flexor muscle, fascia and tendon of unspecified finger at wrist 
and hand level, initial encounter 
S66.221A Laceration of extensor muscle, fascia and tendon of right thumb at wrist and 
hand level, initial encounter 
S66.222A Laceration of extensor muscle, fascia and tendon of left thumb at wrist and 
hand level, initial encounter 
S66.229A Laceration of extensor muscle, fascia and tendon of unspecified thumb at 
wrist and hand level, initial encounter 
S66.320A Laceration of extensor muscle, fascia and tendon of right index finger at wrist 
and hand level, initial encounter 
S66.321A Laceration of extensor muscle, fascia and tendon of left index finger at wrist 
and hand level, initial encounter 
S66.322A Laceration of extensor muscle, fascia and tendon of right middle finger at 
wrist and hand level, initial encounter 
S66.323A Laceration of extensor muscle, fascia and tendon of left middle finger at wrist 
and hand level, initial encounter 
S66.324A Laceration of extensor muscle, fascia and tendon of right ring finger at wrist 
and hand level, initial encounter 
S66.325A Laceration of extensor muscle, fascia and tendon of left ring finger at wrist 
and hand level, initial encounter 
S66.326A Laceration of extensor muscle, fascia and tendon of right little finger at wrist 
and hand level, initial encounter 
   
ICD-10-CM - Code and Description 
S66.327A Laceration of extensor muscle, fascia and tendon of left little finger at wrist 
and hand level, initial encounter 
S66.328A Laceration of extensor muscle, fascia and tendon of other finger at wrist and 
hand level, initial encounter 
S66.329A Laceration of extensor muscle, fascia and tendon of unspecified finger at wrist 
and hand level, initial encounter 
S66.421A Laceration of intrinsic muscle, fascia and tendon of right thumb at wrist and 
hand level, initial encounter 
S66.422A Laceration of intrinsic muscle, fascia and tendon of left thumb at wrist and 
hand level, initial encounter 
S66.429A Laceration of intrinsic muscle, fascia and tendon of unspecified thumb at 
wrist and hand level, initial encounter 
S66.520A Laceration of intrinsic muscle, fascia and tendon of right index finger at wrist 
and hand level, initial encounter 
S66.521A Laceration of intrinsic muscle, fascia and tendon of left index finger at wrist 
and hand level, initial encounter 
S66.522A Laceration of intrinsic muscle, fascia and tendon of right middle finger at 
wrist and hand level, initial encounter 
S66.523A Laceration of intrinsic muscle, fascia and tendon of left middle finger at wrist 
and hand level, initial encounter 
S66.524A Laceration of intrinsic muscle, fascia and tendon of right ring finger at wrist 
and hand level, initial encounter 
S66.525A Laceration of intrinsic muscle, fascia and tendon of left ring finger at wrist 
and hand level, initial encounter 
S66.526A Laceration of intrinsic muscle, fascia and tendon of right little finger at wrist 
and hand level, initial encounter 
S66.527A Laceration of intrinsic muscle, fascia and tendon of left little finger at wrist 
and hand level, initial encounter 
S66.528A Laceration of intrinsic muscle, fascia and tendon of other finger at wrist and 
hand level, initial encounter 
S66.529A Laceration of intrinsic muscle, fascia and tendon of unspecified finger at wrist 
and hand level, initial encounter 
S66.821A Laceration of other specified muscles, fascia and tendons at wrist and hand 
level, right hand, initial encounter 
S66.822A Laceration of other specified muscles, fascia and tendons at wrist and hand 
level, left hand, initial encounter 
S66.829A Laceration of other specified muscles, fascia and tendons at wrist and hand 
level, unspecified hand, initial encounter 
   
ICD-10-CM - Code and Description 
S66.921A Laceration of unspecified muscle, fascia and tendon at wrist and hand level, 
right hand, initial encounter 
S66.922A Laceration of unspecified muscle, fascia and tendon at wrist and hand level, 
left hand, initial encounter 
S66.929A Laceration of unspecified muscle, fascia and tendon at wrist and hand level, 
unspecified hand, initial encounter 
S68.011A Complete traumatic metacarpophalangeal amputation of right thumb, initial 
encounter 
S68.012A Complete traumatic metacarpophalangeal amputation of left thumb, initial 
encounter 
S68.019A Complete traumatic metacarpophalangeal amputation of unspecified thumb, 
initial encounter 
S68.021A Partial traumatic metacarpophalangeal amputation of right thumb, initial 
encounter 
S68.022A Partial traumatic metacarpophalangeal amputation of left thumb, initial 
encounter 
S68.029A Partial traumatic metacarpophalangeal amputation of unspecified thumb, 
initial encounter 
S68.110A Complete traumatic metacarpophalangeal amputation of right index finger, 
initial encounter 
S68.111A Complete traumatic metacarpophalangeal amputation of left index finger, 
initial encounter 
S68.112A Complete traumatic metacarpophalangeal amputation of right middle finger, 
initial encounter 
S68.113A Complete traumatic metacarpophalangeal amputation of left middle finger, 
initial encounter 
S68.114A Complete traumatic metacarpophalangeal amputation of right ring finger, 
initial encounter 
S68.115A Complete traumatic metacarpophalangeal amputation of left ring finger, 
initial encounter 
S68.116A Complete traumatic metacarpophalangeal amputation of right little finger, 
initial encounter 
S68.117A Complete traumatic metacarpophalangeal amputation of left little finger, 
initial encounter 
S68.118A Complete traumatic metacarpophalangeal amputation of other finger, initial 
encounter 
S68.119A Complete traumatic metacarpophalangeal amputation of unspecified finger, 
initial encounter 
   
ICD-10-CM - Code and Description 
S68.120A Partial traumatic metacarpophalangeal amputation of right index finger, initial 
encounter 
S68.121A Partial traumatic metacarpophalangeal amputation of left index finger, initial 
encounter 
S68.122A Partial traumatic metacarpophalangeal amputation of right middle finger, 
initial encounter 
S68.123A Partial traumatic metacarpophalangeal amputation of left middle finger, initial 
encounter 
S68.124A Partial traumatic metacarpophalangeal amputation of right ring finger, initial 
encounter 
S68.125A Partial traumatic metacarpophalangeal amputation of left ring finger, initial 
encounter 
S68.126A Partial traumatic metacarpophalangeal amputation of right little finger, initial 
encounter 
S68.127A Partial traumatic metacarpophalangeal amputation of left little finger, initial 
encounter 
S68.128A Partial traumatic metacarpophalangeal amputation of other finger, initial 
encounter 
S68.129A Partial traumatic metacarpophalangeal amputation of unspecified finger, 
initial encounter 
S68.411A Complete traumatic amputation of right hand at wrist level, initial encounter 
S68.412A Complete traumatic amputation of left hand at wrist level, initial encounter 
S68.419A Complete traumatic amputation of unspecified hand at wrist level, initial 
encounter 
S68.421A Partial traumatic amputation of right hand at wrist level, initial encounter 
S68.422A Partial traumatic amputation of left hand at wrist level, initial encounter 
S68.429A Partial traumatic amputation of unspecified hand at wrist level, initial 
encounter 
S68.511A Complete traumatic transphalangeal amputation of right thumb, initial 
encounter 
S68.512A Complete traumatic transphalangeal amputation of left thumb, initial 
encounter 
S68.519A Complete traumatic transphalangeal amputation of unspecified thumb, initial 
encounter 
S68.521A Partial traumatic transphalangeal amputation of right thumb, initial encounter 
S68.522A Partial traumatic transphalangeal amputation of left thumb, initial encounter 
S68.529A Partial traumatic transphalangeal amputation of unspecified thumb, initial 
encounter 
   
ICD-10-CM - Code and Description 
S68.610A Complete traumatic transphalangeal amputation of right index finger, initial 
encounter 
S68.611A Complete traumatic transphalangeal amputation of left index finger, initial 
encounter 
S68.612A Complete traumatic transphalangeal amputation of right middle finger, initial 
encounter 
S68.613A Complete traumatic transphalangeal amputation of left middle finger, initial 
encounter 
S68.614A Complete traumatic transphalangeal amputation of right ring finger, initial 
encounter 
S68.615A Complete traumatic transphalangeal amputation of left ring finger, initial 
encounter 
S68.616A Complete traumatic transphalangeal amputation of right little finger, initial 
encounter 
S68.617A Complete traumatic transphalangeal amputation of left little finger, initial 
encounter 
S68.618A Complete traumatic transphalangeal amputation of other finger, initial 
encounter 
S68.619A Complete traumatic transphalangeal amputation of unspecified finger, initial 
encounter 
S68.620A Partial traumatic transphalangeal amputation of right index finger, initial 
encounter 
S68.621A Partial traumatic transphalangeal amputation of left index finger, initial 
encounter 
S68.622A Partial traumatic transphalangeal amputation of right middle finger, initial 
encounter 
S68.623A Partial traumatic transphalangeal amputation of left middle finger, initial 
encounter 
S68.624A Partial traumatic transphalangeal amputation of right ring finger, initial 
encounter 
S68.625A Partial traumatic transphalangeal amputation of left ring finger, initial 
encounter 
S68.626A Partial traumatic transphalangeal amputation of right little finger, initial 
encounter 
S68.627A Partial traumatic transphalangeal amputation of left little finger, initial 
encounter 
S68.628A Partial traumatic transphalangeal amputation of other finger, initial encounter 
S68.629A Partial traumatic transphalangeal amputation of unspecified finger, initial 
encounter 
   
ICD-10-CM - Code and Description 
S68.711A Complete traumatic transmetacarpal amputation of right hand, initial 
encounter 
S68.712A Complete traumatic transmetacarpal amputation of left hand, initial encounter 
S68.719A Complete traumatic transmetacarpal amputation of unspecified hand, initial 
encounter 
S68.721A Partial traumatic transmetacarpal amputation of right hand, initial encounter 
S68.722A Partial traumatic transmetacarpal amputation of left hand, initial encounter 
S68.729A Partial traumatic transmetacarpal amputation of unspecified hand, initial 
encounter 
S71.001A Unspecified open wound, right hip, initial encounter 
S71.002A Unspecified open wound, left hip, initial encounter 
S71.009A Unspecified open wound, unspecified hip, initial encounter 
S71.011A Laceration without foreign body, right hip, initial encounter 
S71.012A Laceration without foreign body, left hip, initial encounter 
S71.019A Laceration without foreign body, unspecified hip, initial encounter 
S71.021A Laceration with foreign body, right hip, initial encounter 
S71.022A Laceration with foreign body, left hip, initial encounter 
S71.029A Laceration with foreign body, unspecified hip, initial encounter 
S71.031A Puncture wound without foreign body, right hip, initial encounter 
S71.032A Puncture wound without foreign body, left hip, initial encounter 
S71.039A Puncture wound without foreign body, unspecified hip, initial encounter 
S71.041A Puncture wound with foreign body, right hip, initial encounter 
S71.042A Puncture wound with foreign body, left hip, initial encounter 
S71.049A Puncture wound with foreign body, unspecified hip, initial encounter 
S71.051A Open bite, right hip, initial encounter 
S71.052A Open bite, left hip, initial encounter 
S71.059A Open bite, unspecified hip, initial encounter 
S71.101A Unspecified open wound, right thigh, initial encounter 
S71.102A Unspecified open wound, left thigh, initial encounter 
S71.109A Unspecified open wound, unspecified thigh, initial encounter 
S71.111A Laceration without foreign body, right thigh, initial encounter 
S71.112A Laceration without foreign body, left thigh, initial encounter 
S71.119A Laceration without foreign body, unspecified thigh, initial encounter 
S71.121A Laceration with foreign body, right thigh, initial encounter 
S71.122A Laceration with foreign body, left thigh, initial encounter 
   
ICD-10-CM - Code and Description 
S71.129A Laceration with foreign body, unspecified thigh, initial encounter 
S71.131A Puncture wound without foreign body, right thigh, initial encounter 
S71.132A Puncture wound without foreign body, left thigh, initial encounter 
S71.139A Puncture wound without foreign body, unspecified thigh, initial encounter 
S71.141A Puncture wound with foreign body, right thigh, initial encounter 
S71.142A Puncture wound with foreign body, left thigh, initial encounter 
S71.149A Puncture wound with foreign body, unspecified thigh, initial encounter 
S71.151A Open bite, right thigh, initial encounter 
S71.152A Open bite, left thigh, initial encounter 
S71.159A Open bite, unspecified thigh, initial encounter 
S76.021A Laceration of muscle, fascia and tendon of right hip, initial encounter 
S76.022A Laceration of muscle, fascia and tendon of left hip, initial encounter 
S76.029A Laceration of muscle, fascia and tendon of unspecified hip, initial encounter 
S76.121A Laceration of right quadriceps muscle, fascia and tendon, initial encounter 
S76.122A Laceration of left quadriceps muscle, fascia and tendon, initial encounter 
S76.129A Laceration of unspecified quadriceps muscle, fascia and tendon, initial 
encounter 
S76.221A Laceration of adductor muscle, fascia and tendon of right thigh, initial 
encounter 
S76.222A Laceration of adductor muscle, fascia and tendon of left thigh, initial 
encounter 
S76.229A Laceration of adductor muscle, fascia and tendon of unspecified thigh, initial 
encounter 
S76.321A Laceration of muscle, fascia and tendon of the posterior muscle group at thigh 
level, right thigh, initial encounter 
S76.322A Laceration of muscle, fascia and tendon of the posterior muscle group at thigh 
level, left thigh, initial encounter 
S76.329A Laceration of muscle, fascia and tendon of the posterior muscle group at thigh 
level, unspecified thigh, initial encounter 
S76.821A Laceration of other specified muscles, fascia and tendons at thigh level, right 
thigh, initial encounter 
S76.822A Laceration of other specified muscles, fascia and tendons at thigh level, left 
thigh, initial encounter 
S76.829A Laceration of other specified muscles, fascia and tendons at thigh level, 
unspecified thigh, initial encounter 
S76.921A Laceration of unspecified muscles, fascia and tendons at thigh level, right 
thigh, initial encounter 
   
ICD-10-CM - Code and Description 
S76.922A Laceration of unspecified muscles, fascia and tendons at thigh level, left 
thigh, initial encounter 
S76.929A Laceration of unspecified muscles, fascia and tendons at thigh level, 
unspecified thigh, initial encounter 
S78.011A Complete traumatic amputation at right hip joint, initial encounter 
S78.012A Complete traumatic amputation at left hip joint, initial encounter 
S78.019A Complete traumatic amputation at unspecified hip joint, initial encounter 
S78.021A Partial traumatic amputation at right hip joint, initial encounter 
S78.022A Partial traumatic amputation at left hip joint, initial encounter 
S78.029A Partial traumatic amputation at unspecified hip joint, initial encounter 
S78.111A Complete traumatic amputation at level between right hip and knee, initial 
encounter 
S78.112A Complete traumatic amputation at level between left hip and knee, initial 
encounter 
S78.119A Complete traumatic amputation at level between unspecified hip and knee, 
initial encounter 
S78.121A Partial traumatic amputation at level between right hip and knee, initial 
encounter 
S78.122A Partial traumatic amputation at level between left hip and knee, initial 
encounter 
S78.129A Partial traumatic amputation at level between unspecified hip and knee, initial 
encounter 
S78.911A Complete traumatic amputation of right hip and thigh, level unspecified, 
initial encounter 
S78.912A Complete traumatic amputation of left hip and thigh, level unspecified, initial 
encounter 
S78.919A Complete traumatic amputation of unspecified hip and thigh, level 
unspecified, initial encounter 
S78.921A Partial traumatic amputation of right hip and thigh, level unspecified, initial 
encounter 
S78.922A Partial traumatic amputation of left hip and thigh, level unspecified, initial 
encounter 
S78.929A Partial traumatic amputation of unspecified hip and thigh, level unspecified, 
initial encounter 
S81.001A Unspecified open wound, right knee, initial encounter 
S81.002A Unspecified open wound, left knee, initial encounter 
S81.009A Unspecified open wound, unspecified knee, initial encounter 
S81.011A Laceration without foreign body, right knee, initial encounter 
   
ICD-10-CM - Code and Description 
S81.012A Laceration without foreign body, left knee, initial encounter 
S81.019A Laceration without foreign body, unspecified knee, initial encounter 
S81.021A Laceration with foreign body, right knee, initial encounter 
S81.022A Laceration with foreign body, left knee, initial encounter 
S81.029A Laceration with foreign body, unspecified knee, initial encounter 
S81.031A Puncture wound without foreign body, right knee, initial encounter 
S81.032A Puncture wound without foreign body, left knee, initial encounter 
S81.039A Puncture wound without foreign body, unspecified knee, initial encounter 
S81.041A Puncture wound with foreign body, right knee, initial encounter 
S81.042A Puncture wound with foreign body, left knee, initial encounter 
S81.049A Puncture wound with foreign body, unspecified knee, initial encounter 
S81.051A Open bite, right knee, initial encounter 
S81.052A Open bite, left knee, initial encounter 
S81.059A Open bite, unspecified knee, initial encounter 
S81.801A Unspecified open wound, right lower leg, initial encounter 
S81.802A Unspecified open wound, left lower leg, initial encounter 
S81.809A Unspecified open wound, unspecified lower leg, initial encounter 
S81.811A Laceration without foreign body, right lower leg, initial encounter 
S81.812A Laceration without foreign body, left lower leg, initial encounter 
S81.819A Laceration without foreign body, unspecified lower leg, initial encounter 
S81.821A Laceration with foreign body, right lower leg, initial encounter 
S81.822A Laceration with foreign body, left lower leg, initial encounter 
S81.829A Laceration with foreign body, unspecified lower leg, initial encounter 
S81.831A Puncture wound without foreign body, right lower leg, initial encounter 
S81.832A Puncture wound without foreign body, left lower leg, initial encounter 
S81.839A Puncture wound without foreign body, unspecified lower leg, initial encounter 
S81.841A Puncture wound with foreign body, right lower leg, initial encounter 
S81.842A Puncture wound with foreign body, left lower leg, initial encounter 
S81.849A Puncture wound with foreign body, unspecified lower leg, initial encounter 
S81.851A Open bite, right lower leg, initial encounter 
S81.852A Open bite, left lower leg, initial encounter 
S81.859A Open bite, unspecified lower leg, initial encounter 
S86.021A Laceration of right Achilles tendon, initial encounter 
S86.022A Laceration of left Achilles tendon, initial encounter 
   
ICD-10-CM - Code and Description 
S86.029A Laceration of unspecified Achilles tendon, initial encounter 
S86.121A Laceration of other muscle(s) and tendon(s) of posterior muscle group at 
lower leg level, right leg, initial encounter 
S86.122A Laceration of other muscle(s) and tendon(s) of posterior muscle group at 
lower leg level, left leg, initial encounter 
S86.129A Laceration of other muscle(s) and tendon(s) of posterior muscle group at 
lower leg level, unspecified leg, initial encounter 
S86.221A Laceration of muscle(s) and tendon(s) of anterior muscle group at lower leg 
level, right leg, initial encounter 
S86.222A Laceration of muscle(s) and tendon(s) of anterior muscle group at lower leg 
level, left leg, initial encounter 
S86.229A Laceration of muscle(s) and tendon(s) of anterior muscle group at lower leg 
level, unspecified leg, initial encounter 
S86.321A Laceration of muscle(s) and tendon(s) of peroneal muscle group at lower leg 
level, right leg, initial encounter 
S86.322A Laceration of muscle(s) and tendon(s) of peroneal muscle group at lower leg 
level, left leg, initial encounter 
S86.329A Laceration of muscle(s) and tendon(s) of peroneal muscle group at lower leg 
level, unspecified leg, initial encounter 
S86.821A Laceration of other muscle(s) and tendon(s) at lower leg level, right leg, initial 
encounter 
S86.822A Laceration of other muscle(s) and tendon(s) at lower leg level, left leg, initial 
encounter 
S86.829A Laceration of other muscle(s) and tendon(s) at lower leg level, unspecified 
leg, initial encounter 
S86.921A Laceration of unspecified muscle(s) and tendon(s) at lower leg level, right leg, 
initial encounter 
S86.922A Laceration of unspecified muscle(s) and tendon(s) at lower leg level, left leg, 
initial encounter 
S86.929A Laceration of unspecified muscle(s) and tendon(s) at lower leg level, 
unspecified leg, initial encounter 
S88.011A Complete traumatic amputation at knee level, right lower leg, initial encounter 
S88.012A Complete traumatic amputation at knee level, left lower leg, initial encounter 
S88.019A Complete traumatic amputation at knee level, unspecified lower leg, initial 
encounter 
S88.021A Partial traumatic amputation at knee level, right lower leg, initial encounter 
S88.022A Partial traumatic amputation at knee level, left lower leg, initial encounter 
   
ICD-10-CM - Code and Description 
S88.029A Partial traumatic amputation at knee level, unspecified lower leg, initial 
encounter 
S88.111A Complete traumatic amputation at level between knee and ankle, right lower 
leg, initial encounter 
S88.112A Complete traumatic amputation at level between knee and ankle, left lower 
leg, initial encounter 
S88.119A Complete traumatic amputation at level between knee and ankle, unspecified 
lower leg, initial encounter 
S88.121A Partial traumatic amputation at level between knee and ankle, right lower leg, 
initial encounter 
S88.122A Partial traumatic amputation at level between knee and ankle, left lower leg, 
initial encounter 
S88.129A Partial traumatic amputation at level between knee and ankle, unspecified 
lower leg, initial encounter 
S88.911A Complete traumatic amputation of right lower leg, level unspecified, initial 
encounter 
S88.912A Complete traumatic amputation of left lower leg, level unspecified, initial 
encounter 
S88.919A Complete traumatic amputation of unspecified lower leg, level unspecified, 
initial encounter 
S88.921A Partial traumatic amputation of right lower leg, level unspecified, initial 
encounter 
S88.922A Partial traumatic amputation of left lower leg, level unspecified, initial 
encounter 
S88.929A Partial traumatic amputation of unspecified lower leg, level unspecified, 
initial encounter 
S91.001A Unspecified open wound, right ankle, initial encounter 
S91.002A Unspecified open wound, left ankle, initial encounter 
S91.009A Unspecified open wound, unspecified ankle, initial encounter 
S91.011A Laceration without foreign body, right ankle, initial encounter 
S91.012A Laceration without foreign body, left ankle, initial encounter 
S91.019A Laceration without foreign body, unspecified ankle, initial encounter 
S91.021A Laceration with foreign body, right ankle, initial encounter 
S91.022A Laceration with foreign body, left ankle, initial encounter 
S91.029A Laceration with foreign body, unspecified ankle, initial encounter 
S91.031A Puncture wound without foreign body, right ankle, initial encounter 
S91.032A Puncture wound without foreign body, left ankle, initial encounter 
   
ICD-10-CM - Code and Description 
S91.039A Puncture wound without foreign body, unspecified ankle, initial encounter 
S91.041A Puncture wound with foreign body, right ankle, initial encounter 
S91.042A Puncture wound with foreign body, left ankle, initial encounter 
S91.049A Puncture wound with foreign body, unspecified ankle, initial encounter 
S91.051A Open bite, right ankle, initial encounter 
S91.052A Open bite, left ankle, initial encounter 
S91.059A Open bite, unspecified ankle, initial encounter 
S91.101A Unspecified open wound of right great toe without damage to nail, initial 
encounter 
S91.102A Unspecified open wound of left great toe without damage to nail, initial 
encounter 
S91.103A Unspecified open wound of unspecified great toe without damage to nail, 
initial encounter 
S91.104A Unspecified open wound of right lesser toe(s) without damage to nail, initial 
encounter 
S91.105A Unspecified open wound of left lesser toe(s) without damage to nail, initial 
encounter 
S91.106A Unspecified open wound of unspecified lesser toe(s) without damage to nail, 
initial encounter 
S91.109A Unspecified open wound of unspecified toe(s) without damage to nail, initial 
encounter 
S91.111A Laceration without foreign body of right great toe without damage to nail, 
initial encounter 
S91.112A Laceration without foreign body of left great toe without damage to nail, 
initial encounter 
S91.113A Laceration without foreign body of unspecified great toe without damage to 
nail, initial encounter 
S91.114A Laceration without foreign body of right lesser toe(s) without damage to nail, 
initial encounter 
S91.115A Laceration without foreign body of left lesser toe(s) without damage to nail, 
initial encounter 
S91.116A Laceration without foreign body of unspecified lesser toe(s) without damage 
to nail, initial encounter 
S91.119A Laceration without foreign body of unspecified toe without damage to nail, 
initial encounter 
S91.121A Laceration with foreign body of right great toe without damage to nail, initial 
encounter 
   
ICD-10-CM - Code and Description 
S91.122A Laceration with foreign body of left great toe without damage to nail, initial 
encounter 
S91.123A Laceration with foreign body of unspecified great toe without damage to nail, 
initial encounter 
S91.124A Laceration with foreign body of right lesser toe(s) without damage to nail, 
initial encounter 
S91.125A Laceration with foreign body of left lesser toe(s) without damage to nail, 
initial encounter 
S91.126A Laceration with foreign body of unspecified lesser toe(s) without damage to 
nail, initial encounter 
S91.129A Laceration with foreign body of unspecified toe(s) without damage to nail, 
initial encounter 
S91.131A Puncture wound without foreign body of right great toe without damage to 
nail, initial encounter 
S91.132A Puncture wound without foreign body of left great toe without damage to nail, 
initial encounter 
S91.133A Puncture wound without foreign body of unspecified great toe without 
damage to nail, initial encounter 
S91.134A Puncture wound without foreign body of right lesser toe(s) without damage to 
nail, initial encounter 
S91.135A Puncture wound without foreign body of left lesser toe(s) without damage to 
nail, initial encounter 
S91.136A Puncture wound without foreign body of unspecified lesser toe(s) without 
damage to nail, initial encounter 
S91.139A Puncture wound without foreign body of unspecified toe(s) without damage 
to nail, initial encounter 
S91.141A Puncture wound with foreign body of right great toe without damage to nail, 
initial encounter 
S91.142A Puncture wound with foreign body of left great toe without damage to nail, 
initial encounter 
S91.143A Puncture wound with foreign body of unspecified great toe without damage to 
nail, initial encounter 
S91.144A Puncture wound with foreign body of right lesser toe(s) without damage to 
nail, initial encounter 
S91.145A Puncture wound with foreign body of left lesser toe(s) without damage to nail, 
initial encounter 
S91.146A Puncture wound with foreign body of unspecified lesser toe(s) without 
damage to nail, initial encounter 
   
ICD-10-CM - Code and Description 
S91.149A Puncture wound with foreign body of unspecified toe(s) without damage to 
nail, initial encounter 
S91.151A Open bite of right great toe without damage to nail, initial encounter 
S91.152A Open bite of left great toe without damage to nail, initial encounter 
S91.153A Open bite of unspecified great toe without damage to nail, initial encounter 
S91.154A Open bite of right lesser toe(s) without damage to nail, initial encounter 
S91.155A Open bite of left lesser toe(s) without damage to nail, initial encounter 
S91.156A Open bite of unspecified lesser toe(s) without damage to nail, initial encounter 
S91.159A Open bite of unspecified toe(s) without damage to nail, initial encounter 
S91.201A Unspecified open wound of right great toe with damage to nail, initial 
encounter 
S91.202A Unspecified open wound of left great toe with damage to nail, initial 
encounter 
S91.203A Unspecified open wound of unspecified great toe with damage to nail, initial 
encounter 
S91.204A Unspecified open wound of right lesser toe(s) with damage to nail, initial 
encounter 
S91.205A Unspecified open wound of left lesser toe(s) with damage to nail, initial 
encounter 
S91.206A Unspecified open wound of unspecified lesser toe(s) with damage to nail, 
initial encounter 
S91.209A Unspecified open wound of unspecified toe(s) with damage to nail, initial 
encounter 
S91.211A Laceration without foreign body of right great toe with damage to nail, initial 
encounter 
S91.212A Laceration without foreign body of left great toe with damage to nail, initial 
encounter 
S91.213A Laceration without foreign body of unspecified great toe with damage to nail, 
initial encounter 
S91.214A Laceration without foreign body of right lesser toe(s) with damage to nail, 
initial encounter 
S91.215A Laceration without foreign body of left lesser toe(s) with damage to nail, 
initial encounter 
S91.216A Laceration without foreign body of unspecified lesser toe(s) with damage to 
nail, initial encounter 
S91.219A Laceration without foreign body of unspecified toe(s) with damage to nail, 
initial encounter 
   
ICD-10-CM - Code and Description 
S91.221A Laceration with foreign body of right great toe with damage to nail, initial 
encounter 
S91.222A Laceration with foreign body of left great toe with damage to nail, initial 
encounter 
S91.223A Laceration with foreign body of unspecified great toe with damage to nail, 
initial encounter 
S91.224A Laceration with foreign body of right lesser toe(s) with damage to nail, initial 
encounter 
S91.225A Laceration with foreign body of left lesser toe(s) with damage to nail, initial 
encounter 
S91.226A Laceration with foreign body of unspecified lesser toe(s) with damage to nail, 
initial encounter 
S91.229A Laceration with foreign body of unspecified toe(s) with damage to nail, initial 
encounter 
S91.231A Puncture wound without foreign body of right great toe with damage to nail, 
initial encounter 
S91.232A Puncture wound without foreign body of left great toe with damage to nail, 
initial encounter 
S91.233A Puncture wound without foreign body of unspecified great toe with damage to 
nail, initial encounter 
S91.234A Puncture wound without foreign body of right lesser toe(s) with damage to 
nail, initial encounter 
S91.235A Puncture wound without foreign body of left lesser toe(s) with damage to nail, 
initial encounter 
S91.236A Puncture wound without foreign body of unspecified lesser toe(s) with 
damage to nail, initial encounter 
S91.239A Puncture wound without foreign body of unspecified toe(s) with damage to 
nail, initial encounter 
S91.241A Puncture wound with foreign body of right great toe with damage to nail, 
initial encounter 
S91.242A Puncture wound with foreign body of left great toe with damage to nail, initial 
encounter 
S91.243A Puncture wound with foreign body of unspecified great toe with damage to 
nail, initial encounter 
S91.244A Puncture wound with foreign body of right lesser toe(s) with damage to nail, 
initial encounter 
S91.245A Puncture wound with foreign body of left lesser toe(s) with damage to nail, 
initial encounter 
   
ICD-10-CM - Code and Description 
S91.246A Puncture wound with foreign body of unspecified lesser toe(s) with damage to 
nail, initial encounter 
S91.249A Puncture wound with foreign body of unspecified toe(s) with damage to nail, 
initial encounter 
S91.251A Open bite of right great toe with damage to nail, initial encounter 
S91.252A Open bite of left great toe with damage to nail, initial encounter 
S91.253A Open bite of unspecified great toe with damage to nail, initial encounter 
S91.254A Open bite of right lesser toe(s) with damage to nail, initial encounter 
S91.255A Open bite of left lesser toe(s) with damage to nail, initial encounter 
S91.256A Open bite of unspecified lesser toe(s) with damage to nail, initial encounter 
S91.259A Open bite of unspecified toe(s) with damage to nail, initial encounter 
S91.301A Unspecified open wound, right foot, initial encounter 
S91.302A Unspecified open wound, left foot, initial encounter 
S91.309A Unspecified open wound, unspecified foot, initial encounter 
S91.311A Laceration without foreign body, right foot, initial encounter 
S91.312A Laceration without foreign body, left foot, initial encounter 
S91.319A Laceration without foreign body, unspecified foot, initial encounter 
S91.321A Laceration with foreign body, right foot, initial encounter 
S91.322A Laceration with foreign body, left foot, initial encounter 
S91.329A Laceration with foreign body, unspecified foot, initial encounter 
S91.331A Puncture wound without foreign body, right foot, initial encounter 
S91.332A Puncture wound without foreign body, left foot, initial encounter 
S91.339A Puncture wound without foreign body, unspecified foot, initial encounter 
S91.341A Puncture wound with foreign body, right foot, initial encounter 
S91.342A Puncture wound with foreign body, left foot, initial encounter 
S91.349A Puncture wound with foreign body, unspecified foot, initial encounter 
S91.351A Open bite, right foot, initial encounter 
S91.352A Open bite, left foot, initial encounter 
S91.359A Open bite, unspecified foot, initial encounter 
S96.021A Laceration of muscle and tendon of long flexor muscle of toe at ankle and 
foot level, right foot, initial encounter 
S96.022A Laceration of muscle and tendon of long flexor muscle of toe at ankle and 
foot level, left foot, initial encounter 
S96.029A Laceration of muscle and tendon of long flexor muscle of toe at ankle and 
foot level, unspecified foot, initial encounter 
   
ICD-10-CM - Code and Description 
S96.121A Laceration of muscle and tendon of long extensor muscle of toe at ankle and 
foot level, right foot, initial encounter 
S96.122A Laceration of muscle and tendon of long extensor muscle of toe at ankle and 
foot level, left foot, initial encounter 
S96.129A Laceration of muscle and tendon of long extensor muscle of toe at ankle and 
foot level, unspecified foot, initial encounter 
S96.221A Laceration of intrinsic muscle and tendon at ankle and foot level, right foot, 
initial encounter 
S96.222A Laceration of intrinsic muscle and tendon at ankle and foot level, left foot, 
initial encounter 
S96.229A Laceration of intrinsic muscle and tendon at ankle and foot level, unspecified 
foot, initial encounter 
S96.821A Laceration of other specified muscles and tendons at ankle and foot level, 
right foot, initial encounter 
S96.822A Laceration of other specified muscles and tendons at ankle and foot level, left 
foot, initial encounter 
S96.829A Laceration of other specified muscles and tendons at ankle and foot level, 
unspecified foot, initial encounter 
S96.921A Laceration of unspecified muscle and tendon at ankle and foot level, right 
foot, initial encounter 
S96.922A Laceration of unspecified muscle and tendon at ankle and foot level, left foot, 
initial encounter 
S96.929A Laceration of unspecified muscle and tendon at ankle and foot level, 
unspecified foot, initial encounter 
S98.011A Complete traumatic amputation of right foot at ankle level, initial encounter 
S98.012A Complete traumatic amputation of left foot at ankle level, initial encounter 
S98.019A Complete traumatic amputation of unspecified foot at ankle level, initial 
encounter 
S98.021A Partial traumatic amputation of right foot at ankle level, initial encounter 
S98.022A Partial traumatic amputation of left foot at ankle level, initial encounter 
S98.029A Partial traumatic amputation of unspecified foot at ankle level, initial 
encounter 
S98.111A Complete traumatic amputation of right great toe, initial encounter 
S98.112A Complete traumatic amputation of left great toe, initial encounter 
S98.119A Complete traumatic amputation of unspecified great toe, initial encounter 
S98.121A Partial traumatic amputation of right great toe, initial encounter 
S98.122A Partial traumatic amputation of left great toe, initial encounter 
S98.129A Partial traumatic amputation of unspecified great toe, initial encounter 
   
ICD-10-CM - Code and Description 
S98.131A Complete traumatic amputation of one right lesser toe, initial encounter 
S98.132A Complete traumatic amputation of one left lesser toe, initial encounter 
S98.139A Complete traumatic amputation of one unspecified lesser toe, initial encounter 
S98.141A Partial traumatic amputation of one right lesser toe, initial encounter 
S98.142A Partial traumatic amputation of one left lesser toe, initial encounter 
S98.149A Partial traumatic amputation of one unspecified lesser toe, initial encounter 
S98.211A Complete traumatic amputation of two or more right lesser toes, initial 
encounter 
S98.212A Complete traumatic amputation of two or more left lesser toes, initial 
encounter 
S98.219A Complete traumatic amputation of two or more unspecified lesser toes, initial 
encounter 
S98.221A Partial traumatic amputation of two or more right lesser toes, initial encounter 
S98.222A Partial traumatic amputation of two or more left lesser toes, initial encounter 
S98.229A Partial traumatic amputation of two or more unspecified lesser toes, initial 
encounter 
S98.311A Complete traumatic amputation of right midfoot, initial encounter 
S98.312A Complete traumatic amputation of left midfoot, initial encounter 
S98.319A Complete traumatic amputation of unspecified midfoot, initial encounter 
S98.321A Partial traumatic amputation of right midfoot, initial encounter 
S98.322A Partial traumatic amputation of left midfoot, initial encounter 
S98.329A Partial traumatic amputation of unspecified midfoot, initial encounter 
S98.911A Complete traumatic amputation of right foot, level unspecified, initial 
encounter 
S98.912A Complete traumatic amputation of left foot, level unspecified, initial 
encounter 
S98.919A Complete traumatic amputation of unspecified foot, level unspecified, initial 
encounter 
S98.921A Partial traumatic amputation of right foot, level unspecified, initial encounter 
S98.922A Partial traumatic amputation of left foot, level unspecified, initial encounter 
S98.929A Partial traumatic amputation of unspecified foot, level unspecified, initial 
encounter 
T81.31XA Disruption of external operation (surgical) wound, not elsewhere classified, 
initial encounter 
T81.32XA Disruption of internal operation (surgical) wound, not elsewhere classified, 
initial encounter 
 
   
Transmittals Issued for this Chapter 
Rev #  Issue Date  Subject  Impl Date  CR# 
R11129CP 11/22/2021 Reduced Payment for Physical Therapy and  01/03/2022  12397 
Occupational Therapy Services Furnished In 
Whole or In Part by a Physical Therapist 
Assistant (PTA) or Occupational Therapy 
Assistant (OTA) 
  08/13/2021 Reduced Payment for Physical Therapy and  01/03/2022  12397 
Occupational Therapy Services Furnished In 
Whole or In Part by a Physical Therapist 
Assistant (PTA) or Occupational Therapy 
Assistant (OTA) 
SENSITIVE/CONTROVERSIAL- 
Rescinded and replaced by Transmittal 11129 
R4440CP  11/01/2019 New Modifiers to Identify Occupational  01/06/2020  11362 
Therapy (OT) and Physical Therapy (PT) 
Services Provided by a Therapy Assistant- No 
Longer Sensitive/Controversial 
  09/01/2019 New Modifiers to Identify Occupational  01/06/2020  11362 
Therapy (OT) and Physical Therapy (PT) 
Services Provided by a Therapy Assistant 
SENSITIVE/CONTROVERSIAL- 
Rescinded and replaced by Transmittal 4440 
R4214CP  01/25/2019 Updates to Reflect Removal of Functional  02/26/2019  11120 
Reporting Requirements and Therapy 
Provisions of the Bipartisan Budget Act of 
2018 
R3995CP  03/09/2018 Correction to Pub. 100-04, Chapter 5  06/11/2018  10509 
 
R3936CP  12/21/2017 Updated Editing of Always Therapy Services -  01/02/2018  10176 
MCS 
R3863CP  09/15/2017 Updated Editing of Always Therapy Services  01/02/2018  10176 
 MCS-  Rescinded and replaced by 
Transmittal 3936 
   
Rev #  Issue Date  Subject  Impl Date  CR# 
R3814CP  07/27/2017 Updated Editing of Always Therapy Services  01/02/2018  10176 
 MCS - Rescinded and replaced by 
Transmittal 3863 
R3670CP  12/01/2016 Update to Editing of Therapy Services to  04/03/2017  9698 
Reflect Coding Changes 
R3634CP  10/27/2016 Update to Editing of Therapy Services to  04/03/2017  9698 
Reflect Coding Changes  Rescinded and 
replaced by Transmittal 3670 
R3475CP  03/04/2016 Updates to Pub. 100-04, Chapters 4 and 5 to  06/06/2016  9424 
Correct Remittance Advice Messages 
R3454CP  02/04/2016 Correction to Applying Therapy Caps to  07/05/2016  9489 
Maryland Hospitals and Billing Requirement 
for Rehabilitation Agencies and 
Comprehensive Outpatient Rehabilitation 
Facilities (CORFs) 
R3367CP  10/07/2015 Applying Therapy Caps to Maryland Hospitals  01/04/2016  9223 
R3309CP  08/06/2015 Applying Therapy Caps to Maryland Hospitals  01/04/2016  9223 
 Rescinded and replaced by Transmittal 3367 
R3220CP  03/16/2015 Update to Pub. 100-04, Chapters 5 and 6 to  09/16/2014  8524 
Provide Language-Only Changes for Updating 
ICD-10, ASC X12, and Medicare 
Administrative Contractor (MAC) 
Implementation 
R3028CP  08/15/2014 Update to Pub. 100-04, Chapters 5 and 6 to  09/16/2014  8524 
Provide Language-Only Changes for Updating 
ICD-10, ASC X12, and Medicare 
Administrative Contractor (MAC) 
Implementation  Rescinded and replaced by 
Transmittal 3220 
R2899CP  03/07/2014 Pub 100-04, Language Only Update for  10/01/2014  8524 
Chapters Five and Six for Conversion to ICD-
   
Rev #  Issue Date  Subject  Impl Date  CR# 
10 - Rescinded and replaced by Transmittal 
3028 
R2868CP  02/06/2014 Therapy Modifier Consistency Edits  07/07/2014  8556 
R2859CP  01/17/2014 Applying the Therapy Caps to Critical Access  01/31/2014  8426 
Hospitals 
R2844CP  12/27/2013 2014 Annual Update to the Therapy Code List  01/06/2014  8482 
R2809CP  11/06/2013 2014 Annual Update to the Therapy Code List  01/06/2014  8482 
 Rescinded and replaced by Transmittal 2844 
R2783CP  09/10/2013 Corrections to the Medicare Claims Processing  09/17/2013  8343 
Manual 
R2736CP  06/28/2013 Billing Social Work and Psychological  10/07/2013  8257 
Services in Comprehensive Outpatient 
Rehabilitation Facilities (CORFs) 
R2725CP  06/14/2013 Corrections to the Medicare Claims Processing  09/17/2013  8343 
Manual  Rescinded and replaced by 
Transmittal 2783 
R2690CP  05/03/2013 Billing Social Work and Psychological  10/07/2013  8257 
Services in Comprehensive Outpatient 
Rehabilitation Facilities (CORFs)  Rescinded 
and replaced by Transmittal 2736 
R2622CP  12/21/2012 Implementing the Claims-Based Data  01/07/2013  8005 
Collection Requirement for Outpatient 
Therapy Services -- Section 3005(g) of the 
Middle Class Tax Relief and Jobs Creation Act 
(MCTRJCA) of 2012 
R2615CP  12/14/2012 Revisions of the Financial Limitation for  10/01/2012  7785 
Outpatient Therapy Services-Section 3005 of 
the Middle Class Tax Relief and Job Creation 
Act of 2012 
   
Rev #  Issue Date  Subject  Impl Date  CR# 
R2603CP  11/30/2012 Implementing the Claims-Based Data  01/07/2013  8005 
Collection Requirement for Outpatient 
Therapy Services -- Section 3005(g) of the 
Middle Class Tax Relief and Jobs Creation Act 
(MCTRJCA) of 2012  Rescinded and 
replaced by Transmittal 2622 
R2537CP  08/31/2012 Expiration of 2012 Therapy Cap Revisions and 01/07/2013  7881 
User-Controlled Mechanism to Identify 
Legislative Effective Dates 
R2532CP  08/24/2012 Implementing the Claims-Based Data  01/07/2013  8005 
Collection Requirement for Outpatient 
Therapy Services -- Section 3005(g) of the 
Middle Class Tax Relief and Jobs Creation Act 
(MCTRJCA) of 2012  Rescinded and 
replaced by Transmittal 2603 
R2457CP  04/27/2012 Revisions of the Financial Limitation for  10/01/2012  7785 
Outpatient Therapy Services-Section 3005 of 
the Middle Class Tax Relief and Job Creation 
Act of 2012  Rescinded and replaced by 
Transmittal 2615 
R2328CP  10/27/2011 Claim Adjustment Reason Code (CARC) Used 04/02/2012  7564 
for Therapy Claims Subject to the Multiple 
Procedure Payment Reduction 
R2160CP  02/18/2011 Correction to Manual References in Chapter 5,  05/19/2011  7315 
Section 20.2 
R2121CP  12/17/2010 Reporting of Service Units With HCPCS  03/21/2011  7247 
R2091CP  11/12/2010 Correct Reporting of Modifiers and Revenue  04/04/2011  7170 
Codes on Claims for Therapy Services 
R2073CP  10/22/2010 Therapy Cap Values for Calendar Year (CY)  01/03/2011  7107 
2011 
   
Rev #  Issue Date  Subject  Impl Date  CR# 
R2055CP  09/17/2010 Therapy Cap Values for Calendar Year (CY)  01/03/2011  7107 
2011  Rescinded and replaced by Transmittal 
2073 
R2044CP  09/03/2010 Revisions and Re-issuance of Audiology  09/30/2010  6447 
Policies 
R2007CP  07/23/2007 Revisions and Re-issuance of Audiology  08/11/2010  6447 
Policies  Rescinded and replaced by 
Transmittal 2044 
R1985CP  06/11/2010 Clarifications and Updates of Therapy  07/11/2010  6980 
Services Policies 
R1975CP  05/28/2010 Revisions and Re-issuance of Audiology  07/28/2010  6447 
Policies - Rescinded and replaced by 
Transmittal 2007 
R1951CP  04/27/2010 Removal of the Provider Reporting  10/04/2010  6899 
Requirement for Total Number of Therapy 
Visits Using Value Codes 50-53 
R1921CP  02/19/2010 Billing for Services Related to Voluntary Uses  04/05/2010  6563 
of Advanced Beneficiary Notices of 
Noncoverage (ABNs) 
R1894CP  01/15/2010 Billing for Services Related to Voluntary Uses  04/05/2010  6563 
of Advanced Beneficiary Notices of 
Noncoverage (ABNs)  Rescinded and 
replaced by Transmittal 1921 
R1876CP  12/18/2009 Coverage of Kidney Disease Patient Education  04/05/2010  6557 
Services 
R1860CP  11/20/2009 Therapy Cap Values for Calendar Year (CY)  01/04/2010  6660 
2010 
R1851CP  11/13/2009 Therapy Cap Values for Calendar Year (CY)  01/04/2010  6660 
2010  Rescinded and replaced by Transmittal 
1860 
   
Rev #  Issue Date  Subject  Impl Date  CR# 
R1850CP  11/13/2009 2010 Annual Update to the Therapy Code List  01/04/2010  6719 
R1843CP  10/30/2009 Outpatient Mental Health Treatment  01/04/2010  6686 
Limitation 
R1840CP  10/29/2009 Billing for Services Related to Voluntary Uses  04/05/2010  6563 
of Advanced Beneficiary Notices of 
Noncoverage (ABNs)  Rescinded and 
replaced by Transmittal 1894 
R1733CP  05/08/2009 Manual Clarification for Skilled Nursing  04/27/2009  6407 
Facility (SNF) and Therapy Billing 
R1717CP  04/24/2009 Speech-Language Pathology Practice Payment  07/06/2009  6381 
Policy 
R1706CP  03/27/2009 Manual Clarification for Skilled Nursing  04/27/2009  6407 
Facility (SNF) and Therapy Billing  
Rescinded and replaced by Transmittal 1733 
R1678CP  02/13/2009 Outpatient Therapy Caps With Exceptions in  04/06/2009  6321 
CY 2009 
R1631CP  11/07/2008 Extension of Therapy Cap Exception Process  12/08/2008  6222 
R1593CP  09/12/2008 Smoking and Tobacco Use Cessation  12/12/2008  6163 
Counseling Billing Update for Comprehensive 
Outpatient Rehabilitation Facilities (CORFs) 
and Outpatient Physical Therapy Providers 
(OPTs) 
R1472CP  03/06/2008 Update of Institutional Claims References  04/07/2008  5893 
R1459CP  02/22/2008 Comprehensive Outpatient Rehabilitation  07/07/2008  5898 
Facility (CORF) Billing Requirement Updates 
for Fiscal Year (FY) 2008 
R1421CP  01/25/2008 Update of Institutional Claims References -  04/07/2008  5893 
Rescinded and Replaced by Transmittal 1472 
   
Rev #  Issue Date  Subject  Impl Date  CR# 
R1414CP  01/17/2008 Outpatient Therapy Caps Without KX  01/07/2008  5871 
Modifier Exceptions Start January 1, 2008 
R1407CP  01/10/2008 Outpatient Therapy Caps Without KX  01/07/2008  5871 
Modifier Exceptions Start January 1, 2008  
Replaced by Transmittal 1414 
R1377CP  11/23/2007 2008 Annual Update to the Therapy Code List  01/07/2008  5810 
R1183CP  02/09/2007 Infrared Therapy Devices  01/16/2007  5421 
R1145CP  12/29/2006 Outpatient Therapy Cap Exceptions Process  01/29/2007  5478 
for Calendar Year (CY) 2007 
R1127CP  12/15/2006 Infrared Therapy Devices  Replaced by  01/16/2007  5421 
Transmittal 1183 
R1106CP  11/09/2006 Outpatient Therapy Cap Clarifications  12/09/2006  5271 
R1019CP  08/03/2006 Outpatient Therapy - Additional DRA  01/02/2007  5253 
Mandated Service Edits 
R1016CP  07/28/2006 Outpatient Therapy - Additional DRA  01/02/2007  5253 
Mandated Service Edit 
R1000CP  07/19/2006 Common Working File (CWF) to the  10/02/2006  4300 
Medicare Beneficiary Database (MBD) Data 
Exchange Changes 
R980CP  06/14/2006 Changes Conforming to CR 3648 Instructions  10/02/2006  4014 
for Therapy Services - Replaces Rev. 941 
R941CP  05/05/2006 Changes Conforming to CR 3648 Instructions  10/02/2006  4014 
for Therapy Services 
R908CP  04/21/2006 Common Working File (CWF) to the  10/02/2006  4300 
Medicare Beneficiary Database (MBD) Data 
Exchange Changes 
   
Rev #  Issue Date  Subject  Impl Date  CR# 
R855CP  02/15/2006 Therapy Caps Exception Process  3/13/2006  4364 
R853CP  02/13/2006 Therapy Caps Exception Process  3/13/2006  4364 
R805CP  01/06/2006 Annual Update to the Therapy Code List  02/06/2006  4226 
R771CP  12/02/2005 Revisions to Pub.100-04, Medicare Claims  01/03/2006  4181 
Processing Manual in Preparation for the 
National Provider Identifier 
R759CP  11/18/2005 Therapy Caps to be Effective January 1, 2006  01/03/2006  4115 
R515CP  04/01/2005 Update to 100-04 and Therapy Code Lists  07/05/2005  3647 
R463CP  02/04/2005 Update to 100-04 and Therapy Code Lists  07/05/2005  3647 
R319CP  10/22/2004 CORF/OPT Edit for Billing Inappropriate  04/04/2005  3468 
Supplies 
R042CP  12/08/2003 The Financial Limitation on Therapy Services  12/08/2003  3005 
R030CP  11/14/2003 The Financial Limitation on Therapy Services  01/05/2004  2973 
R001CP  10/01/2003 Initial Publication of Manual  NA  NA 
Back to top of Chapter