The American Medical Association created CPT code 29581 that became effective for dates of service on and after January 1, 2010 and CPT code 29584 that became effective for dates of service on and after January 1, 2012. Even though these codes have been active for 11 and 9 years respectively, there is still much confusion regarding the use and billing of these codes for patients who have lymphedema and are receiving outpatient physical and/or occupational therapy services.
In this article, I will answer the following questions:
- What is the description of each CPT code?
- Are these CPT codes time-based or untimed?
- Can these codes be billed by physical therapists, physical therapist assistants, occupational therapists and occupational therapy assistants?
- Does the Medicare program pay for CPT codes 29581 and 29584?
- Do commercial and private insurance carriers pay for CPT codes 29581 and 29584?
- Can CPT codes 29581 and 29584 be billed by physical therapists, physical therapist assistants, occupational therapists and occupational therapy assistants who apply a multi-layer compression wrap for a patient with a diagnosis of lymphedema?
- If I provide a multi-layer compression wrap to either both upper extremities or lower extremities, how would I do the billing?
- If an insurance carrier does not pay for CPT codes 29581 and 29584, can I add the minutes it takes me to perform the compression bandaging to the manual therapy CPT code, 97140?
What is the description of each CPT code?
Are these CPT codes time-based or untimed?
Can these codes be billed by physical therapists, physical therapist assistants, occupational therapists and occupational therapy assistants?
Does the Medicare program pay for CPT codes 29581 and 29584?
Do commercial and private insurance carriers pay for CPT codes 29581 and 29584?
Can CPT codes 29581 and 29584 be billed by physical therapists, physical therapist assistants, occupational therapists and occupational therapy assistants who apply a multi-layer compression wrap for a patient with a diagnosis of lymphedema?
If I provide a multi-layer compression wrap to either both upper extremities or lower extremities, how would I do the billing?
If an insurance carrier does not pay for CPT codes 29581 and 29584, can I add the minutes it takes me to perform the compression bandaging to the manual therapy CPT code, 97140?
I hope you found this Q&A article helpful and informative. Thank you for being a Gold Member!
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We treat people with lymphedema 5 days / week for approximately 2 weeks. Can we bill 29581 every visit, plus 1-2 units of 97140 or 97124?
You would need to know what the patient’s coverage is for therapy and then make sure documentation supports that level of intensity. Technically, you can bill whatever you want as long as it’s provided. The key is the insurance coverage and your documentation on whether you will be reimbursed or not.
Rick, is this approved in Pennsylvania with novitas ?
You would want to review the Novitas therapy policy.
Can these codes be billed with 97140 – manual therapy during the same visit?
Please refer to the current version of NCCI edits regarding your question.
Does this code cover only the application of the bandages? If you are billing bandages to the insurance, do you use different supply codes?
The code includes the bandages as that is part of the practice expense RVU.
I was hoping for clarification. It describes the codes are to be used for a multi layer system. Is that a special device this is referring to or simply the application of the wrapping.
A multi-layer compression system can be accomplished via bandaging.
Do these codes count towards the Medicare cap?
There is no Medicare cap. It has been called a therapy threshold since January 1, 2018. To answer your question, no.
I’m confused as to why the code only covers the lower leg. Quite often we have to wrap the entire leg. Is there a code for that as it certainly is a lengthier procedure.
29581: Application of multi-layer compression system; leg (below knee), including ankle and foot
It would be the same code if you did the entire leg.
Regarding your above answer to the question about CPT codes 29581 or 29584 when applied bilaterally:
“You would bill the applicable CPT code for 1 unit with the full charge for both applications and apply modifier 50 to that CPT code on the claim form. For Medicare and many commercial payors, proper application of modifier 50 increases reimbursement to 150 percent of the allowable fee…” Would the charge billed need to be at least the 50% above the allowable amount than in order to receive the 150%? Meaning, if my charge was just the allowable and I used modifier 50, my assumption is I am just going to receive that charge and not expect to see them add the additional 50% because I did not charge for it? Can you please clarify. Thank you.
I would make sure your charge for the service is above the dollar amount that you are expecting the insurance carrier to reimburse.
Yes I understand,
but if the amount expected for unilateral care is say $92 and I charge $100, and then do bilateral care and am using the same CPT code but just adding a modifier 50, my reimbursement would only be $100 rather than $138 (50% above allowed unilaterally). Is that correct? That would suggest to me I would want to charge, in this case, something like $140 whether performing the procedure unilaterally or bilaterally. Is my thinking correct on that? Thank you.
You would want to make sure your charge is at least, if not higher, than what you are expecting to be reimbursed.
Hello, I sent this via the contact me link as well but wasn’t sure which method was more appropriate.
The CCI edit page and your comments above seem to indicate that 29581 can be billed with 97140 with a 59 modifier. However, our coding team is indicating that is not true if both are being performed in the same anatomic region. They are referencing the chapter 4 of the NCCI policy manual on page 16 it has the statement pasted below. Can you comment on if you believe they are interpreting this accurately in stating that 97140 and 29581 cannot be billed for the same anatomic region in the same day? If you do not believe it is accurate can you provide additional support for why?
17. Application of a multi-layer compression system (CPT
codes 29581-29584) includes manual therapy in the anatomic
region of the multi-layer compression system. CPT code 97140
(Manual therapy techniques…) shall not be reported for any
type of manual therapy at the same patient encounter in the
anatomic region where a multi-layer compression system is
Is there a limit to how many times you can bill these treatment codes? 3 or fewer treatments?
That would be insurance carrier specific if they limit the billing and reimbursement of any CPT codes.