Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 339.00 - Rates for Restorative Services › Section 339.04 - Allowable Fees

Current through Register 1525, July 5, 2024
(1)
Fee
			 Schedule
.
Service Code
Allowable Fee
Service Description
Special Otorhinolaryngologic
							 Services
92507
$73.64
Treatment of speech, language, voice, communication,
							 and/or auditory processing disorder; individual (maximum one unit per
							 visit)
92508
$31.53
Treatment of speech, language, voice, communication,
							 and/or auditory processing disorder; group, two or more individuals (maximum
							 one unit per visit)
92521
$79.52
Evaluation of speech fluency (e.g., stuttering,
							 cluttering)
92521 HA
$79.52
Evaluation of speech fluency (e.g., stuttering,
							 cluttering) (for patients younger than 21 years old)
92521 TF
$79.52
Evaluation of speech fluency
(e.g.,
stuttering, cluttering) (for developmentally disabled adults 22 years of age or
							 older)
92522
$64.41
Evaluation of speech sound production
(e.g.,
articulation, phonological process, apraxia,
							 dysarthria)
92522 HA
$64.41
Evaluation of speech sound production
(e.g.,
articulation, phonological process, apraxia,
							 dysarthria) (for patients younger than 21 years old)
92522 TF
$64.41
Evaluation of speech sound production (e.g.,
							 articulation, phonological process, apraxia, dysarthria) (for developmentally
							 disabled adults 22 years of age or older)
92523
$133.99
Evaluation of speech sound production (e.g.,
							 articulation, phonological process, apraxia, dysarthria); with evaluation of
							 language comprehension and expression (e.g., receptive and expressive
							 language)
92523 HA
$133.99
Evaluation of speech sound production (e.g.,
							 articulation, phonological process, apraxia, dysarthria); with evaluation of
							 language comprehension and expression (e.g., receptive and expressive language)
							 (for patients younger than 21 years old)
92523 TF
$133.99
Evaluation of speech sound production (e.g.,
							 articulation, phonological process, apraxia, dysarthria); with evaluation of
							 language comprehension and expression
(e.g.,
receptive and
							 expressive language) (for developmentally disabled adults 22 years of age or
							 older)
92524
$66.82
Behavioral and qualitative analysis of voice and
							 resonance
92524 HA
$66.82
Behavioral and qualitative analysis of voice and
							 resonance (for patients younger than 21 years old)
92524 TF
$66.82
Behavioral and qualitative analysis of voice and
							 resonance (for developmentally disabled adults 22 years of age or
							 older)
92526
$28.15
Treatment of swallowing dysfunction and/or oral
							 function for feeding (maximum one unit per visit)
Evaluative and Therapeutic
							 Services
92605
$64.41
Evaluation for prescription of non-speech-generating
							 augmentative and alternative communication device, face-to-face with the
							 patient; first hour
92606
$16.11
Therapeutic service(s) for the use of
							 non-speech-generating device, including programming and
							 modification
92607
$64.41
Evaluation for prescription for speech-generating
							 augmentative and alternative communication device, face-to-face with the
							 patient; first hour
92608
$32.21
Evaluation for prescription for speech-generating
							 augmentative and alternative communication device, face-to-face with the
							 patient; each additional 30 minutes (list separately in addition to code for
							 primary procedure)
92609
$16.11
Therapeutic services for the use of speech-generating
							 device, including programming and modification
92610
$64.41
Evaluation of oral and pharyngeal swallowing function
							 (per hour, maximum of one hour)
92630
$14.68
Auditory rehabilitation; prelingual hearing
							 loss
92633
$14.68
Auditory rehabilitation; postlingual hearing
							 loss
Physical Medicine and
							 Rehabilitation
97161
$64.41
Physical therapy evaluation - Low complex 20
							 min
97162
$64.41
Physical therapy evaluation - Mod complex - 30
							 min
97163
$64.41
Physical therapy evaluation High complex - 45
							 min
97164
$64.41
Physical therapy reevaluation Est. Plan Care - 20
							 min
97165
$64.41
Occupational therapy evaluation Low complex - 30
							 min
97166
$64.41
Occupational therapy evaluation Mod complex - 45
							 min
97167
$64.41
Occupational therapy evaluation High complex - 60
							 min
97168
$64.41
Occupational therapy re-evaluation Est. Plan Care -
							 30 min
Modalities - Supervised
97010
$4.27
Application of a modality to one or more areas; hot
							 or cold packs
97012
$12.63
Application of a modality to one or more areas;
							 traction, mechanical
97014
$12.69
Application of a modality to one or more areas;
							 electrical stimulation (unattended)
97016
$13.04
Application of a modality to one or more areas;
							 vasopneumatic devices
97018
$6.47
Application of a modality to one or more areas;
							 paraffin bath
97022
$4.64
Application of a modality to one or more areas;
							 whirlpool
97024
$4.27
Application of a modality to one or more areas;
							 diathermy
(e.g.,
microwave)
97026
$5.24
Application of a modality to one or more areas;
							 infrared
97028
$4.27
Application of a modality to one or more areas;
							 ultraviolet
Modalities - Constant
							 Attendance
97032
$14.68
Application of a modality to one or more areas;
							 electrical stimulation (manual), each 15 minutes
97033
$14.68
Application of a modality to one or more areas;
							 iontophoresis, each 15 minutes
97034
$14.68
Application of a modality to one or more areas;
							 contrast baths, each 15 minutes
97035
$14.68
Application of a modality to one or more areas;
							 ultrasound, each 15 minutes
97036
$14.68
Application of a modality to one or more areas;
							 Hubbard tank, each 15 minutes
97039
$14.68
Unlisted modality (specify type and time if constant
							 attendance)
Therapeutic Procedures
97110
$16.11
Therapeutic procedure, one or more areas, each 15
							 minutes; therapeutic exercises to develop strength and endurance, range of
							 motion and flexibility
97112
$16.11
Therapeutic procedure, one or more areas, each 15
							 minutes; neuromuscular reeducation of movement, balance, coordination,
							 kinesthetic sense, posture, and/or proprioception for sitting and/or standing
							 activities
97113
$16.11
Therapeutic procedure, one or more areas, each 15
							 minutes; aquatic therapy with therapeutic exercises
97116
$16.11
Therapeutic procedure, one or more areas, each 15
							 minutes; gait training (includes stair climbing)
97124
$16.11
Therapeutic procedure, one or more areas, each 15
							 minutes; massage, including effleurage, petrissage and/or tapotement (stroking,
							 compression, percussion)
97139
$16.11
Unlisted therapeutic procedure (specify) (each 15
							 minutes)
97140
$16.11
Manual therapy techniques
(e.g.,
mobilization/ manipulation, manual lymphatic drainage, manual traction), one or
							 more regions, each 15 minutes
97150
$25.56
Therapeutic procedure(s), group (two or more
							 individuals) (services delivered under an outpatient plan of care) (maximum one
							 unit per visit)
97530
$16.11
Therapeutic activities, direct (one-on-one) patient
							 contact (use of dynamic activities to improve functional performance), each 15
							 minutes
97532
$14.68
Development of cognitive skills to improve attention,
							 memory, problem solving (includes compensatory training), direct (one-on-one)
							 patient contact, each 15 minutes
97533
$14.68
Sensory integrative techniques to enhance sensory
							 processing and promote adaptive responses to environmental demands, direct
							 (one-on-one) patient contact, each 15 minutes
97535
$16.11
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, each 15 minutes
97537
$14.68
Community/work reintegration training (e.g.,
							 shopping, transportation, money management, avocational activities and/or work
							 environment/modification analysis, work task analysis, use of assistive
							 technology device/adaptive equipment) direct one-on-one contact, each 15
							 minutes
97542
$14.68
Wheelchair management (e.g., assessment, fitting,
							 training), each 15 minutes
97545
$117.41
Work hardening/conditioning; initial two
							 hours
97546
$58.70
Work hardening/conditioning; each additional hour
							 (list separately in addition to code for primary procedure) (use in conjunction
							 with 97545)
Active Wound Care
							 Management
97597
$47.06
Debridement (e.g., high pressure waterjet
							 with/without suction, sharp selective debridement with scissors, scalpel and
							 forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis,
							 exudate, debris, biofilm), including topical application(s), wound assessment,
							 use of a whirlpool, when performed and instruction(s) for ongoing care, per
							 session, total wound(s) surface area; first 20 square centimeters or
							 less
97598
$58.90
Debridement (e.g., high pressure waterjet
							 with/without suction, sharp selective debridement with scissors, scalpel and
							 forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis,
							 exudate, debris, biofilm), including topical application(s), wound assessment,
							 use of a whirlpool, when performed and instruction(s) for ongoing care, per
							 session, total wound(s) surface area; each additional 20 sq. cm., or part
							 thereof (list separately in addition to code for primary procedure)
97602
I.C.
Removal of devitalized tissue from wound(s),
							 non-selective debridement, without anesthesia (e.g., wet-to-moist dressings,
							 enzymatic, abrasion), including topical application(s), wound assessment, and
							 instruction(s) for ongoing care, per session
97605
$30.44
Negative pressure wound therapy (e.g., vacuum
							 assisted drainage collection), utilizing durable medical equipment (DME),
							 including topical application(s), wound assessment, and instruction(s) for
							 ongoing care, per session; total wound(s) surface area less than or equal to 50
							 square centimeters
97606
$32.58
Negative pressure wound therapy (e.g., vacuum
							 assisted drainage collection), utilizing durable medical equipment (DME),
							 including topical application(s), wound assessment, and instruction(s) for
							 ongoing care, per session; total wound(s) surface area greater than 50 square
							 centimeters
Tests and Measurements
97750
$14.68
Physical performance test or measurement (e.g.,
							 musculoskeletal, functional capacity), with written report, each 15
							 minutes
97755
$14.68
Assistive technology assessment (e.g., to restore,
							 augment or compensate for existing function, optimize functional tasks and/or
							 maximize environmental accessibility), direct one-on-one contact, with written
							 report, each 15 minutes
Orthotic Management and Prosthetic
							 Management
97760
$16.11
Orthotic(s) management and training (including
							 assessment and fitting when not otherwise reported), upper extremity(s), lower
							 extremity(s) and/or trunk, each 15 minutes
97761
$16.11
Prosthetic training, upper and/or lower extremity(s),
							 each 15 minutes
97762
$14.68
Checkout for orthotic/prosthetic use, established
							 patient, each 15 minutes
Other Procedures
97799
$16.11
Unlisted physical medicine/rehabilitation service or
							 procedure (each 15 minutes, maximum six units per visit)
Evaluation and Management - Office or Other
							 Outpatient Services
99203
$84.41
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key
							 components:
- a detailed history;
- a detailed examination; and
- medical decision making of low
							 complexity
99205
$160.33
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components
							 (written report required):
- a comprehensive history;
- a comprehensive examination; and
- medical decision making of high
							 complexity
99212
$34.20
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components:
- a problem focused history;
- a problem focused examination; and
- straightforward medical decision making
99214
$82.96
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components (written report required):
- a detailed history;
- a detailed examination; and
- medical decision making of moderate
							 complexity
99215
$112.01
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components (written report required):
- a comprehensive history;
- a comprehensive examination; and
- medical decision making of high
							 complexity
(2)
Hourly Rates for I.C. Designated Services, Special Contracts, and
			 Unlisted Procedures
. As a guideline, rates for restorative and
			 rehabilitation center services for aquatic therapy, nautilus training, work
			 evaluations/job site analysis, work hardening programs, and other unlisted
			 services are determined by applying the appropriate portion of the hourly rate
			 specified in 101 CMR 339.04(2). Diagnostic procedures that require specialized
			 machinery, such as muscle testing during isometric and isokinetic exercises
(e.g.,
use of cybex machine), should be reimbursed with
			 consideration for additional equipment costs and technical assistance, in
			 addition to the prorated hourly fee for therapists' services and routine
			 overhead expenses.
Rehabilitation Center Physical
							 Therapist
$64.41/hr.
Rehabilitation Center Occupational
							 Therapist
$64.41/hr.
Rehabilitation Center Speech
							 Therapist
$64.41/hr.
Restorative Physical Therapy office
							 visit
$64.41/hr.
Restorative Occupational Therapy office
							 visit
$64.41/hr.
Restorative Speech Therapy office
							 visit
$64.41/hr.
Restorative Physical Therapy out-of-office
							 visit
$74.07/hr.
Restorative Occupational Therapy out-of-office
							 visit
$74.07/hr.
Restorative Speech Therapy out-of-office
							 visit
$74.07/hr.