Denials for Canalith Repositioning (CPT Code 95992)
I have been receiving emails from some of my followers regarding their Medicare Administrative Contractor (MAC) not paying for CPT code 95992 – Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day. This CPT code came out in 2009 and the Centers for Medicare and Medicaid Services (CMS) made this a payable CPT code in 2011. This CPT code is a “per day” CPT code meaning
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Can one NOT bill using 95992 and bill 97112 instead or can one bill both? Basically what are the options to bill the optimal codes in a 45 min treatment session. Thank you. Jo
You must report the CPT code that best describes the intervention(s) provided unless instructed otherwise by the insurance carrier.
The therapist feels that her “education” is in the Canalith charge and concerned about billing another education charge. I don not think its an issue. I would say 97112 is warranted for the additional education during the visit as well as possibly a self care charge. (45 min appointment). So, education in addition to the Canalith “education” built into charge…is reasonable? Certainly ThEX and THProcedures as well, as appropriate. Other thoughts on goal of 3.25 codes per 45 min visit with this population? I am looking into our current denials as well. Thanks or any added suggestions/insight. Jo
Is there a recommendation on how to obtain an dx of BPPV for a patient that you want to perform canalith repositioning on? I know that many practice acts limit a therapist from providing a diagnosis. Would “patient presents with symptoms that are consistent with L BPPV” and having the MD sign off on it, be appropriate?
That is not a question I can answer as it could be state law and/or state practice act specific. Best way is for a physician to DX the patient with BPPV. If they do not DX the patient, then you have to look at your practice act regarding what you are able to provide.
My hospital outpatient departments (part of a large organization) have been asked to use a blanket ABN for all patients we intend to treat with canalith repositioning. The concern is that going back to the provider for an updated diagnosis code is not timely enough. Have you had any experience with this request? It does not feel like the right use of an ABN to me. Thank you!
I would recommend you read my ABN FAQs to get your answer. You can also search for articles on the ABN under Current News.
Hi Rick,
Are PTA’s (with the appropriate supervision based on setting type) able to provide CRT? or is this code limited to a Physical Therapist only, when provided in a Physical Therapy Outpatient Clinic? Thanks!
Whether or not a PTA can provide CRT would be dependent on your state practice act and scope of practice.