Highmark Medical Policy Bulletin |
Section: | Therapy |
Number: | Y-1 |
Topic: | Physical Medicine |
Effective Date: | October 11, 2010 |
Issued Date: | April 11, 2011 |
Date Last Reviewed: |
Indications and Limitations of Coverage
Physical medicine is a covered service when performed with the expectation of restoring the patient's level of function that has been lost or reduced by injury or illness. This type of therapy should be provided in accordance with an ongoing, written treatment plan. The treatment plan should include:
The treatment plan should be updated as the patient's condition changes. Treatment plans for physical medicine, aquatic therapy, and gait training must be maintained in the medical record, and made available upon request. A typical session usually consists of up to one hour of rehabilitative therapy or up to three physical medicine modalities/procedures performed on the same date of service. Coverage for physical medicine is determined according to individual or group customer benefits. Participating, preferred and network providers can bill the member for denied services that exceed the member's benefit limitations. Outpatient physical medicine should be paid in accordance with the following guidelines: Physical Medicine or Athletic Training Evaluation Consequently, when an evaluation and management service is reported in conjunction with a physical medicine evaluation or athletic training evaluation, the services should be combined under the appropriate code for the physical medicine evaluation or athletic training evaluation. A participating, preferred, or network provider cannot bill the member for the E&M service. Modifier 25 may be reported with medical care (e.g. visits, consults) to identify it as significant and separately identifiable from the other service(s) provided on the same day. When modifier 25 is reported, the patient’s records must clearly document that separately identifiable medical care was rendered. Muscle testing (95831-95834), range of motion testing (95851-95852), and physical performance testing (97750) are considered components of a physical medicine evaluation (97001-97002) or an athletic training evaluation (97005-97006), and are not eligible for separate payment when billed on the same day as a physical medicine evaluation or athletic training service. Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines. Maintenance Therapy Physical Medicine Modalities
Aquatic Therapy A provider must have direct (one to one) patient contact when reporting aquatic therapy. Supervising multiple patients in a pool at one time and billing for each of these patients per 15 minutes of therapy time is not acceptable. Before beginning an aquatic therapy program, the provider must prepare a treatment plan that includes short-term and long-term goals that the patient can be reasonably expected to accomplish through the aquatic therapy program and the specific methods chosen. Proper documentation should include:
Procedure code 97113 represents aquatic therapy with therapeutic exercise. Payment for procedure code 97113 includes whirlpool (97022) and/or Hubbard tank (97036). Separate payment will not be made for 97022 or 97036 in addition to 97113 for a single patient encounter. Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines. Gait Training Generally accepted indications for gait training include:
Documentation for gait training must demonstrate that the patient's gait was improved either by lengthening the gait or increasing the frequency of cadence lower-extremity. Procedure code 97116 should not be used to report orthotics or prosthetics training. Orthotics training should be reported using procedure code 97760. Prosthetics training should be reported using procedure code 97761. Vestibular Rehabilitation Therapy A vestibular rehabilitation program may be considered medically necessary for patients with vertigo, disequilibrium, and balance deficits related to the following conditions:
If none of these conditions are reported, a vestibular rehabilitation program is considered not medically necessary, and therefore, not covered. A participating, preferred or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records. A vestibular rehabilitation program may include the following physical medicine or occupational therapy modalities:
The following services are considered experimental/investigational or not medically necessary and therefore, not covered: Dry Hydro Massage (97799) Dry hydro massage is considered not medically necessary. A participating, preferred or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records. The Profiler and Aqua PT are considered forms of dry hydro massage. (See Medical Policy Bulletin V-37 for guidelines on hydrotherapy provided to members with autism spectrum disorders.) Electromagnetic Stimulation (Code 97799) Electromagnetic therapy devices create a magnetic field that penetrates the body creating nerve impulses that innervate smooth and striated muscles. This type of therapy is used for the treatment of bulk muscle excitation, relaxation of muscle spasms, maintaining or increasing range of motion, prevention or retardation of disuse atrophy, muscle re-education, increasing local blood circulation, and immediate post-surgical stimulation of the calf muscles to prevent venous thrombosis. Because the effectiveness of electromagnetic stimulation has not been established, this service is considered experimental/investigational. A participating, preferred or network provider may bill the member for the denied therapy. Equestrian/Hippotherapy (S8940) Date Last Reviewed: 10/2010 Hippotherapy (Equestrian therapy) is a treatment modality that utilizes the movement of a horse as a tool to improve the patient’s neuromuscular function. Hippotherapy is used for patients with compromised neuromuscular function, e.g., cerebral palsy. The horse’s walk provides sensory stimulation through its rhythmic, repetitive movement. The goals of hippotherapy are to combine this treatment modality with other therapeutic modalities to improve balance, posture , mobility and function. Hippotherapy is considered experimental/investigational. Scientific evidence does not demonstrate the efficacy of this service. A participating, preferred, or network provider can bill the member for the denied service. Low-Intensity Pulsed Ultrasound (Hands-Free Ultrasound)(97799) Date Last Reviewed: 02/2011 Hands-free ultrasound is used as an alternative to traditional manual ultrasound. The lower intensity, pulsed treatment allows for a longer treatment time. In traditional ultrasound, the therapist manually moves the soundhead over the treatment area, whereas the stationary soundhead used in this method of ultrasound therapy does not require that the therapist remain with the patient during the duration of the treatment. Hands-free ultrasound therapy is considered investigational. There is a lack of clinical studies showing that lower intensity ultrasound therapy is as effective as traditional ultrasound. Participating, preferred, and network providers can bill the patient for the denied service. Use procedure code 97799 (Unlisted physical medicine/rehabilitation service or procedure) to report this service. Horizontal Therapy (97799) Date Last Reviewed: 01/2011 Horizontal therapy is a form of bioelectrical stimulation. During horizontal therapy, electric current moves through tissues horizontally rather than vertically. Horizontal therapy is considered experimental/investigational. Further studies are needed to determine the long-term efficacy of this modality. A participating, preferred, or network provider can bill the member for the denied service. Use procedure code 97799 (Unlisted physical rehabilitation service or procedure) to report this service. Low-Level Laser Therapy (S8948)(Cold Laser Therapy) Date Last Reviewed: 10/2009 Low-level laser therapy is the non-invasive application of red or cold (subthermal) laser light to injuries or wounds to improve soft tissue healing and relieve both acute and chronic pain (e.g., wound healing, carpal tunnel syndrome, and pain management). Low-level laser therapy is considered experimental/investigational. This service is still being performed in a clinical trial setting with no long-term outcomes available. Further studies are needed to determine the long-term efficacy of this modality. A participating, preferred, or network provider can bill the member for the denied service. NOTE: For information on cognitive rehabilitation, refer to Medical Policy Bulletin Y-21. For information on interferential stimulation, refer to Medical Policy Bulletin E-45. For information on electromagnetic therapy provided for the treatment of urinary incontinence, see Medical Policy Bulletin Y-12. |
97001 | 97002 | 97005 | 97006 | 97010 | 97012 |
97014 | 97016 | 97018 | 97022 | 97024 | 97026 |
97028 | 97032 | 97033 | 97034 | 97035 | 97036 |
97039 | 97110 | 97112 | 97113 | 97116 | 97124 |
97139 | 97140 | 97150 | 97530 | 97760 | 97761 |
97799 | G0283 | S8948 | S8950 | S8990 |
Traditional (UCR/Fee Schedule) Guidelines
This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits are determined by the Federal Employee Program. |
Comprehensive / Wraparound / PPO / Major Medical Guidelines
Any reference in this bulletin to non-billable services by a network provider may not be applicable to Major Medical.
Managed Care (HMO/POS) Guidelines
Please note that POS members may self-refer for outpatient PM&R services. When the member meets the medical necessity criteria detailed in this medical policy, please refer to the member's specific benefits schedule to determine and approve the duration of outpatient physical medicine services. |
PRN References 02/1993, Physical therapy reporting tips |
Electromagnetic Stimulation The Canadian Chiropractic Association, Canadian Federation of Chiropractic Regulatory Boards, Clinical Practice Guidelines Development Initiative, Guidelines Development Committee (GDC). Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash. J Can Chiropr Asso. 2005;49(3):158-209. Work Loss Data Institute. Forearm, wrist, & hand (acute & chronic), not including carpal tunnel syndrome. Corpus Christi (TX). Work Loss Data Institute. 2008. Work Loss Data Institute. Elbow (acute & chronic). Corpus Christi (TX). Work Loss Data Institute. 2008. Benazzo F, Zanon G, Pederzini L, et al. Effects of biophysical stimulation in patients undergoing arthroscopic reconstruction of anterior cruciate ligament: prospective, randomized and double-blind study. Knee Surg Spors Traumatol Arthrosx. 2008;16:595-601. Wróbel M, Szymborska-Kajanek A, Wystrychowski G, et al. Impact of low frequency pulsed magnetic fields on pain intensity, quality of life and sleep disturbances in patients with painful diabetic polyneuropathy. Diabetes & Metabolism. 2008;34:349-354. Hedén P, Pilla A. Effects of Pulsed Electromagnetic Fields on Postoperative Pain: A Double-Blind Randomized Pilot Study in Breast Augmentation Patients. Aesth Plast Surg. 2008;32:660-666. Foley K, Mroz T, Arnold P, et. al. Randomized, prospective, and controlled clinical trial of pulsed electromagnetic field stimulation for cervical fusion. The Spine Journal. 2008:436-442. Weintraub M, Herrmann D, Smith G, Backonja M, Cold S. Pulsed Electromagnetic Fields to Reduce Diabetic Neuropathic Pain and Stimulate Neuronal Repair: A Randomized Controlled Trial. Arch Phys Med Rehabil. July 2009;90:1102-1109. Sutbeyaz S, Sezer N, Koseoglu F, Kibar S. Low-frequency pulsed electromagnetic Field Therapy in Fibromyalgia: A Randomized, Double-blind, Sham-controlled Clinical Study. Clin J Pain. October 2009;25(8):722-728. Ay S, Eveik D. The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial. Rheumatol Int. 2009;29:663-666. Dallari D, Fini M, Giavaresi G, et al. Effects of Pulsed Electromagnetic Stimulation on Patients Undergoing Hip Revision Prostehses: A Randomized Prospective Double-Blind Study. Bioelectromagnetics. 2009;30:423-430. Kroeling P, Gross A, Goldsmith C, et al. Electrotherapy for neck pain. Cochrane Database of Systematic Reviews. 2009;Issue 4. Kaskutas V, Snodgrass J. Occupational therapy practice guidelines for individuals with work-related injuries and illnesses. Bethesda (MD). American Occupational Therapy Association (AOTA). 2009. Hands-Free Ultrasound Frykberg RG, Zgonis T, Armstrong D, et al. Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg. Sept-Oct 2006;45(5):S-2-66. www.guideline.gov/popups/printView.aspx?id=9846. American College of Occupational and Environmental Medicine (ACOEM). Elbow disorders. American College of Occupational and Environmental Medicine (ACOEM). 2007. www.guideline.gov/popups/printView.aspx?id-10883. Rand S, Goerlich C, Marchand K. The Physical Therapy Prescription. Am Fam Physician. Dec. 1, 2007;76(11):1661-1666. Kaskutas V, Snodgrass J. Occupational therapy practice guidelines for individuals with work-related injuries and illnesses. Bethesda (MD). American Occupational Therapy Association (AOTA). 2009. www.guideline.gov/popups/printView.aspx?id=15288. El-Bialy T, Hasan A, Janadas A, Albaghdadi T. Nonsurgical treatment of hemifacial microsomia by therapeutic ultrasound and hybrid functional appliance. Open Access Journal of Clinical Trials. 2010;2:29-36. Gulich DR. Comparison of tissue heating between manual and hands-free ultrasound techniques. Physiother Theory Pract. 2010 Feb;26(2):100-6. Hippotherapy Helga E, Kakebeeke T, Hegemann D, Baumberger M. The Effect of Hippotherapy on Spasticity and on Mental Well-Being of Persons with Spinal Cord Injury. Arch Phys Med Rehabil. 2007;88: Snider L, Korner-Bitensky N, Kammann C, Warner S, Saleh M. Horseback Riding as Therapy for Children with Cerebral Palsy: Is There Evidence of Its Effectiveness? Physical and Occupational Therapy in Pediatrics. 2007 27(2): 5-23 Silkwood-Sherer D, Warmbier H, Effects of Hippotherapy on Postural Stability, in Persons with Multiple Sclerosis: A Pilot Study. JNPT. June 2007;31: 77-84 Murphy D, Kahn-D'Angelo K, Gleason J. The Effect of Hippotherapy on Functional Outcomes for Children with Disabilities: A Pilot Study. Pedistr Phys Ther Fall 2008 20(3):264-70 Anttila H, Autti-Rämö, Suoranta J, Mäkelä M, Malmivaara A. Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatrics. April 24, 2008; 8(14) Johnson C. The Benefits of Physical Activity for Youth with Developmental Disabilities: A Systematic Review. Health Promotion. January/February 2009;23(3): 157-167 Debuse D, Gibb C, Chandler C. Effects of hippotherapy on people with cerebral palsy, from the users’ perspective: A qualitative study. Physiotherapy Theory and Practice. 2009; 25(3): 174 - 192 McGee M, Reese N. Immediate Effects of a Hippotherapy Session on Gait Parameters in Children with Spastic Cerebral Palsy. Pediatric Physical Therapy. 2009;21: 212-218 Oppenheim W. Complementary and alternative methods in cerebral palsy. Developmental Medicine & Child Neurology. 2009;51(4): 122-129 McGibbon N, Benda W, Duncan B, Silkwood-Sherer D. Immediate anhd Long-Term Effectis of Hippotherapy on Symmetry of Adductor Muscle Activity and Functional Ability in Children with Spastic Cerebral Palsy. Arch Phys Med Rehabil. June 2009;90: 966-974. Horizontal Stimulation California Technology Assessment Form. Interferential Stimulation for the Treatment of Musculoskeletal Pain. October 19, 2005. Demirtürk F, Akbayrak T, Karakaya C, et al. Interferential current versus biofeedback results in urinary stress incontinence. SwissMed Wkly. 2008;138(21-22):317-321. Kajbafzadeh A, Sharif-Rad L, Baradaran N, Nejat F. Effect of Pelvic Floor Interferential Electrostimulation on Urodynamic Parameters and Incontinency of Children with Myelomeningocele and Detrusor Overactivity. Urology. August 2009;74(2). Chen C, Johnson M. An Investigational Into the Effects of Frequency-Modulated Transcutaneous Electrical Nerve Stimulation (TENS) on Experimentally-Induced Pressure Pain in Health Human Participants. J Pain. October 2009;10(10):1029-1037. Clarke M, Chase J, Gibb S, et al. Improvement of quality of life in children with slow transit constipation after treatment with transcutaneous electrical stimulation. J Ped Surg. 2009;44:1268-1273. Clark M, Chase J, Gibb S, et al. Decreased colonic transit time after transcutaneous interferential electrical stimulation in children with slow transit constipation. J Ped Surg. 2009;44:408-412. Duffy R. Low Back Pain: An Approach to Diagnosis and Management. Primary Care: Clinics in Office Practice. Dec. 2010;37(4). Horizontal Therapy (Interferential Stimulation) CMS National Coverage Determination: Infrared Therapy Devices (CAG-0029IN), Oct. 4, 2006 Saggini R, Carniel R, Cancelli F. Treatment of Shoulder Injuries with Associated Arthrosynovitis Using Horizontal Therapy. Eur Med Phys. 2006; 42(Suppl. 1 to No 2): 669-72 Zambito A, Bianchini D, Gatti D, Rossini M, Adami S, Viapiana O. Interferential and horizontal therapies in chronic low back pain due to multiple vertebral fractures: a randomized, double blind, clinical study. Osteoporos Int. 2007; 18(11): 1541-5 Low Level Laser Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database of Systemic Reviews, 2003, Issue 3. www.mrw.interscience.wiley.com/cochrane/clsysrev. Mazzetto M, Carrasco T, Bidinelo E, Pizzo R, Mazzetto R. Low Intensity Laser Application in Temporomandibular Disorders: A Phase I Double-Blind Study. J Craniomandibular Practice. July 2007;25(3): 186-192 Bjordal J, Johnson M, Rodrigo A, et. al. Short-term Efficacy of Physical Interventions in Osteoarthritic Knee Pain. A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials. BMC Musculoskeletal Disorders. 10/02/2007; www.medscape.com. Accessed June 25, 2009 Crawford F, Thomson C. Low level laser therapy for nonspecific low-back pain. Cochrane Database of Systemic Reviews, April 2008, Issue 2 www.mrw.interscience.wiley.com/cochrane/clsysrev. Accessed June 22, 2009 Gungor A, Dogru S, Cincik H, Erkul E, Poyrazoclu E. Effectiveness of transmeatal low power laser irradiation for chronic tinnitus. J Laryng Otol. 2008; 122: 447-451 Emshoff R, Bosch R, Pümpel E, Schöning H, Strobl H. Low-level laser therapy for treatment of temporomandibular joint pain: a double-blind and placebo-controlled trial. Oral Med Oral Pathol Oral Radiol Endod.2008;105(4):452-6 Stergioulas A, Stergioula M, Aarskog R, et. al. Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes with Chronic Achilles Tendinopathy. The American Journal of Sports Medicine. 2008;36(5): 881 – 887 Shooshtari S, Badie V, Taghizadeh S, et. al. The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome. Electromyogr. Clin Neurophysiol. 2008; 48: 229-231 Unlu Z, Tascl S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 Physical Therapy Modalities for Acute Pain in Lumbar Disc Herniation Measured by Clinical Evaluation and Magnetic Resonance Imaging. J. Manip Phys Thera, Vol 31, No 3;March/April 2008: 191-198 Lawenda B, Mondry T, Johnstone P. Lymphedema: A Primer on the Identification and Management of a Chronic Condition in Oncologic Treatment. CA Cancer J Clin. January/February 2009;59(1): 8-24 Low-intensity Pulsed Ultrasound Magnetotherapy: Historical Background with a Stimulating Future, Critical Reviews in Physical and Rehabilitation Medicine, Vol. 16, No. 2, 2004 Pulsed magnetic field therapy in refractory neuropathic pain secondary to peripheral neuropathy: electrodiagnostic parameters - pilot study, Neurorehabil Neural Repair, Vol 18, No.1, March 2004 Effect of pulsed magnetic field therapy on the level of fatigue in patients with multiple sclerosis - a randomized controlled trial, Multiple Sclerosis, Vol. 11, No.3, June 2005 The Effect of Monochromatic Infrared Energy on Sensation in Patients with Diabetic Peripheral Neuropathy, Diabetes Care, Vol. 28, No. 12, December 2005 Paick JS, Lee SC, Ku JH. More effects of extracorporeal magnetic innervation and terazosin therapy than terazosin therapy lone for non-inflammatory chronic pelvic pain syndrome: a pilot study. Prostate Cancer and Prostate Diseases. 2006;9(3): 261-65 Warden S, Hons B. Avin K, et. al. Low-Intensity Pulsed Ultrasound Accelerates and a Nonsteroidal Anti-inflammatory Drug Delays Knee Ligament Healing. The American Journal of Sports Medicine. 2006; 34(7): 1094 – 1101 Fernandex M, Watson P, Rowbotham D. Effect of pulsed magnetic field therapy on pain reported by human volunteers in a laboratory model of acute pain. Br J Anaesth. 2007; 99(2):266-269 Ilknur A, Kenan A, Bahar C. Therapeutic effect of pulsed electromagnetic field in conservative treatment of subacromial impingement syndrome. Clin Rheumatol. 2008;26: 1234-1239 Szymborska-Kajanek A; Wystrychowski G, Biniszkiewicq T, Impact of low frequency pulsed magnetic fields on pain intensity, quality of life and sleep disturbances in patients with painful diabetic polyneuropathy. Diabetes Metab 01-Sept-2008;34(4 Pt 1): 349-54 Warden S, Metcalf B, Kiss Z, et. al. Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial. Rheumatology. February 2008; 47: 467-471 Khanna A, Nelmes R, Gougoulias N, Maffulli N, Gray J. The effects of LIPUS on soft-tissue healing: a review of literature. British Medical Bulletin. November 2008: 1-14 Korstjens C, van der Rijt R, Albers G, Semeins C, Klein-Nulend J. Low-intensity pulsed ultrasound affects human articular chondrocytes in vitro. Med Biol Eng Comput. 2008; 46: 1263-1270 Fu S, MPhil, Shum W, et. al. Low-Intensity Pulsed Ultrasound on Tendon Healing. The American Journal of Sports Medicine. 2008;36(9): 1742 – 1749 Weintraub M, Cole S. A Randomized Controlled Trial of the Effects of a Combination of Static and Dynamic Magnetic Fields on Carpal Tunnel Syndrome. Pain Med. 2008;9(5): 493-504 Vestibular Rehabilitation Vestibular Rehabilitation of Patients with Vestibular Hypofunction or with Benign Paroxysmal Positional Vertigo, Current Opinions, Neurology, Vol. 13, No. 1, 02/2000 Efficacy of Vestibular Rehabilitation, Otolaryngologic Clinics of North America, Vol. 33, No. 3, 06/2000 Outcome Analysis of Individualized Vestibular Rehabilitation Protocols, The American Journal of Otology, Vol. 21, No. 4, 07/2000 |
Covered Diagnosis Codes
Vasopneumatic Compression (97016)
457.0 | 457.1 | 459.81 | 729.81 |
757.0 | 782.3 | 924.00 | 924.10 |
924.4 | 924.5 |
Non-covered Diagnosis Codes
Infrared Therapy (97026)
250.60-250.63 | 354.4 | 354.5 | 354.9 |
355.1-355.6 | 355.71-355.79 | 355.8-355.9 | 356.0 |
356.2-356.4 | 356.8-356.9 | 357.0-357.7 | 674.10 |
674.12 | 674.14 | 674.20 | 674.22 |
674.24 | 707.00-707.07 | 707.09 | 707.10-707.15 |
707.19 | 870.0-870.9 | 871.0-871.9 | 872.00-872.02 |
872.10-872.12 | 872.61-872.69 | 872.71-872.79 | 872.8-872.9 |
873.0-873.1 | 873.20-873.29 | 873.30-873.39 | 873.40-873.49 |
873.50-873.59 | 873.60-873.69 | 873.70-873.79 | 873.8-873.9 |
874.00-874.02 | 874.10-874.12 | 874.2-874.9 | 875.0-875.1 |
876.0-876.1 | 877.0-877.1 | 878.0-878.9 | 879.0-879.9 |
880.00-880.09 | 880.10-880.19 | 880.20-880.29 | 881.00-881.02 |
881.10-881.12 | 881.20-881.22 | 882.0-882.2 | 883.0-883.2 |
884.0-884.2 | 885.0-885.1 | 886.0-886.1 | 887.0-887.7 |
890.0-890.2 | 891.0-891.2 | 892.0-892.2 | 893.0-893.2 |
894.0-894.2 | 895.0-895.1 | 896.0-896.3 | 897.0-897.7 |
998.31-998.32 |
Covered Diagnosis Codes
Vestibular Rehabilitation Therapy
340 | 386.10-386.19 | 386.30-386.35 |
INFORMATIONAL ONLY
Covered Diagnosis Codes
Vasopneumatic Compression (97016)
I87.2 | I87.9 | I89.0 | I97.2 |
M79.89 | Q82.0 | R60.0 | R60.1 |
R60.9 | S70.10xA | S70.11xA | S70.12xA |
S80.10xA | S80.11xA | S80.12xA |
Non-covered Diagnosis Codes
Infrared Therapy (97026)
A52.15 | E08.40 | E08.41 | E08.42 |
E08.621 | E09.40 | E09.41 | E09.42 |
E09.621 | E10.40 | E10.41 | E10.42 |
E10.43 | E10.44 | E10.49 | E10.610 |
E10.65 | E11.40 | E11.41 | E11.42 |
E11.43 | E11.44 | E11.49 | E11.610 |
E11.65 | E13.40 | E13.41 | E13.42 |
E13.43 | E13.44 | E13.49 | E13.610 |
G13.0 | G13.1 | G56.40 | G56.41 |
G56.42 | G56.90 | G56.91 | G56.92 |
G57.10 | G57.11 | G57.12 | G57.20 |
G57.21 | G57.22 | G57.30 | G57.31 |
G57.32 | G57.40 | G57.41 | G57.42 |
G57.50 | G57.51 | G57.52 | G57.60 |
G57.61 | G57.62 | G57.70 | G57.71 |
G57.72 | G57.80 | G57.81 | G57.82 |
G57.90 | G57.91 | G57.92 | G58.7 |
G58.8 | G58.9 | G59 | G60.0 |
G60.1 | G60.2 | G60.3 | G60.8 |
G60.9 | G61.0 | G61.1 | G62.0 |
G62.1 | G62.2 | G62.82 | G63 |
G65.0 | G65.1 | G65.2 | I70.231 |
I70.232 | I70.233 | I70.234 | I70.235 |
I70.238 | I70.239 | I70.241 | I70.242 |
I70.243 | I70.244 | I70.245 | I70.248 |
I70.249 | I70.331 | I70.332 | I70.333 |
I70.334 | I70.335 | I70.338 | I70.339 |
I70.341 | I70.342 | I70.343 | I70.344 |
I70.345 | I70.348 | I70.349 | I70.431 |
I70.432 | I70.433 | I70.434 | I70.435 |
I70.438 | I70.439 | I70.441 | I70.442 |
I70.443 | I70.444 | I70.445 | I70.448 |
I70.449 | I70.531 | I70.532 | I70.533 |
I70.534 | I70.535 | I70.538 | I70.539 |
I70.541 | I70.542 | I70.543 | I70.544 |
I70.545 | I70.548 | I70.549 | I70.631 |
I70.632 | I70.633 | I70.634 | I70.635 |
I70.638 | I70.639 | I70.641 | I70.642 |
I70.643 | I70.644 | I70.645 | I70.648 |
I70.649 | I70.731 | I70.732 | I70.733 |
I70.734 | I70.735 | I70.738 | I70.739 |
I70.741 | I70.742 | I70.743 | I70.744 |
I70.745 | I70.748 | I70.749 | L89.000 |
L89.001 | L89.002 | L89.003 | L89.004 |
L89.009 | L89.010 | L89.011 | L89.012 |
L89.013 | L89.014 | L89.019 | L89.020 |
L89.021 | L89.022 | L89.023 | L89.024 |
L89.029 | L89.100 | L89.101 | L89.102 |
L89.103 | L89.104 | L89.109 | L89.110 |
L89.111 | L89.112 | L89.113 | L89.114 |
L89.119 | L89.120 | L89.121 | L89.122 |
L89.123 | L89.124 | L89.129 | L89.130 |
L89.131 | L89.132 | L89.133 | L89.134 |
L89.139 | L89.140 | L89.141 | L89.142 |
L89.143 | L89.144 | L89.149 | L89.150 |
L89.151 | L89.152 | L89.153 | L89.154 |
L89.159 | L89.200 | L89.201 | L89.202 |
L89.203 | L89.204 | L89.209 | L89.210 |
L89.211 | L89.212 | L89.213 | L89.214 |
L89.219 | L89.220 | L89.221 | L89.222 |
L89.223 | L89.224 | L89.229 | L89.300 |
L89.301 | L89.302 | L89.303 | L89.304 |
L89.309 | L89.310 | L89.311 | L89.312 |
L89.313 | L89.314 | L89.319 | L89.320 |
L89.321 | L89.322 | L89.323 | L89.324 |
L89.329 | L89.40 | L89.41 | L89.42 |
L89.43 | L89.44 | L89.45 | L89.500 |
L89.501 | L89.502 | L89.503 | L89.504 |
L89.509 | L89.510 | L89.511 | L89.512 |
L89.513 | L89.514 | L89.519 | L89.520 |
L89.521 | L89.522 | L89.523 | L89.524 |
L89.529 | L89.600 | L89.601 | L89.602 |
L89.603 | L89.604 | L89.609 | L89.610 |
L89.611 | L89.612 | L89.613 | L89.614 |
L89.619 | L89.620 | L89.621 | L89.622 |
L89.623 | L89.624 | L89.629 | L89.810 |
L89.811 | L89.812 | L89.813 | L89.814 |
L89.819 | L89.890 | L89.891 | L89.892 |
L89.893 | L89.894 | L89.899 | L89.90 |
L89.91 | L89.92 | L89.93 | L89.94 |
L89.95 | L97.101 | L97.102 | L97.103 |
L97.104 | L97.109 | L97.111 | L97.112 |
L97.113 | L97.114 | L97.119 | L97.121 |
L97.122 | L97.123 | L97.124 | L97.129 |
L97.201 | L97.202 | L97.203 | L97.204 |
L97.209 | L97.211 | L97.212 | L97.213 |
L97.214 | L97.219 | L97.221 | L97.222 |
L97.223 | L97.224 | L97.229 | L97.301 |
L97.302 | L97.303 | L97.304 | L97.309 |
L97.311 | L97.312 | L97.313 | L97.314 |
L97.319 | L97.321 | L97.322 | L97.323 |
L97.324 | L97.329 | L97.401 | L97.402 |
L97.403 | L97.404 | L97.409 | L97.411 |
L97.412 | L97.413 | L97.414 | L97.419 |
L97.421 | L97.422 | L97.423 | L97.424 |
L97.429 | L97.501 | L97.502 | L97.503 |
L97.504 | L97.509 | L97.511 | L97.512 |
L97.513 | L97.514 | L97.519 | L97.521 |
L97.522 | L97.523 | L97.524 | L97.529 |
L97.801 | L97.802 | L97.803 | L97.804 |
L97.809 | L97.811 | L97.812 | L97.813 |
L97.814 | L97.819 | L97.821 | L97.822 |
L97.823 | L97.824 | L97.829 | L97.901 |
L97.902 | L97.903 | L97.904 | L97.909 |
L97.911 | L97.912 | L97.913 | L97.914 |
L97.919 | L97.921 | L97.922 | L97.923 |
L97.924 | L97.929 | M05.50 | M05.511 |
M05.512 | M05.519 | M05.521 | M05.522 |
M05.529 | M05.531 | M05.532 | M05.539 |
M05.541 | M05.542 | M05.549 | M05.551 |
M05.552 | M05.559 | M05.561 | M05.562 |
M05.569 | M05.571 | M05.572 | M05.579 |
M05.59 | M34.83 | O90.0 | O90.1 |
S01.00xA | S01.01xA | S01.02xA | S01.03xA |
S01.04xA | S01.05xA | S01.101A | S01.102A |
S01.109A | S01.111A | S01.112A | S01.119A |
S01.121A | S01.122A | S01.129A | S01.131A |
S01.132A | S01.139A | S01.141A | S01.142A |
S01.149A | S01.151A | S01.152A | S01.159A |
S01.20xA | S01.21xA | S01.22xA | S01.23xA |
S01.24xA | S01.25xA | S01.301A | S01.302A |
S01.309A | S01.311A | S01.312A | S01.319A |
S01.321A | S01.322A | S01.329A | S01.331A |
S01.332A | S01.339A | S01.341A | S01.342A |
S01.349A | S01.351A | S01.352A | S01.359A |
S01.401A | S01.402A | S01.409A | S01.411A |
S01.412A | S01.419A | S01.421A | S01.422A |
S01.429A | S01.431A | S01.432A | S01.439A |
S01.441A | S01.442A | S01.449A | S01.451A |
S01.452A | S01.459A | S01.501A | S01.502A |
S01.511A | S01.512A | S01.521A | S01.522A |
S01.531A | S01.532A | S01.541A | S01.542A |
S01.551A | S01.552A | S01.80xA | S01.81xA |
S01.82xA | S01.83xA | S01.84xA | S01.85xA |
S01.90xA | S01.91xA | S01.92xA | S01.93xA |
S01.94xA | S01.95xA | S02.5xxA | S02.5xxB |
S03.2xxA | S05.20xA | S05.21xA | S05.22xA |
S05.30xA | S05.31xA | S05.32xA | S05.40xA |
S05.41xA | S05.42xA | S05.50xA | S05.51xA |
S05.52xA | S05.60xA | S05.61xA | S05.62xA |
S05.70xA | S05.71xA | S05.72xA | S05.8x1A |
S05.8x2A | S05.8x9A | S05.90xA | S05.91xA |
S05.92xA | S08.0xxA | S08.111A | S08.112A |
S08.119A | S08.121A | S08.122A | S08.129A |
S08.811A | S08.812A | S08.89xA | S09.12xA |
S09.20xA | S09.21xA | S09.22xA | S09.301A |
S09.302A | S09.309A | S09.311A | S09.312A |
S09.313A | S09.319A | S09.391A | S09.392A |
S09.399A | S09.8xxA | S09.90xA | S09.91xA |
S09.93xA | S11.011A | S11.012A | S11.013A |
S11.014A | S11.015A | S11.019A | S11.021A |
S11.022A | S11.023A | S11.024A | S11.025A |
S11.029A | S11.031A | S11.032A | S11.033A |
S11.034A | S11.035A | S11.039A | S11.10xA |
S11.11xA | S11.12xA | S11.13xA | S11.14xA |
S11.15xA | S11.20xA | S11.21xA | S11.22xA |
S11.23xA | S11.24xA | S11.25xA | S11.80xA |
S11.81xA | S11.82xA | S11.83xA | S11.84xA |
S11.85xA | S11.89xA | S11.90xA | S11.91xA |
S11.92xA | S11.93xA | S11.94xA | S11.95xA |
S16.2xxA | S21.001A | S21.002A | S21.009A |
S21.011A | S21.012A | S21.019A | S21.021A |
S21.022A | S21.029A | S21.031A | S21.032A |
S21.039A | S21.041A | S21.042A | S21.049A |
S21.051A | S21.052A | S21.059A | S21.101A |
S21.102A | S21.109A | S21.111A | S21.112A |
S21.119A | S21.121A | S21.122A | S21.129A |
S21.131A | S21.132A | S21.139A | S21.141A |
S21.142A | S21.149A | S21.151A | S21.152A |
S21.159A | S21.201A | S21.202A | S21.209A |
S21.211A | S21.212A | S21.219A | S21.221A |
S21.222A | S21.229A | S21.231A | S21.232A |
S21.239A | S21.241A | S21.242A | S21.249A |
S21.251A | S21.252A | S21.259A | S21.90xA |
S21.91xA | S21.92xA | S21.93xA | S21.94xA |
S21.95xA | S28.1xxA | S28.211A | S28.212A |
S28.219A | S28.221A | S28.222A | S28.229A |
S29.021A | S29.022A | S29.029A | S31.000A |
S31.010A | S31.020A | S31.030A | S31.040A |
S31.050A | S31.100A | S31.101A | S31.102A |
S31.103A | S31.104A | S31.105A | S31.109A |
S31.110A | S31.111A | S31.112A | S31.113A |
S31.114A | S31.115A | S31.119A | S31.120A |
S31.121A | S31.122A | S31.123A | S31.124A |
S31.125A | S31.129A | S31.130A | S31.131A |
S31.132A | S31.133A | S31.134A | S31.135A |
S31.139A | S31.140A | S31.141A | S31.142A |
S31.143A | S31.144A | S31.145A | S31.149A |
S31.150A | S31.151A | S31.152A | S31.153A |
S31.154A | S31.155A | S31.159A | S31.20xA |
S31.21xA | S31.22xA | S31.23xA | S31.24xA |
S31.25xA | S31.30xA | S31.31xA | S31.32xA |
S31.33xA | S31.34xA | S31.35xA | S31.40xA |
S31.41xA | S31.42xA | S31.43xA | S31.44xA |
S31.45xA | S31.501A | S31.502A | S31.511A |
S31.512A | S31.521A | S31.522A | S31.531A |
S31.532A | S31.541A | S31.542A | S31.551A |
S31.552A | S31.801A | S31.802A | S31.803A |
S31.804A | S31.805A | S31.809A | S31.811A |
S31.812A | S31.813A | S31.814A | S31.815A |
S31.819A | S31.821A | S31.822A | S31.823A |
S31.824A | S31.825A | S31.829A | S31.831A |
S31.832A | S31.833A | S31.834A | S31.835A |
S31.839A | S38.211A | S38.212A | S38.221A |
S38.222A | S38.231A | S38.232A | S38.3xxA |
S39.021A | S39.022A | S39.023A | S41.001A |
S41.002A | S41.009A | S41.011A | S41.012A |
S41.019A | S41.021A | S41.022A | S41.029A |
S41.031A | S41.032A | S41.039A | S41.041A |
S41.042A | S41.049A | S41.051A | S41.052A |
S41.059A | S41.101A | S41.102A | S41.109A |
S41.111A | S41.112A | S41.119A | S41.121A |
S41.122A | S41.129A | S41.131A | S41.132A |
S41.139A | S41.141A | S41.142A | S41.149A |
S41.151A | S41.152A | S41.159A | S46.021A |
S46.022A | S46.029A | S46.121A | S46.122A |
S46.129A | S46.221A | S46.222A | S46.229A |
S46.321A | S46.322A | S46.329A | S46.821A |
S46.822A | S46.829A | S46.921A | S46.922A |
S46.929A | S48.011A | S48.012A | S48.019A |
S48.021A | S48.022A | S48.029A | S48.111A |
S48.112A | S48.119A | S48.121A | S48.122A |
S48.129A | S48.911A | S48.912A | S48.919A |
S48.921A | S48.922A | S48.929A | S51.001A |
S51.002A | S51.009A | S51.011A | S51.012A |
S51.019A | S51.021A | S51.022A | S51.029A |
S51.031A | S51.032A | S51.039A | S51.041A |
S51.042A | S51.049A | S51.051A | S51.052A |
S51.059A | S51.801A | S51.802A | S51.809A |
S51.811A | S51.812A | S51.819A | S51.821A |
S51.822A | S51.829A | S51.831A | S51.832A |
S51.839A | S51.841A | S51.842A | S51.849A |
S51.851A | S51.852A | S51.859A | S56.021A |
S56.022A | S56.029A | S56.121A | S56.122A |
S56.123A | S56.124A | S56.125A | S56.126A |
S56.127A | S56.128A | S56.129A | S56.221A |
S56.222A | S56.229A | S56.321A | S56.322A |
S56.329A | S56.421A | S56.422A | S56.423A |
S56.424A | S56.425A | S56.426A | S56.427A |
S56.428A | S56.429A | S56.521A | S56.522A |
S56.529A | S56.821A | S56.822A | S56.829A |
S56.921A | S56.922A | S56.929A | S58.011A |
S58.012A | S58.019A | S58.021A | S58.022A |
S58.029A | S58.111A | S58.112A | S58.119A |
S58.121A | S58.122A | S58.129A | S58.911A |
S58.912A | S58.919A | S58.921A | S58.922A |
S58.929A | S61.001A | S61.002A | S61.009A |
S61.011A | S61.012A | S61.019A | S61.021A |
S61.022A | S61.029A | S61.031A | S61.032A |
S61.039A | S61.041A | S61.042A | S61.049A |
S61.051A | S61.052A | S61.059A | S61.101A |
S61.102A | S61.109A | S61.111A | S61.112A |
S61.119A | S61.121A | S61.122A | S61.129A |
S61.131A | S61.132A | S61.139A | S61.141A |
S61.142A | S61.149A | S61.151A | S61.152A |
S61.159A | S61.200A | S61.201A | S61.202A |
S61.203A | S61.204A | S61.205A | S61.206A |
S61.207A | S61.208A | S61.209A | S61.210A |
S61.211A | S61.212A | S61.213A | S61.214A |
S61.215A | S61.216A | S61.217A | S61.218A |
S61.219A | S61.220A | S61.221A | S61.222A |
S61.223A | S61.224A | S61.225A | S61.226A |
S61.227A | S61.228A | S61.229A | S61.230A |
S61.231A | S61.232A | S61.233A | S61.234A |
S61.235A | S61.236A | S61.237A | S61.238A |
S61.239A | S61.240A | S61.241A | S61.242A |
S61.243A | S61.244A | S61.245A | S61.246A |
S61.247A | S61.248A | S61.249A | S61.250A |
S61.251A | S61.252A | S61.253A | S61.254A |
S61.255A | S61.256A | S61.257A | S61.258A |
S61.259A | S61.300A | S61.301A | S61.302A |
S61.303A | S61.304A | S61.305A | S61.306A |
S61.307A | S61.308A | S61.309A | S61.310A |
S61.311A | S61.312A | S61.313A | S61.314A |
S61.315A | S61.316A | S61.317A | S61.318A |
S61.319A | S61.320A | S61.321A | S61.322A |
S61.323A | S61.324A | S61.325A | S61.326A |
S61.327A | S61.328A | S61.329A | S61.330A |
S61.331A | S61.332A | S61.333A | S61.334A |
S61.335A | S61.336A | S61.337A | S61.338A |
S61.339A | S61.340A | S61.341A | S61.342A |
S61.343A | S61.344A | S61.345A | S61.346A |
S61.347A | S61.348A | S61.349A | S61.350A |
S61.351A | S61.352A | S61.353A | S61.354A |
S61.355A | S61.356A | S61.357A | S61.358A |
S61.359A | S61.401A | S61.402A | S61.409A |
S61.411A | S61.412A | S61.419A | S61.421A |
S61.422A | S61.429A | S61.431A | S61.432A |
S61.439A | S61.441A | S61.442A | S61.449A |
S61.451A | S61.452A | S61.459A | S61.501A |
S61.502A | S61.509A | S61.511A | S61.512A |
S61.519A | S61.521A | S61.522A | S61.529A |
S61.531A | S61.532A | S61.539A | S61.541A |
S61.542A | S61.549A | S61.551A | S61.552A |
S61.559A | S66.021A | S66.022A | S66.029A |
S66.120A | S66.121A | S66.122A | S66.123A |
S66.124A | S66.125A | S66.126A | S66.127A |
S66.128A | S66.129A | S66.221A | S66.222A |
S66.229A | S66.320A | S66.321A | S66.322A |
S66.323A | S66.324A | S66.325A | S66.326A |
S66.327A | S66.328A | S66.329A | S66.421A |
S66.422A | S66.429A | S66.520A | S66.521A |
S66.522A | S66.523A | S66.524A | S66.525A |
S66.526A | S66.527A | S66.528A | S66.529A |
S66.821A | S66.822A | S66.829A | S66.921A |
S66.922A | S66.929A | S68.011A | S68.012A |
S68.019A | S68.021A | S68.022A | S68.029A |
S68.110A | S68.111A | S68.112A | S68.113A |
S68.114A | S68.115A | S68.116A | S68.117A |
S68.118A | S68.119A | S68.120A | S68.121A |
S68.122A | S68.123A | S68.124A | S68.125A |
S68.126A | S68.127A | S68.128A | S68.129A |
S68.411A | S68.412A | S68.419A | S68.421A |
S68.422A | S68.429A | S68.511A | S68.512A |
S68.519A | S68.521A | S68.522A | S68.529A |
S68.610A | S68.611A | S68.612A | S68.613A |
S68.614A | S68.615A | S68.616A | S68.617A |
S68.618A | S68.619A | S68.620A | S68.621A |
S68.622A | S68.623A | S68.624A | S68.625A |
S68.626A | S68.627A | S68.628A | S68.629A |
S68.711A | S68.712A | S68.719A | S68.721A |
S68.722A | S68.729A | S71.001A | S71.002A |
S71.009A | S71.011A | S71.012A | S71.019A |
S71.021A | S71.022A | S71.029A | S71.031A |
S71.032A | S71.039A | S71.041A | S71.042A |
S71.049A | S71.051A | S71.052A | S71.059A |
S71.101A | S71.102A | S71.109A | S71.111A |
S71.112A | S71.119A | S71.121A | S71.122A |
S71.129A | S71.131A | S71.132A | S71.139A |
S71.141A | S71.142A | S71.149A | S71.151A |
S71.152A | S71.159A | S76.021A | S76.022A |
S76.029A | S76.121A | S76.122A | S76.129A |
S76.221A | S76.222A | S76.229A | S76.321A |
S76.322A | S76.329A | S76.821A | S76.822A |
S76.829A | S76.921A | S76.922A | S76.929A |
S78.011A | S78.012A | S78.019A | S78.021A |
S78.022A | S78.029A | S78.111A | S78.112A |
S78.119A | S78.121A | S78.122A | S78.129A |
S78.911A | S78.912A | S78.919A | S78.921A |
S78.922A | S78.929A | S81.001A | S81.002A |
S81.009A | S81.011A | S81.012A | S81.019A |
S81.021A | S81.022A | S81.029A | S81.031A |
S81.032A | S81.039A | S81.041A | S81.042A |
S81.049A | S81.051A | S81.052A | S81.059A |
S81.801A | S81.802A | S81.809A | S81.811A |
S81.812A | S81.819A | S81.821A | S81.822A |
S81.829A | S81.831A | S81.832A | S81.839A |
S81.841A | S81.842A | S81.849A | S81.851A |
S81.852A | S81.859A | S86.021A | S86.022A |
S86.029A | S86.121A | S86.122A | S86.129A |
S86.221A | S86.222A | S86.229A | S86.321A |
S86.322A | S86.329A | S86.821A | S86.822A |
S86.829A | S86.921A | S86.922A | S86.929A |
S88.011A | S88.012A | S88.019A | S88.021A |
S88.022A | S88.029A | S88.111A | S88.112A |
S88.119A | S88.121A | S88.122A | S88.129A |
S88.911A | S88.912A | S88.919A | S88.921A |
S88.922A | S88.929A | S91.001A | S91.002A |
S91.009A | S91.011A | S91.012A | S91.019A |
S91.021A | S91.022A | S91.029A | S91.031A |
S91.032A | S91.039A | S91.041A | S91.042A |
S91.049A | S91.051A | S91.052A | S91.059A |
S91.101A | S91.102A | S91.103A | S91.104A |
S91.105A | S91.106A | S91.109A | S91.111A |
S91.112A | S91.113A | S91.114A | S91.115A |
S91.116A | S91.119A | S91.121A | S91.122A |
S91.123A | S91.124A | S91.125A | S91.126A |
S91.129A | S91.131A | S91.132A | S91.133A |
S91.134A | S91.135A | S91.136A | S91.139A |
S91.141A | S91.142A | S91.143A | S91.144A |
S91.145A | S91.146A | S91.149A | S91.151A |
S91.152A | S91.153A | S91.154A | S91.155A |
S91.156A | S91.159A | S91.201A | S91.202A |
S91.203A | S91.204A | S91.205A | S91.206A |
S91.209A | S91.211A | S91.212A | S91.213A |
S91.214A | S91.215A | S91.216A | S91.219A |
S91.221A | S91.222A | S91.223A | S91.224A |
S91.225A | S91.226A | S91.229A | S91.231A |
S91.232A | S91.233A | S91.234A | S91.235A |
S91.236A | S91.239A | S91.241A | S91.242A |
S91.243A | S91.244A | S91.245A | S91.246A |
S91.249A | S91.251A | S91.252A | S91.253A |
S91.254A | S91.255A | S91.256A | S91.259A |
S91.301A | S91.302A | S91.309A | S91.311A |
S91.312A | S91.319A | S91.321A | S91.322A |
S91.329A | S91.331A | S91.332A | S91.339A |
S91.341A | S91.342A | S91.349A | S91.351A |
S91.352A | S91.359A | S96.021A | S96.022A |
S96.029A | S96.121A | S96.122A | S96.129A |
S96.221A | S96.222A | S96.229A | S96.821A |
S96.822A | S96.829A | S96.921A | S96.922A |
S96.929A | S98.011A | S98.012A | S98.019A |
S98.021A | S98.022A | S98.029A | S98.111A |
S98.112A | S98.119A | S98.121A | S98.122A |
S98.129A | S98.131A | S98.132A | S98.139A |
S98.141A | S98.142A | S98.149A | S98.211A |
S98.212A | S98.219A | S98.221A | S98.222A |
S98.229A | S98.311A | S98.312A | S98.319A |
S98.321A | S98.322A | S98.329A | S98.911A |
S98.912A | S98.919A | S98.921A | S98.922A |
S98.929A | T81.31xA | T81.32xA |
Covered Diagnosis Codes
Vestibular Rehabilitation Therapy
G35 | H81.10 | H81.11 | H81.12 |
H81.13 | H81.20 | H81.21 | H81.22 |
H81.23 | H81.311 | H81.312 | H81.313 |
H81.319 | H81.391 | H81.392 | H81.393 |
H81.399 | H83.01 | H83.02 | H83.03 |
H83.09 |