Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-XII - EXPERIMENTAL OR INVESTIGATIONAL PROCEDURES

Current through June 25, 2024
See the General Rules section for information about
				  procedures that are considered investigational or experimental for purposes of
				  this Fee Schedule and are not approved for reimbursement.
Code
Description
Amount
PC Amount
TC Amount
FUD
Assist Surg
92507
TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC
								IND
131.57
XXX
N
92508
TX SPEECH LANGUAGE VOICE COMMJ AUDITRY
								2/>INDIV
39.53
XXX
N
92521
EVALUATION OF SPEECH FLUENCY (STUTTER
								CLUTTER)
189.39
XXX
N
92522
EVALUATION OF SPEECH SOUND PRODUCTION
								ARTICULATE
153.40
XXX
N
92523
EVAL SPEECH SOUND PRODUCT LANGUAGE
								COMPREHENSION
326.86
XXX
N
95831
MUSC TSTG MNL W/REPRT XTR EX HAND/TRNK
54.28
XXX
N
95832
MUSC TSTG MNL W/REPRT HAND W/WO CMPRSN NRML
								SIDE
53.69
XXX
N
95833
MUSC TSTG MNL W/REPRT TOTAL EVAL BODY EX
								HANDS
70.80
XXX
N
95834
MUSC TSTG MNL W/REPRT TOTAL EVAL BODY
								W/HANDS
92.63
XXX
N
95836
ECOG IMPLANTED BRAIN NPGT W/REC I&R <30
								DAYS
185.26
XXX
N
95851
ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ
								SPI
34.81
XXX
N
95852
ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL
								SID
31.27
XXX
N
97010
APPLICATION MODALITY 1/> AREAS HOT/COLD
								PACKS
9.72
XXX
N
97012
APPL MODALITY 1/> AREAS TRACTION
								MECHANICAL
22.68
XXX
N
97014
APPL MODALITY 1/> AREAS ELEC STIMJ
								UNATTENDED
22.68
XXX
N
97016
APPL MODALITY 1/> AREAS VASOPNEUMATIC
								DEVICES
19.44
XXX
N
97018
APPL MODALITY 1/> AREAS PARAFFIN BATH
10.80
XXX
N
97022
APPLICATION MODALITY 1/> AREAS WHIRLPOOL
27.54
XXX
N
97024
APPLICATION MODALITY 1/> AREAS DIATHERMY
10.80
XXX
N
97026
APPLICATION MODALITY 1/> AREAS INFRARED
9.72
XXX
N
97028
APPL MODALITY 1/> AREAS ULTRAVIOLET
12.42
XXX
N
97032
APPL MODALITY 1/> AREAS ELEC STIMJ EA 15
								MIN
22.68
XXX
N
97033
APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15
								MIN
31.86
XXX
N
97034
APPL MODALITY 1/> AREAS CONTRAST BATHS EA 15
								MIN
23.22
XXX
N
97035
APPL MODALITY 1/> AREAS ULTRASOUND EA 15
								MIN
21.06
XXX
N
97036
APPL MODALITY 1/> AREAS HUBBARD TANK EA 15
								MIN
53.46
XXX
N
97039
UNLIST MODALITY SPEC TYPE&TIME CONSTANT
								ATTEND
BR
XXX
N
97110
THERAPEUTIC PX 1/> AREAS EACH 15 MIN
								EXERCISES
46.98
XXX
N
97112
THER PX 1/> AREAS EACH 15 MIN NEUROMUSC
								REEDUCA
53.46
XXX
N
97113
THER PX 1/> AREAS EACH 15 MIN AQUA THER
								W/XERSS
59.40
XXX
N
97116
THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ
								W/STAIR
46.44
XXX
N
97124
THER PX 1/> AREAS EACH 15 MINUTES MASSAGE
43.74
XXX
N
97127
THERAPEUTIC IVNTJ W/FOCUS ON COGNITIVE
								FUNCTION
42.66
XXX
N
97139
UNLISTED THERAPEUTIC PROCEDURE SPECIFY
27.18
XXX
N
97140
MANUAL THERAPY TQS 1/> REGIONS EACH 15
								MINUTES
42.66
XXX
N
97150
THERAPEUTIC PROCEDURES GROUP 2/>
								INDIVIDUALS
28.08
XXX
N
97151
BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN
BR
XXX
N
97152
BEHAVIOR ID SUPPORT ASSMT BY 1 TECH EA 15
								MIN
BR
XXX
N
97153
ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15
								MIN
BR
XXX
N
97154
GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15
								MIN
BR
XXX
N
97155
ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15
								MIN
BR
XXX
N
97156
FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN
BR
XXX
N
97157
MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15
								MIN
BR
XXX
N
97158
GRP ADAPT BHV PRTCL MODIFCAJ PHYS/QHP EA 15
								MIN
BR
XXX
N
97161
PHYSICAL THERAPY EVALUATION LOW COMPLEX 20
								MINS
129.60
XXX
N
97162
PHYSICAL THERAPY EVALUATION MOD COMPLEX 30
								MINS
129.60
XXX
N
97163
PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45
								MINS
129.60
XXX
N
97164
PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20
								MINS
88.02
XXX
N
97165
OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30
								MINS
139.32
XXX
N
97166
OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45
								MINS
139.32
XXX
N
97167
OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60
								MINS
139.32
XXX
N
97168
OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30
								MINS
95.58
XXX
N
97169
ATHLETIC TRAINING EVAL LOW COMPLEX 15 MINS
85.32
XXX
N
97170
ATHLETIC TRAINING EVAL MOD COMPLEX 30 MINS
99.36
XXX
N
97171
ATHLETIC TRAINING EVAL HIGH COMPLEX 45 MINS
113.94
XXX
N
97172
ATHLETIC TRAINING RE-EVAL EST PLAN CARE 20
								MINS
71.28
XXX
N
97530
THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15
								MIN
61.02
XXX
N
97533
SENSORY INTEGRATIVE TECHNIQUES EACH 15
								MINUTES
65.34
XXX
N
97535
SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
52.38
XXX
N
97537
COMMUNITY/WORK REINTEGRATION TRAINJ EA 15
								MIN
50.22
XXX
N
97542
WHEELCHAIR MGMT EA 15 MIN
50.76
XXX
N
97545
WORK HARDENING/CONDITIONING 1ST 2 HR
130.68
XXX
N
+
97546
WORK HARDENING/CONDITIONING EACH HOUR
64.80
ZZZ
N
97597
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
136.08
000
N
+
97598
DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ
								CM
42.66
ZZZ
N
97602
RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1
								SESS
49.14
XXX
N
97750
PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15
								MIN
53.46
XXX
N
97755
ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15
								MIN
58.32
XXX
N
97760
ORTHOTICS MGMT & TRAINJ INITIAL ENCTR EA 15
								MINS
72.90
XXX
N
97761
PROSTHETICS TRAINING INITIAL ENCTR EA 15
								MINS
62.64
XXX
N
97763
ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15
								MIN
77.22
XXX
N
97799
UNLISTED PHYSICAL MEDICINE/REHAB
								SERVICE/PROC
BR
XXX
N
97810
ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15
								MIN
55.62
XXX
N
+
97811
ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15
								MIN
42.12
ZZZ
N
97813
ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15
								MIN
61.02
XXX
N
+
97814
ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN
								W/RE-INSJ
49.14
ZZZ
N
98925
OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS
52.51
000
N
98926
OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS
75.52
000
N
98927
OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS
99.12
000
N
98928
OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS
120.36
000
N
98929
OSTEOPATHIC MANIPULATIVE TX 9-10 BODY
								REGIONS
143.96
000
N
98940
CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2
								REGIONS
47.20
000
N
98941
CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4
								REGIONS
68.44
000
N
98942
CHIROPRACTIC MANIPULATIVE TX SPINAL 5
								REGIONS
88.50
000
N
98943
CHIROPRACTIC MANIPLTV TX EXTRASPINAL 1/>
								REGION
45.43
XXX
N
99070
SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY
								PHYS/QHP
BR
XXX
N