Part 447 - Standard Unit Of Measure References

Effective Date: 
Tuesday, December 23, 1980
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2803-b

Section 447.1 - Laboratory Services

447.1 Laboratory Services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7210 Laboratory Services--Clinical

7230 Laboratory Services--Pathological

7250 Whole Blood and Packed Red Cells

7260 Blood Processing and Storing

7290 Electrocardiology

7440 Pulmonary Function Testing

(b) The above cost centers use as the basis for the Standard Unit of Measure the Laboratory Workload Recording Method published by the College of American Pathologists (CAP). The college has a policy of revising their publication annually and it is available in January of each year. The latest edition is to be used for determining the standard units of measure for tests and procedures performed. In recording Workload Measurement Units for reporting to the Health Care Financing Administration (HCFA), workload units related to quality control studies, calibration standards, and specimen collection, and repeats and duplicates for which a patient is not charged are not to be counted. Workload units for unlisted tests and procedures should be reasonably estimated based upon work units for other comparable procedures, or estimated by qualified personnel. Workload measurement units shall be maintained and reported for laboratory services obtained from outside laboratories.

(c) Copies of the Laboratory Workload Recording Method can be obtained by writing to:

College of American Pathologists

7400 North Skokie Boulevard

Skokie, Ill. 60076
 

Doc Status: 
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Section 447.2 - Radiology Services

447.2 Radiology Services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7320 Radiology--Diagnostic

7360 Radiology--Therapeutic

7380 Nuclear Medicine

(b) The above cost centers use as the basis for the Standard Unit of Measure the Radiology Relative Values as determined by the California Medical Association, 1974 California Relative Value Studies (RVS). Relative Value Units for unlisted BR (By Report), and RNE (Relativity Not Established) procedures are to be reasonably estimated on the basis of other comparable procedures or estimated by qualified personnel. Use the "Total Unit Value", not the "PC Unit Value", in recording the relative value unit counts. Because the California Medical Association is no longer publishing their Relative Value Studies booklet, the Radiology/Nuclear Medicine chapter is set forth as subdivisions (c)-(g) of this section with the approval of CMA.

(c) RADIOLOGY AND NUCLEAR MEDlClNE GROUND RULES

(1) GENERAL: Listed values for radiology procedures apply only when these services are performed by or under the supervision of a physician.

(i) The total unit value includes the professional component (see PC unit value below) plus the technical component. The value for injection procedure is not included except when procedure is marked with a small star (*). (See ground rule 6, below). This value is applicable in any situation in which a single charge is made to include both professional services and the technical cost of providing that service.Identification of a procedure by its 5-digit code without modifier -26 or -27 indicates that the charge includes both the "professional" and "technical" components.

(ii) The PC unit value (professional component unit value) represents the value of the professional radiological services of the physician. This includes examination of the patient, when indicated, performance and/or supervision of the procedure, interpretation and written report of the examination and consultation with the referring physician. The value for injection procedure is not included except when procedure is marked with a small star (*). (See ground rule 6, below). This component is applicable in any situation in which the physician submits a charge for these professional services only. It does not include the cost of personnel, materials, space, equipment or other facilities. To identify a charge for professional component, use the 6-digit procedure code followed by modifier -26. (See modifier -26 and Appendix 1 for use of modifiers.)

(iii) When this section of the RVS is used in connection with a "conversion factor" to establish fees, it must be emphasized that the SAME conversion factor cannot be applied to both the TOTAL UNIT VALUE and the PROFESSIONAL COMPONENT UNIT VALUE. Physicians who determine their fees by application of conversion factors to the unit values in this section must determine a separate factor for TOTAL UNIT VALUE and for PC UNIT VALUE.

(iv) The technical component includes the charges for personnel, materials, including usual contrast media and drugs, film or xerograph, space, equipment and other facility but excludes the cost of radioisotopes. No unit values are listed for the technical component of radiology procedures, since these are institutional charges not billed separately by physicians. To identify a charge for the technical component, use thc 5-digit procedure code followed by modifier -27. (See modifier -27 and Appendix 1 for use of modifiers.)

(2) UNUSUAL SERVICE OR PROCEDURE: A service may necessitate skills and time of the physician over and above listed services and values. If substantiated "by report," additional values may be warranted. (See unit value modifier -22 and rule 4, below.)

(3) UNLISTED SERVICE OR PROCEDURE: When an unlisted service or procedure is provided, the values used should be substantiated "by report." (See rule 4 below.) Identify by unlisted procedure number in appropriate section. For a comprehensive listing, see pages 15-16.

(4) PROCEDURES LISTED WITHOUT SPECIFIC UNIT VALUES:

(i) BY REPORT "BR" ITEMS: BR in the value column indicates that the value of this service is to be determined "by report," because the service is too unusual or variable to be assigned a unit value. Pertinent information concerning the nature, extent and need for the procedure or service, the time, the skill and equipment necessary, etc., is to furnished. A detailed clinical record is not necessary.

(ii) RELATIVITY NOT ESTABLISHED "RNE"ITEMS: RNE in the value column indicates new or infrequently performed services for which sufficient data have not been collected to allow establishment of a relative value. A report may be necessary. (5) MATERIALS SUPPLIED BY PHYSICIAN: Identify as 99070. (Radionuclides are identified as 99069.) Supplies and materials provided by the physician (e.g., sterile trays, drugs, etc.) over and above those usually included with the office visit or other services rendered may be charged for separately. (List drugs, trays, materials or supplies provided.)

(6) INJECTION PROCEDURES: Values for Injection procedures include all usual pre- and post-injection care specifically related to the injection procedure, necessary local anesthesia, placement of needle or catheter, and injection of contrast media. Vascular injection procedures are listed in the cardiovascular section, under procedure codes 36000-36299. Other injection procedures are listed in appropriate sections. The injection procedure is included in the unit value for radiographic procedures marked with a small star (*).

(7) MISCELLANEOUS:

(i) A physician may elect to reduce the listed value of a service for a variety of reasons. To identify such charges, see modifier -52.

(ii) Examination outside of regular hours, at bedside or in operating room, may warrant an additional charge for technologist's time (see 99065, 99066).

(iii) Values for office, home and hospital visits, consultation and other medical services, anesthesia, surgical and laboratory procedures are listed in the sections entitled "Medicine," "Anesthesia," "Surgery" and "Pathology."

(8) SPECIAL SERVICES AND BILLING PROCEDURES:

(i) The following services are generally not part of the basic services as listed in the RVS, but do involve additional expense to the physician for materials, for his time or that of his employees. Those services that are generally provided as an adjunct to common medical services should be charged for only when circumstances clearly warrant an additional charge over and above the usual charges for the basic services.
Unit Value
(ii) 99065 Examination outside of regular hours maywarrant an additional charge for technologist'stime ........................................... 1.3(R)
(iii) 99066 Examination at bedside or in operating room,unless otherwise indicated, may warrant anadditional charge for technologist's time ...... 1.3(R)
(iv) 99069 Radiopharmaceutical or other radionuclidematerial cost. Listed values in this section donot include these costs. List the name ofradiopharmiceutical, dosage and cost ........... BRt
(v) 99070 Supplies and material provided by the physician(e.g., sterile trays, drugs, etc.), over and abovethose usually included with the office visit orother services rendered may be charged forseparately. List drugs, trays, supplies ormaterials provided ............................. BRt
(vi) 99080 Special Reports (e.g., Insurance forms, narrativereports, review of medical records): Wheninformation more than that necessary to establishor to clarify a patient's status is requested(e.g., more than the standard reporting form) or arequest is made for review of medical records andreport, a charge adequate to cover the value ofthe additional service is justifiable .......... BRt
(9) UNIT VALUE MODIFIERS.

(i) Listed values for most procedures may be modified undercertain circumstances as listed below. When applicable, themodifying circumstances should be identified by the addition ofthe appropriate "modifier code number" (including the hyphen)after the usual procedure number. The values should be listed asa single modified total for the procedure. When multiplemodifiers are applicable to a single procedure, see modifier-99.
Unit Value
(ii) -22 Unusual services: When the services provided aregreater than those usually required for the listedprocedure, identify by adding this modifier (-22)to the usual procedure number. List modified value.May require report.
(iii) -28 Professional component: Under certain circumstancesthe physician may wish to submit a charge for theprofessional component of a procedure and not forthe technical component. (See definition ofprofessional component under Ground Rule 1). Underthese circumstances the professional component chargeis identified by adding this modifier (-28) to theusual procedure number and valued according to the"PC unit value" for that procedure.(iv) -27 Technical component: Under certain circumstances, acharge may be made for the technical component alone(see definition of technical component under GroundRule 1). Under those circumstances the technicalcomponent charge is identified by adding thismodifier (-27) to the usual procedure number.
(v) -52 Reduced values: Under certain circumstances, thelisted value is reduced or eliminated because ofground rules, common practice, or at the physician'selection (e.g., a physician may elect to reduce thelisted values in a patient with multiple injuriesrequiring extensive radiographic examination). Underthese or similar circumstances, the services providedcan be identified by their usual procedure numbersand the use of a reduced value indicated by addingthis modifier (-52) to the procedure number. (Useof this modifier provides a means of reportingservices at reduced charge without disturbing usualrelative values.)
(vi) -90 Reference (outside) laboratory: When laboratoryprocedures are performed by other than the billingphysician, the procedure(s) shall be identified byadding this modifier (-90) to the usual single orpanel procedure number and shall be billed as chargedto the physician. (For collection and handlingcharges, see 99007 et seq.)
(vii)-99 Multiple modifiers: Under certain circumstances,multiple modifiers may be applicable (e.g., aphysician may perform services greater than thoseusually required (modifier -22)) and bill theprofessional component (modifier -26)). Underthese circumstances, identify by adding this modifier(-99) to the usual procedure number and brieflyindicate the circumstances. Value in accordance withappropriate modifiers ............................... BRt
(d) DIAGNOSTIC RADIOLOGY. (1) Definitions.
(i) Limited examination: An examination which usually includesAP and lateral views but is less than the "complete examination"defined below. This may be due to limitation of routine viewsby the physician; limitation for a specific purpose (e.g., APand lateral views on post-reduction fracture of ankle); ornecessary limitation due to the condition of the patient (e.g.,single views for fractures in critically injured patient).
(ii) Complete examination: An examination which includes all ofthe necessary views for optimal examination of the part for thesuspected condition. All listed values are for completeexaminations unless otherwise indicated. Necessary additionalmethods cf examination (e.g., fluoroscopy, tomography,cineradiography) may be charged for separately.
(2) Head and Neck.
70002 Pneumoencephalography.............. 25.0(For injection procedure forpneumoencephalography, see61053, 62286)
70010 Cisternography, positivecontrast (posterior, fossamyelography........................ RNE~(For injection procedure, see61052, 61053)
70020 Ventriculography, air or positivecontrast........................... 15.5(For injection procedures forventriculography, see 61025,61030, 61120)
70022 Stereotactic localization.......... BR**
*70024 Computer assisted tomography,cerebral (e.g., EMI scan), withor without intravenous contrast,limited (2 or 3 scans)............. RNE~
*70025 complete (4 scans)................ RNE
*70028 each additional scan above 4....... RNE~
70030 Eye, for detection of foreignbody............................... 5.2
70040 for localization of foreignbody (70030 not included).......... 8.4
70050 combined 70030 and 70040........... 10.5
70100 Mandible, limited orunilateral......................... 3.8
70110 complete........................... 5.9
70120 Mastoid(s), limited orunilateral......................... 3.8
70130 complete and bilateral............. 7.6
70134 Internal auditory measures......... 7.1
*70136 Middle and Inner ear,polytomography..................... RNE
70140 Facial bones, limited.............. 4.4
70150 complete, and/or orbits............ 6.4
70154 with nasal bones................... 7.3
70160 Nasal bones ....................... 3.9
70170 Nasolacrimal duct(dacryocystography)................ 5.9(For injection procedure fordacryocystography, see 68850)70190 Optic foramina .................... 3.8
70210 Paranasal sinuses limited.......... 3.1
70220 complete........................... 6.4
70240 Sella Turcica...................... 3.3
70250 Skull, limited .................... 3.8
70260 complete........................... 7.1
70300 Teeth, single view................. 1.3
70310 partial examination, less thenfull mouth ........................ 2.5
70320 complete examination, fullmouth.............................. 4.7
70330 Temporomandibular joints........... 5.6
70350 Cephalogram (orthodontic).......... RNE
70360 Neck for soft tissues.............. 2.7
*70368 Soft palate, cineradiography orvideotape.......................... RNE
*70373 Laryngography, contrast............ 8.2(For injection procedure forlaryngography, see 31708)
70380 Salivary gland for calculus........ 3.8
70390 Sialography........................ 5.1(For injection procedure forsialography, see 42550)
*70400 Orbitography, air or positivecontrast........................... BR**(For injection procedure fororbitography, see 67510)
*70999 Unlisted procedure, head andneck............................... BR**
(3) Chest.
71000 Chest, "minifilm".................. 1.2
71010 Chest, single view................. 2.5
71020 two views.......................... 3.8
*71021 three views........................ 4.4
71030 complete, minimum of fourviews.............................. 4.9

71034 including fluoroscopy.............. 6.4(For independent chestfluoroscopy, see 76000)
*71036 Fluoroscopic localization forneedle biopsy of intrathoraciclesion, including follow-upfilms.............................. BR**(For biopsy procedure, see 32420)
*71038 Fluoroscopic localization forbronchial brush biopsy or fiberoptic bronchoscopy, includingfilms.............................. BR**(For biopsy procedure, see 31717)
71040 Bronchography, unilateral.......... 9.1
71060 bilateral.......................... 13.0(For injection procedure forbronchography, see 31710, 31715)
*71090 Fluoroscopy and radiographyfor pacemaker insertion............ BR**(For extended room time, see76001)
*71100 Ribs, unilateral................... 4.4
71110 bilateral.......................... 5.4
71120 Sternum............................ 3.8
71130 Sternoclavicular joint(s).......... 3.8
*71199 Unlisted procedure, chest.......... BR**
(4) Spine and Pelvis.
72010 Spine, entire, survey study (APand lateral)....................... 9.3
*72020 Spine, any level, single view...... RNE
72040 cervical, AP and lateral........... 3.8
72050 complete........................... 6.0
72052 including flexion and extensionviews.............................. 7.7
72070 thoracic........................... 4.4
72080 thoraco-lumbar junction ........... 4.4
72090 scoliosis study.................... 3.5
72190 lumbar, limited ................... 4.4
72110 lumbosacral, complete ............. 7.4
72114 including bending views............ 9.3
72120 bending views only................. 4.7
72170 Pelvis, limited.................... 3.1
72180 stereo............................. 3.8
72190 complete........................... 4.9(For pelvimetry, see 74710)
72202 Sacro-iliac joints ................ 5.1
72220 Sacrum and coccyx ................. 4.1
72250 Myelography, lumbar or anyother single levels ............... 11.5
72270 all levels......................... 18.0
*72275 gas................................ BR**(For injection procedures formyelography, see 62284)
72290 Discography, lumbar or cervical.... 12.2(For injection procedures fordiscography, see 62290, 62291)
*72299 Unlisted procedures, spine orpelvis............................. BR**
(5) Upper Extremities.
73000 Clavicle........................... 3.1
73010 Scapula............................ 3.8
73020 Shoulder, limited.................. 2.7
73030 complete........................... 3.8
73040 arthrography....................... 6.4(For injection procedure forarthrography, see 23350)73050 Acromio-clavicular joints, bilateral, with or without weighteddistraction........................ 4.4
73060 Humerus, including one joint....... 3.1
73070 Elbow limited...................... 2.8
73080 complete........................... 3.8
*73085 arthrography....................... BR**(For injection procedure, see24220)
73090 Forearm, including one joint....... 3.0
73100 Wrist, limited..................... 2.5
73110 complete........................... 3.8
*73115 arthrography....................... BR**(For injection procedure, see25246)
73120 Hand, limited...................... 2.5
73130 complete .......................... 3.5
73140 Finger(s).......................... 2.3
*73499 Unlisted procedure, upperextremities........................ BR**
(6) Lower Extremities.
73500 Hip, unilateral limited ........... 3.1
73510 complete (including AP pelvis)............................... 4.4
*73515 bilateral, limited (e.g., infantAP and frog lateral................ 3.9
73520 bilateral, complete (includingAP of pelvis)...................... 5.8
*73525 arthrography...................... RNE(For injection procedures, see27093-27094)
73530 during operative proceduresup to four studies................. 9.4
73532 each additional study.............. 1.8
73550 Femur (thigh), including onejoint.............................. 3.8
73560 Knee, limited...................... 2.7
73570 complete .......................... 4.0
73580 arthrography ...................... 9.1(For injection procedure, see27370)
73590 Tibia and fibula (leg), includingone joint ......................... 3.1
73600 Ankle, limited .................... 2.7
73610 complete .......................... 3.6
*73615 arthrography...................... RNE(For injection procedures, see27646)
73620 Foot, limited...................... 2.5
73630 complete........................... 3.4
73640 Foot and ankle..................... 5.9
73650 Os calcis (heel) .................. 2.7
73660 Toe(s)............................. 2.3
*73999 Unlisted procedure, lowerextremities........................ BR**
(7) Abdomen.
74000 Abdomen, single view (KUB)......... 2.6
74010 with additional oblique orcone view.......................... 3.9
74020 complete, includes decubitusand/or erect view.................. 5.1
(8) Gastrointestinal Tract.
74210 Pharynx and/or cerical esophagus... 5.4
74220 Esophagus.......................... 5.4
74230 Pharynx and/or esophagus,by cineradiography................. 7.4
*74242 Upper gastronintestinal tract,with or without KUB and withor without delayed films........... 9.1
*74243 limited upper gastrointestinaltract (e.g., recheck or followup study).......................... 6.4
74245 with small bowel, includesmultiple serial films, with orwithout fluoroscopy................ 11.0
74250 Small bowel, includesmultiple serial films with orwithout fluoroscopy or KUB,independent study.................. 8.5
*74260 Duodenography, hypotonic........... RNE
74270 Colon, barium enema ............... 7.5
74275 combined with air contrast......... 11.0
74280 air contrast (independentprocedure)......................... 8.9
74290 Cholecystography, oral............. 6.0
74291 repeat examination, samestudy.............................. 3.0
74300 Cholangiography operative.......... 7.6
*74305 post-operative (t-tube)............ *7.2(For biliary duct stone

Doc Status: 
Complete

Section 447.3 - Neurology--Diagnostic Services

447.3 Neurology--Diagnostic Services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7460 Neurology--Diagnostic

(b) The above cost center uses as the basis for the Standard Unit of Measure the applicable procedures from the Neuro-Muscular section of the Medicine Relative Values as determined by the California Medical Association, 1974 California Relative Value Studies (RVS). Relative Value Units for unlisted, BR (By Report), and RNE (Relativity Not Established) procedures are to be reasonably estimated by qualified personnel. Because the California Medical Association is no longer publishing their Relative Value Studies booklet, the applicable procedures from the Neuro-Muscular section of the Medicine chapter are set forth below with the approval of CMA.

Unit

Value

(1) 95819 Electro-encephalogram (EEG), standard or portable,

same facility............................................ 20.0

(2) 95821 portable, to an alternate facility....................... 30.0

(3) 95822 sleep.................................................... 30.0

(4) 95823 physical or pharmacological, activation.................. 30.0

(5) 95824 cerebral death evaluation recording...................... BR

(6) 95826 Intra-cerebral (depth) EEG............................... BR

(7) 95827 all night sleep recording................................ BR

(8) 95860 Electromyography, one extremity and related paraspinal areas......................................... 20.0

(9) 95861 two extremities and related paraspinal areas............. 36.0

(10) 95863 three extremities and related paraspinal areas........... 44.0

(11) 95864 four extremities and related paraspinal areas............ 52.0

(12) 95867 cranial nerve supplied muscles, unilateral............... RNE

(13) 95868 bilateral................................................ RNE

(14) 95869 limited study of specific muscles, e.g., external and sphincter, thoracic spinal muscles, etc.................. BR
 

Effective Date: 
Tuesday, December 23, 1980
Doc Status: 
Complete

Section 447.4 - Physical therapy services

447.4 Physical therapy services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7510 Physical Therapy

(1) The standard unit of measure will be the relative value units developed by the American Physical Therapy Association. Relative value units shall be counted during a patient visit for all cost center activities for which a charge is made. A patient visit is the occasion for service during which the resources of the physical therapy cost center are used. A visit is one appearance of a patient regardless of the number of evaluation, therapeutic, patient education activities performed during that appearance.

(2) The two major components of the relative value unit are: personnel time associated with the activity, and other direct and appropriate indirect department resources used in providing the activity. Fifteen minutes has been established as the least increment of time for which a unit of service (e.g., evaluation, therapeutic, or patient educational activity) can occur. The unit of service which requires the least amount of the physical therapy department's total resources is a modality. This activity is used to establish the basic relative value unit of 1.0. Since the basic relative value unit of 1.0 does not require the continuous attendance of physical therapy personnel, the initial unit value for those services that do require the continuous attendance of physical therapy personnel is adjusted upward. An additional .4 of a unit will be added to the initial increment for those activities requiring continuous attendance by physical therapy personnel. When subsequent 15-minute increments of service are provided, some of the initial direct and indirect costs do not recur or are reduced. Therefore, relative value units for subsequent increments of time are approximately 10 percent less than the initial unit value.

(3) The recording of 15-minute increments of service begins with the initiation of the evaluation, therapeutic, or patient educational activity. Although time may have been spent transporting the patient to the department or making entries in the medical record, RVU's are not counted for these activities. Patient transportation, treatment preparation and cleanup, and recordkeeping costs are incorporated in the weighting of the initial 15-minute increment of service and additional RVU's cannot be added for these activities. However, the time required to complete a separate formal report for patient evaluations or aftercare planning can be counted.

(4) Therapeutic or evaluation activities performed in the home shall have a unit value equivalent to that for the appropriate therapeutic or evaluation activity rendered plus an allowance for travel time to and from the home. Travel time for home visits is valued the same as those activities requiring continuous attendance by physical therapy personnel with the patient.
(b) RELATIVE VALUE UNITS
Initial Additional 1515 minutes (round toDescription minutes nearest 15 minutes)
(1) EVALUATION ACTIVITIES
Evaluation activities are assessments of patients' performance toassist in establishing diagnoses orto establish or reevaluatetreatment plans. 1.4 1.3
(2) THERAPEUTIC ACTIVITIES
(i) Modalities
A modality does not require thecontinuous attendance of physicaltherapy personnel during a therapeutics activity 1.0 0.9
(ii) Procedures
A procedure does require the continuousattendance of physical therapy personnelduring a therapeutic activity. 1.4 1.3
(iii) Hydrotherapy
Continuousattendance ofpersonnel
notrequired required
Extremity or Body Whirlpool 1.4 1.3 0.9
Hubbard Tank or Therapeutic Pool 2.5 1.3 0.9
Initial Additional 1515 minutes (round tominutes nearest 15minutes)
(3) PATIENT EDUCATIONAL ACTIVITIES
Patient educational activities are usedto instruct the patient or his attendant,family or their substitute in maintainingand improving the patient's condition. 1.4 1.3
(4) COMBINATION OF EVALUATION, THERAPEUTICOR PATIENT EDUCATIONAL ACTIVITIESMultiple evaluation, therapeutic, patienteducational activities performed duringa patient visit will be reported as acombination.
(i) Any number of modalities in combination 1.0 0.9
(ii) Any number of evaluation, therapeutic,or patient educational activities incombination 1.4 1.3
(iii) Hydrotherapy in combination withother activities:
Extremity or Body Whirlpool 1.4 1.3
Hubbard Tank or Therapeutic Pool 2.5 1.3
(5) HOME VISITS
A home visit is provided to an individualpatient in a setting other than the physicaltherapist's office or work facility. Thestandard unit of measure for home visitsincludes the number of relative value unitsfor the evaluation, therapeutic, or patienteducational activity and for travel time.
(i) Evaluation, Therapeutic, orEducational Activities 1.4 1.3
(ii) Travel Time
Travel time for home visits is the actualtime spent by physical therapy personnelgoing to and from the home. Travel timefor multiple home visits during a singletrip is calculated by dividing the totalnumber of relative value units for traveltime by the number of patients treatedduring that trip. 1.3 1.3
(6) GROUP ACTIVITIES
A group activity is the occasion forservice during which two or more patientssimultaneously receive a therapeutic,evaluation, or patient educationalactivity. Group activities will bereported by counting the number of RVU'sfor one patient participating in thegroup activity session, and adding 0.1RVU per session for each patientparticipating in the group activity. 1.3 1.3
(7) Notes
(i) For further explanation of how to use the relative value units seethe accompanying Schedule of Unit Values and Examples of RelativeValue Unit Computations for Combination Activities.
(ii) When multiple personnel are used during an entire activityperiod, additional 1.3 RVU's are recorded for each person for each15-minute increment.
(iii) The units of measure do not Include wound dressing, debridement,exercise or other activities performed in conjunction with hydrotherapy.
(iv) When computing an indiviudal's RVU's, the value should be roundedto the nearest one-tenth (e.g., 0.62 = 0.6, 0.68 = 0.7).
(c) SCHEDULE OF UNIT VALUES
UNIT VALUE TOTAL VALUES
Initial Additional
Description 15 15 30 45 60min. min. min. min. min.
(1) Evaluation Activities 1.4 1.3 2.7 4.0 5.3
(2) Therapeutic Activities
(i) Modalities 1.0 0.9 1.9 2.8 3.7
(ii) Procedures 1.4 1.3 2.7 4.0 5.3
UNIT VALUE TOTAL VALUES
Initial Additional
Description 15 15 30 45 60min. min. min. min. min.

(iii) Hydrotherapy
Extremity or Body
Whirlpool
Continuous attendanceof personnelrequired 1.4 1.3 2.7 4.0 5.3
not required 1.4 0.9 2.3 3.2 4.1
Hubbard Tank orTherapeutic Pool
Continuous attendanceof personnel
required 2.5 1.3 3.8 5.1 6.4
not required 2.5 0.9 3.4 4.3 5.2
(3) Patient EducationalActivities 1.4 1.3 2.7 4.0 5.3
(4) Combination of Evaluation,Therapeutic, or PatientEducational Activities
(i) Any Number of Modalitiesin Combination 1.0 0.9 1.9 2.8 3.7
(ii) Any Number of Evaluation,Therapeutic, or PatientEducational Activitiesin Combination 1.4 1.3 2.7 4.0 5.3
(iii) Hydrotherapy inCombination withOther ActivitiesExtremity or BodyWhirlpool 1.4 1.3 2.7 4.0 5.3
Hubbard Tank orTherapeutic Pool 2.5 1.3 3.8 5.1 6.4
(5) Home Visits
(i) Evaluation, Therapeutic,or Patient EducationalActivities 1.4 1.3 2.7 4.0 5.3
(ii) Travel Time 1.3 1.3 2.6 3.9 5.2
(6) Group Activities(total RVU's plus 0.1 persession for each patient) 1.3 1.3 2.6 3.9 5.2Note: Activities that exceed 60 minutes are recorded by adding theappropriate values from the "additional 15 minutes" column.
(d) EXAMPLES OF RELATIVE VALUE UNIT COMPUTATIONS FOR COMBINATIONACTIVITIES
(1) Description Calculations RVU's
(1) MODALITIES
A patient is in the department for 60 minutes.The patient waits 30 minutes before receiving30 minutes of hot packs and cervicaltraction to the neck. 1.0 + 0.9 = 1.9
(2) PROCEDURES
Therapeutic exercise to the right legand gait training for 1.4 + 1.3 + 1.3 = 4.0
45 minutes.
(3) EVALUATION AND MODALITIES/PROCEDURES
Evaluation, hot pack, ultrasound,and massage to the left shoulderfor 75 minutes. 1.4 + 1.3 + 1.3 +
1.3 + 1.3 = 6.6
(4) HYDROTHERAPY
(i) Extremity whirlpool, not requiringcontinuous attendance of physicaltherapy personnel, 30 minutes. 1.4 + 0.9 = 2.3
(ii) Therapeutic pool, requiring continuousattendance of physical therapypersonnel, 45 minutes. 1.4 + 1.3 + 1.3 = 4.0
(5) HYDROTHERAPY COMBINATIONS
(i) Extremity whirlpool massage andexercise to the left arm for 60minutes. 1.4 + 1.3 + 1.3
+ 1.3 = 5.3
(ii) Body whirlpool and exercise to bothlegs and back for 60 minutes. 1.4 + 1.3 + 1.3
+ 1.3 = 5.3
(iii) Hubbard tank and burn debridementto upper torso for 60 minutes with onestaff member required; 2.5 + 1.3 + 1.3
+ 1.3 = 6.4
with two staff members required. (2.5 + 1.3 + 1.3 +
1.3) + (1.3 + 1.3 +
1.3 + 1.3) = 11.6
(6) HOME VISIT
(i) A visit is made to a patient's homeand 25 minutes of diathermy is provided.A visit is then made to another patient'shome and 35 minutes of gait trainingis provided. Travel time to and from thehospital as well as between the twohomes is 45 minutes.
(ii) The RVU's for travel time per homevisit are the total number of RVU'sfor travel time divided by the totalnumber of home visits. 1.3 + 1.3 +
1.3 = 3.9
3.9 -2.0 = 1.95
or 2.0 2.0
(iii) First visit: Diathermy treatmentfor 25 minutes. 1.4 + 1.3 = 2.7
Total RVU's for first 2.0 + 2.7 = 4.7
home visit.
(iv) Second visit: Gait training for35 minutes. 1.4 + 1.3 = 2.7
Total RVU's for second 2.0 + 2.7 = 4.7home visit
(7) GROUP ACTIVITIES
(i) Ten patients received exerciseinstruction and patient education. Theactivity session was 35 minutes inDuration.
(ii) One staff member required. (1.3 + 1.3) +
(0.1 x 10) = 3.6
(Average RVU's
per patient =
0.36 or 0.4
(iii) Two staff members required. (1.3 + 1.3) +
(1.3 + 1.3) +
(1.3 + 1.3) = 6.2
(10 x 0.1)
(Average RVU's
per patient =
0.62 or 0.6)

Effective Date: 
Tuesday, December 23, 1980
Doc Status: 
Complete

Section 447.5 - Occupational Therapy Services

447.5 Occupational therapy services.
(a) ACCOUNT NUMBER COST CENTER TITLE
7530 Occupational Therapy
(1) The standard unit of measure will be the relative value units developed by the American Occupational Therapy Association. Relative value units should be counted during a patient visit for all assessment, treatment or other activities which use the resources of the occupational therapy department, and for which a charge is made. Fifteen minutes is the smallest increment of time for which a unit of service should occur. After the initial 15 minutes, patient contact for less than 15 minutes should be rounded to the nearest whole 15-minute period.
(2) For patient groups of two or more, the appropriate relative value units listed in the schedule should be counted for each patient in the group. Different codes should be used to indicate the same treatment given to different size groups.
(3) Since a charge for only one treatment for a 15-minute period can be made, concurrent or combination treatments should be handled by selecting the most significant or longest treatment determined by the therapist.
(4) Occupational therapy services provided in the home will have a unit value equivalent to that shown in the schedule for the service provided, plus the applicable unit value for travel time to and from the home.
(5) Relative value units for unlisted procedures should be reasonably estimated on the basis of other comparable procedures, or estimated by qualified personnel. If your facility has a standard set of treatments that all patients receive unique to your facililty, using the system as a guide, relative value units should be developed.
(6) The system includes several definitions of activities not listed on the Relative Value Schedule, as the schedule is designed only for direct treatment.
RVU's per 15
minutes Patient Group
Categories

9 or
Code 1 2-4 5-8 more
number* Service category pt. pts. pts. pts.

(b) Occupational Therapy Assessment.

98001-03 (1) Screening 11 5.5 3.3

98004 (2) Patient Related Consultation 14

(3) Evaluation

98005-06 (i) Independent Living/Daily
Living Skills and
Performance 18 9.0

98010-00 (ii) Sensorimotor Skill and
Performance Components 21 10.5

98015-16 (iii) Cognitive Skill and Performance
Components 20 10.0

98020-21 (iv) Psychosocial Skill and
Performance Components 18 9.0

98025-26 (v) Therapeutic Adaptations 19

98030-32 (vi) Specialized Evaluation 23 11.5 6.9

(4) Reassessment 18 9.0

(c) Occupational Therapy Treatment.

(1) Independent Living/Daily Living
Skills and Performance

98040-42 (i) Physical Daily Living Skills 13 6.5 3.9

98045-47 (ii) Psychosocial/Emotional Daily
Living Skills 13 6.5 3.9

(iii) Work

98050-52 (a) Homemaking 15 7.5 4.5

98055-57 (b) Child Care/Parenting 18 9.0 5.4

98060-62 (c) Employment Preparation 19 9.5 5.7

98065-67 (iv) Play/Leisure 14 7.0 4.2

(2) Sensorimotor Components

(i) Neuromuscular

98070 (a) Reflex Integration 18

98075-78 (b) Range of Motion 13 6.5 3.9 1.3

98080-83 (c) Gross and Fine 13 6.5 3.9 1.3
Coordination

98085-88 (d) Strength and Endurance 13 6.5 3.9 1.3

98090-92 (ii) Sensory Integration 16 8.0 4.8

(3) Cognitive Components

98095-98 (i) Orientation 10 5.0 3.0 1.0

98100-01 (ii) Conceptualization/Comprehension 14 7.0

98105-06 (iii) Cognitive Integration 14 7.0

(4) Psychosocial Components

98110-13 (i) Self Management 14 7.0 4.2 1.4

98115-16 (ii) Dyadic Interaction 14 7.0

98120-23 (iii) Group Interaction 10 5.0 3.0 1.0

(5) Therapeutic Adaptation

98125 (i) Orthotics 20

98130-31 (ii) Prosthetics 16 8.0

98135-36 (iii) Assistive/Adaptive 16 8.0

98140-43 (6) Prevention 13 6.5 3.9 1.3

98145 (d) Patient/Client-Related 14
Conferences

98150-53 (e) Travel: Patient 12 6.0 3.6 1.2
Treatment Related
(f) Only one code number may be used for a given category. Thus, where a series of code numbers are listed, each code number in the series is to be used for a different patient group category. For example, code numbers 98001 through 98003 are given for screening: 98001 would be used for screening one patient, 98002 for screening a group of two to five patients, and 98003 for screening a group of six to eight patients.

 

Doc Status: 
Complete