Choose Your Medicare Locality: ALABAMA ALASKA* ARIZONA ARKANSAS ATLANTA AUSTIN BAKERSFIELD BALTIMORE/SURR. CNTYS BEAUMONT BRAZORIA CHICAGO CHICO COLORADO CONNECTICUT DALLAS DC + MD/VA SUBURBS DELAWARE DETROIT EAST ST. LOUIS EL CENTRO FORT LAUDERDALE FORT WORTH FRESNO GALVESTON HANFORD-CORCORAN HAWAII, GUAM HOUSTON IDAHO INDIANA IOWA KANSAS KENTUCKY LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) MADERA MANHATTAN MERCED METROPOLITAN BOSTON METROPOLITAN KANSAS CITY METROPOLITAN PHILADELPHIA METROPOLITAN ST. LOUIS MIAMI MINNESOTA MISSISSIPPI MODESTO MONTANA** NAPA NEBRASKA NEVADA** NEW HAMPSHIRE NEW MEXICO NEW ORLEANS NORTH CAROLINA NORTH DAKOTA** NORTHERN NJ NYC SUBURBS/LONG ISLAND OHIO OKLAHOMA OXNARD-THOUSAND OAKS-VENTURA PORTLAND POUGHKPSIE/N NYC SUBURBS PUERTO RICO QUEENS REDDING REST OF CALIFORNIA REST OF FLORIDA REST OF GEORGIA REST OF ILLINOIS REST OF LOUISIANA REST OF MAINE REST OF MARYLAND REST OF MASSACHUSETTS REST OF MICHIGAN REST OF MISSOURI REST OF NEW JERSEY REST OF NEW YORK REST OF OREGON REST OF PENNSYLVANIA REST OF TEXAS REST OF WASHINGTON RHODE ISLAND RIVERSIDE-SAN BERNARDINO-ONTARIO SACRAMENTO-ROSEVILLE-FOLSOM SALINAS SAN DIEGO-CHULA VISTA-CARLSBAD SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) SAN LUIS OBISPO-PASO ROBLES SANTA CRUZ-WATSONVILLE SANTA MARIA-SANTA BARBARA SANTA ROSA-PETALUMA SEATTLE (KING CNTY) SOUTH CAROLINA SOUTH DAKOTA** SOUTHERN MAINE STOCKTON SUBURBAN CHICAGO TENNESSEE UTAH VALLEJO VERMONT VIRGIN ISLANDS VIRGINIA VISALIA WEST VIRGINIA WISCONSIN WYOMING** YUBA CITY

Assistant involved in treatment: No Yes

Encounter Charges:

97161: PT Initial Eval (Low Complexity) ¹ 97162: PT Initial Eval (Moderate Complexity) ¹ 97163: PT Initial Eval (High Complexity) ¹ 97164: PT Re-Eval ¹ 97165: OT Initial Eval (Low Complexity) ¹ 97166: OT Initial Eval (Moderate Complexity) ¹ 97167: OT Initial Eval (High Complexity) ¹ 97168: OT Re-Eval ¹ 97110: Therapeutic Exercises 97140: Manual Therapy 97012: Mechanical Traction 97014: Electrical Stimulation (unattended) 97016: Vasopneumatic device 97018: Paraffin Bath 97022: Whirlpool 97024: Diathermy 97026: Infrared 97028: Ultraviolet 97032: Electrical Stimulation (manual) 97033: Iontophoresis 97034: Contrast Bath 97035: Ultrasound 97036: Hubbard Tank / Hydrotherapy 97039: Physical therapy treatment - unlisted 97112: Neuromuscular Re Education 97113: Aquatic Therapy/Exercises 97116: Gait Training 97150: Group Therapeutic Procedures 97530: Therapeutic Activities 97532: Cognitive skills development 97533: Sensory integration 97535: Self Care / Home Management Training 97537: Community / work reintegration training 97542: Wheelchair Management / Propulsion training 97550: Caregiver Training Without the Patient Present, Initial 30 Minutes 97551: Caregiver Training Without the Patient Present, Additional 15 Minures 97552: Group Caregiver Training Without the Patient Present 97760: Orthotic mgmt and training 97761: Prosthetic training 97762: C/o for orthotic/prosth use G0283: Elec stim other than wound 95907: Motor 1-2 nrv cndj test 95908: Motor 3-4 nrv cndj test 95909: Motor 5-6 nrv cndj test 95910: Motor 7-8 nrv cndj test 95911: Motor 9-10 nrv cndj test 95912: Motor 11-12 nrv cndj test 95913: Motor 13 nrv cndj test G2061: Non-Physician E-Visit (5-10 Minutes) G2062: Non-Physician E-Visit (11-20 Minutes) G2063: Non-Physician E-Visit (21+ Minutes) 95992: Canalith Repositioning		Units   1 2 3 4 5 6
97161: PT Initial Eval (Low Complexity) ¹ 97162: PT Initial Eval (Moderate Complexity) ¹ 97163: PT Initial Eval (High Complexity) ¹ 97164: PT Re-Eval ¹ 97165: OT Initial Eval (Low Complexity) ¹ 97166: OT Initial Eval (Moderate Complexity) ¹ 97167: OT Initial Eval (High Complexity) ¹ 97168: OT Re-Eval ¹ 97110: Therapeutic Exercises 97140: Manual Therapy 97012: Mechanical Traction 97014: Electrical Stimulation (unattended) 97016: Vasopneumatic device 97018: Paraffin Bath 97022: Whirlpool 97024: Diathermy 97026: Infrared 97028: Ultraviolet 97032: Electrical Stimulation (manual) 97033: Iontophoresis 97034: Contrast Bath 97035: Ultrasound 97036: Hubbard Tank / Hydrotherapy 97039: Physical therapy treatment - unlisted 97112: Neuromuscular Re Education 97113: Aquatic Therapy/Exercises 97116: Gait Training 97150: Group Therapeutic Procedures 97530: Therapeutic Activities 97532: Cognitive skills development 97533: Sensory integration 97535: Self Care / Home Management Training 97537: Community / work reintegration training 97542: Wheelchair Management / Propulsion training 97550: Caregiver Training Without the Patient Present, Initial 30 Minutes 97551: Caregiver Training Without the Patient Present, Additional 15 Minures 97552: Group Caregiver Training Without the Patient Present 97760: Orthotic mgmt and training 97761: Prosthetic training 97762: C/o for orthotic/prosth use G0283: Elec stim other than wound 95907: Motor 1-2 nrv cndj test 95908: Motor 3-4 nrv cndj test 95909: Motor 5-6 nrv cndj test 95910: Motor 7-8 nrv cndj test 95911: Motor 9-10 nrv cndj test 95912: Motor 11-12 nrv cndj test 95913: Motor 13 nrv cndj test G2061: Non-Physician E-Visit (5-10 Minutes) G2062: Non-Physician E-Visit (11-20 Minutes) G2063: Non-Physician E-Visit (21+ Minutes) 95992: Canalith Repositioning		Units   1 2 3 4 5 6
97161: PT Initial Eval (Low Complexity) ¹ 97162: PT Initial Eval (Moderate Complexity) ¹ 97163: PT Initial Eval (High Complexity) ¹ 97164: PT Re-Eval ¹ 97165: OT Initial Eval (Low Complexity) ¹ 97166: OT Initial Eval (Moderate Complexity) ¹ 97167: OT Initial Eval (High Complexity) ¹ 97168: OT Re-Eval ¹ 97110: Therapeutic Exercises 97140: Manual Therapy 97012: Mechanical Traction 97014: Electrical Stimulation (unattended) 97016: Vasopneumatic device 97018: Paraffin Bath 97022: Whirlpool 97024: Diathermy 97026: Infrared 97028: Ultraviolet 97032: Electrical Stimulation (manual) 97033: Iontophoresis 97034: Contrast Bath 97035: Ultrasound 97036: Hubbard Tank / Hydrotherapy 97039: Physical therapy treatment - unlisted 97112: Neuromuscular Re Education 97113: Aquatic Therapy/Exercises 97116: Gait Training 97150: Group Therapeutic Procedures 97530: Therapeutic Activities 97532: Cognitive skills development 97533: Sensory integration 97535: Self Care / Home Management Training 97537: Community / work reintegration training 97542: Wheelchair Management / Propulsion training 97550: Caregiver Training Without the Patient Present, Initial 30 Minutes 97551: Caregiver Training Without the Patient Present, Additional 15 Minures 97552: Group Caregiver Training Without the Patient Present 97760: Orthotic mgmt and training 97761: Prosthetic training 97762: C/o for orthotic/prosth use G0283: Elec stim other than wound 95907: Motor 1-2 nrv cndj test 95908: Motor 3-4 nrv cndj test 95909: Motor 5-6 nrv cndj test 95910: Motor 7-8 nrv cndj test 95911: Motor 9-10 nrv cndj test 95912: Motor 11-12 nrv cndj test 95913: Motor 13 nrv cndj test G2061: Non-Physician E-Visit (5-10 Minutes) G2062: Non-Physician E-Visit (11-20 Minutes) G2063: Non-Physician E-Visit (21+ Minutes) 95992: Canalith Repositioning		Units   1 2 3 4 5 6
97161: PT Initial Eval (Low Complexity) ¹ 97162: PT Initial Eval (Moderate Complexity) ¹ 97163: PT Initial Eval (High Complexity) ¹ 97164: PT Re-Eval ¹ 97165: OT Initial Eval (Low Complexity) ¹ 97166: OT Initial Eval (Moderate Complexity) ¹ 97167: OT Initial Eval (High Complexity) ¹ 97168: OT Re-Eval ¹ 97110: Therapeutic Exercises 97140: Manual Therapy 97012: Mechanical Traction 97014: Electrical Stimulation (unattended) 97016: Vasopneumatic device 97018: Paraffin Bath 97022: Whirlpool 97024: Diathermy 97026: Infrared 97028: Ultraviolet 97032: Electrical Stimulation (manual) 97033: Iontophoresis 97034: Contrast Bath 97035: Ultrasound 97036: Hubbard Tank / Hydrotherapy 97039: Physical therapy treatment - unlisted 97112: Neuromuscular Re Education 97113: Aquatic Therapy/Exercises 97116: Gait Training 97150: Group Therapeutic Procedures 97530: Therapeutic Activities 97532: Cognitive skills development 97533: Sensory integration 97535: Self Care / Home Management Training 97537: Community / work reintegration training 97542: Wheelchair Management / Propulsion training 97550: Caregiver Training Without the Patient Present, Initial 30 Minutes 97551: Caregiver Training Without the Patient Present, Additional 15 Minures 97552: Group Caregiver Training Without the Patient Present 97760: Orthotic mgmt and training 97761: Prosthetic training 97762: C/o for orthotic/prosth use G0283: Elec stim other than wound 95907: Motor 1-2 nrv cndj test 95908: Motor 3-4 nrv cndj test 95909: Motor 5-6 nrv cndj test 95910: Motor 7-8 nrv cndj test 95911: Motor 9-10 nrv cndj test 95912: Motor 11-12 nrv cndj test 95913: Motor 13 nrv cndj test G2061: Non-Physician E-Visit (5-10 Minutes) G2062: Non-Physician E-Visit (11-20 Minutes) G2063: Non-Physician E-Visit (21+ Minutes) 95992: Canalith Repositioning		Units   1 2 3 4 5 6