Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 41.00 - RATES OF PAYMENT FOR SERVICES PROVIDED TO INDUSTRIAL ACCIDENT PATIENTS BY HOSPITALS › Section 41.04 - Hospital Outpatient Rates

Current through Register 1525, July 5, 2024
(1)
General
. Except as specified below, payments for
			 outpatient services provided by Massachusetts hospitals shall be made at the
			 rates established for comparable services in accordance with 114.3 CMR 40.00,
			 Rates for Services Under M.G.L. c. 152, Workers' Compensation Act.
(a)
Rehabilitation Clinic
			 Services and Restorative Services
.
1.
Fees for Sites of Service
			 After July 1, 1993
. Payment for rehabilitation clinic or
			 restorative services provided in a program or location established after July
			 1, 1993, shall be equal to the rates specified in 114.3 CMR 40.00.
2.
Fees for Sites of Service
			 Before July 1, 1993
. The rates for individual outpatient physical,
			 occupational, and speech therapy services that a Hospital provided in a program
			 established before July 1, 1993 are listed below. A list of these sites of
			 service is available on the Division's web site at
www.mass.gov/dhcfp
.
a. Fees for Physical Therapy and Occupational
			 Therapy in Out Patient Department (OPD) Clinics and Satellites Owned and
			 Operated by a Hospital Prior to July 1, 1993.
CODE
FEE
DESCRIPTION
97002
43.46
Physical therapy re-evaluation (per 30
							 minutes)
97004
53.45
Occupational therapy re-evaluation (per 30
							 minutes)
97012
16.10
Application of a modality to one or more areas;
							 traction, mechanical
G0283
14.24
Electrical stimulation (unattended), to one or more
							 areas for indication(s) other than wound care, as part of a therapy plan of
							 care
97016
15.55
Application of a modality to one or more areas;
							 vasopneumatic devices
97018
7.41
Application of a modality to one or more areas;
							 paraffin bath
97022
16.46
Application of a modality to one or more areas;
							 whirlpool
97024
5.24
Application of a modality to one or more areas;
							 diathermy
97026
5.24
Application of a modality to one or more areas;
							 infrared
97028
6.45
Application of a modality to one or more areas;
							 ultraviolet
97032
17.83
Application of a modality to one or more areas;
							 electrical stimulation (manual), each 15 minutes
97034
15.41
Application of a modality to one or more areas;
							 contrast baths, each 15 minutes
97035
13.24
Application of a modality to one or more areas;
							 ultrasound, each 15 minutes
97036
25.51
Application of a modality to one or more areas;
							 Hubbard tank, each 15 minutes
97039
12.85
Unlisted modality (specify type and time if constant
							 attendance)
97110
30.55
Therapeutic procedure, one or more areas, each 15
							 minutes; therapeutic exercises to develop strength and endurance, range of
							 motion and flexibility
97112
31.55
Therapeutic procedure, one or more areas, each 15
							 minutes; neuromuscular reeducation of movement, balance, coordination,
							 kinesthetic sense, posture, and proprioception
97113
32.77
Therapeutic procedure, one or more areas, each 15
							 minutes; aquatic therapy with therapeutic exercises
97116
27.00
Therapeutic procedure, one or more areas, each 15
							 minutes; gait training (includes stair climbing)
97124
24.32
Therapeutic procedure, one or more areas, each 15
							 minutes; massage, including effleurage, petrissage and/or tapotement (stroking,
							 compression, percussion)
97139
17.58
Therapeutic procedure, one or more areas, each 15
							 minutes; unlisted therapeutic procedure (specify)
97140
29.04
Manual therapy techniques (
e.g.
,
							 mobilization/ manipulation, manual lymphatic drainage, manual traction), one or
							 more regions, each 15 minutes
97150
20.52
Therapeutic procedure(s), group (two or more
							 individuals)
97530
31.16
Therapeutic activities, direct (one on one) patient
							 contact by the provider (use of dynamic activities to improve functional
							 performance), each 15 minutes
97532
26.08
Development of cognitive skills to improve attention,
							 memory, problem solving, (includes compensatory training), direct (one-on-one)
							 patient contact by the provider, each 15 minutes
97533
27.82
Sensory integrative techniques to enhance sensory
							 processing and promote adaptive responses to environmental demands, direct
							 (one-on-one) patient contact by the provider, each 15 minutes
97535
33.72
Self care/home management training
							 (
e.g
., activities of daily living (ADL) and compensatory
							 training, meal preparation, safety procedures, and instructions in use of
							 assistive technology devices/adaptive equipment) direct one on one contact by
							 provider, each 15 minutes
97537
29.51
Community/work reintegration training
							 (
e.g
., shopping, transportation, money management, avocational
							 activities and/or work environment/modification analysis, work task analysis),
							 direct one-on-one contact by provider, each 15 minutes
97542
30.38
Wheelchair management/propulsion training, each 15
							 minutes
97545
147.92
Work hardening/conditioning; initial two
							 hours
97546
73.96
Work hardening/conditioning; each additional
							 hour
97750
33.55
Physical performance test or measurement
							 (
e.g
., musculoskeletal, functional capacity), with written
							 report, each 15 minutes
97799
I.C.
Unlisted physical medicine/rehabilitation service or
							 procedure
b.
			 Fees for Speech Therapy in OPD Clinics and Satellites Owned and Operated by a
			 Hospital Prior to July 1, 1993.
CODE
FEE
DESCRIPTION
92507
88.56
Treatment of speech, language, voice, communication,
							 and/or auditory processing disorder (includes aural rehabilitation);
							 individual
92508
73.38
Treatment of speech, language, voice, communication,
							 and/ or auditory processing disorder (includes aural rehabilitation); group,
							 two or more individuals
92526
92.33
Treatment of swallowing dysfunction and/or oral
							 function for feeding
c.
Exceptions
. To comply with the requirements of M.G.L.
			 c. 152, & 13, the rates for the following Hospitals shall equal the higher
			 of the rates contained in 114.3 CMR 40.00 or the product of the fees listed in
			 114.1 CMR 41.04(1)(b)2.a. and 114.1 CMR 41.04(1)(b)2.b. and the Hospital
			 specific percentage listed below:
Hospital Name
Physical Therapy: Fee X %
Occupational Therapy: Fee X %
Speech Therapy: Fee X %
Brockton Hospital
79%
100%
100%
Fairlawn Hospital
99%
99%
99%
Mass. Eye and Ear
100%
92%
100%
New England Rehabilitation Hospital
86%
86%
86%
North Shore Medical Center - Shaughnessy Kaplan
							 Rehab
87%
91%
82%
Southwood Community Hospital
88%
100%
100%
3.
Functional Capacity
			 Assessments
. To report a functional capacity assessment (or Key
			 functional assessment), hospitals shall use CPT code 97750 that may be billed
			 up to a maximum of nine units per session.
4.
Work Hardening and Work
			 Conditioning
. Work hardening and work conditioning are
			 goal-oriented therapies designed to prepare injured workers for their return to
			 work. Hospitals shall use CPT codes 97545 and 97456 to report these
			 services.
5.
Modalities
. Hospitals may assess a Charge for
			 supportive services (CPT codes 97012-97039) only in conjunction with a
			 procedure performed during the course of the same visit. When determining the
			 correct units allowed, Hospitals shall round partial units to one decimal
			 place.