Copyright held by The John Cooke Fraud Report. Reprint rights are granted with attribution to The John Cooke Fraud Report with a link to this website.
Modality Billing Codes
97010 hot or cold packs
97012 mechanical traction
97014 electrical stimulation (unattended)
97016 vasopneumatic devices
97018 paraffin bath
97020 microwave
97022 whirlpool
97024 diathermy
97026 infrared
97028 ultraviolet
97039 unlisted modality (must be specified)
97110 therapeutic exercise
97112 neuromuscular reeducation
97114 functional activities
97116 gait training
97118 electrical stimulation (manual)
97120 iontophoresis
97122 manual traction
97124 massage
97126 contrast baths
97128 ultrasound
97139 unlisted procedure (must specify)
97145 additional 15 minutes of treatment (per area)
97260 spinal manipulation
97799 extremity manipulation; or any single modality, any combination of two, three or four modalities; from 15 to 60 minutes of treatment time.
Supplies, Services and Reports Billing Codes
99070 cervical collar; cervical pillow; lumbosacral support
99070-22 custom molded orthotics
99075 expert witness testimony (per hour)
99080 supplemental medical report/insurance form (one page)
99199 full narrative medical report
99050 requested services after hours (additional charge)
99052 requested services from 10 pm to 8 am (additional)
99054 medical services on Sundays and holidays (additional)
Examination Billing Codes
99201 new patient limited history & exam, simple medical decision making; approximately 10 minutes inlength.
99202 new patient limited history & exam; straightforward medical decision making; about 20
minutes in length.99203 new patient detailed history & exam; low complexity medical decision making; about 30
minutes in length.99204 new patient comprehensive history & exam; moderate complexity medical decision making; about 45 minutes in length.
99205 new patient comprehensive history & exam; high complexity medical decision making; about 60 minutes in length.
99211 established patient exam (reexam) minimal; two of three criteria must be met – history, and/or exam, and/or diagnosis; approximately 5 minutes in length.
99212 established patient exam (re-exam) limited; two of three criteria must be met – history and/or exam and/or diagnosis; approximately 10 minutes in length.
99213 established patient exam (re-exam) expanded; two of three criteria must be met – history and/or exam and/or diagnosis; approximately 15 minutes in length.
99214 established patient exam (re-exam) detailed; two of three criteria must be met – history and/or exam and/or diagnosis; approximately 25 minutes in length.
99215 established patient exam (re-exam) comprehensive; two of three criteria must be met – history and/or exam and/or diagnosis; approximately 40 minutes in length.
99241 consultation by physician requested by another physician, which request is documented in patient file; office/outpatient, new/established; limited.
99242 consultation by physician requested by another physician, which request is documented in patient file; office/outpatient, new/established; somewhat more inclusive than 99241.
99243 consultation by physician requested by another physician, which request is documented in patient file; office/outpatient, new/established; somewhat more inclusive than 99242.
99244 consultation by physician requested by another physician, which request is documented in patient file; office/outpatient, new/established; detailed.
99245 consultation by physician requested by another physician, which request is documented in patient file; comprehensive/high complexity.
Radiology Billing Codes
72040 2 views cervical spine
72050 4-5 views cervical spine
72052 7 views cervical spine
72070 2-3 views thoracic spine
72100 2 views lumbar spine
72110 4-5 views lumbar spine
72114 6-7 views lumbar spine
The above billing codes are the ones most commonly used by up-to-date clinics. Understanding what these codes represent can make it easier for the claims professional to recognize overbilling for medical services. These code lists were lifted, with the author’s permission, from “The Investigative Medical Audit” by Eric Tackett.
© Copyright 1995 Alikim Media