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PTP Hospital Edits Q2 2021

PTP Hospital edits are applied to Types of Bills (TOBs) subject to the Outpatient Code Editor (OCE) for OPPS. These edits are applied to outpatient hospital services and other facility services including, but not limited to, therapy providers (Part B Skilled Nursing Facilities (SNFs)), comprehensive outpatient rehabilitation facilities (CORFs), outpatient physical therapy and speech-language pathology providers (OPTs), and certain claims for home health agencies (HHAs) billing under TOBs 22X, 23X, 75X, 74X, 34X.

Updated: April 1, 2021

Physical and Occupational Therapy Evals and Re-evals

  • PT eval; low complexity
  • PT eval; med complexity
  • PT eval; high complexity
  • PT Reevaluation
  • OT Evaluation; low complexity
  • OT Evaluation; med complexity
  • OT Evaluation; high complexity
  • OT Reevaluation

    Therapeutic Procedures

    • Therapeutic Exercise
    • Neuromuscular Reeducation
    • Aquatic Therapy
    • Gait Training
    • Massage Therapy
    • Therapeutic Intervention; 15 min
    • Therapeutic Intervention; add 15 min
    • Physical Medicine Procedure
    • Manual Therapy
    • Group Therapy
    • Therapeutic Activities
    • Sensory Integrative Techniques
    • Self-Care Management
    • Community/Work Integration
    • Wheelchair Management Training
    • Work Hardening


    • Biofeedback Modality
    • Biofeedback Training; initial 15 minutes
    • Biofeedback Training; each additional 15 minutes
    • Hot or Cold Packs
    • Mechanical Traction
    • Vasopneumatic Devices
    • Paraffin Bath
    • Whirlpool
    • Diathermy
    • Ultraviolet
    • Electrical Stimulation (manual)
    • Iontophoresis
    • Contrast Baths
    • Ultrasound
    • Hydrotherapy
    • Electrical Stimulation (unattended)
    • Electrical Stimulation (Non wound)

    Assessments and Orthotics/Prosthetics

    • Range of Motion Measurements
    • Range of Motion; hand
    • Canalith Repositioning
    • Cognitive Testing HC Pro
    • Physical Performance Test
    • Assistive Technology Assessment
    • Orthotic Management
    • Prosthetic Management
    • Orthotic/Prosthetic Management

    Wound Care

      • Removal Devitalized Tissue 20cm/<
      • Removal Devitalized Tissue addl 20 cm<
      • Wound Care (non-selective
      • Negative Press Wound tx < 50 cm
      • Negative Press Wound tx > 50 cm
      • Negative Press Wound tx </=50 sq cm
      • Negative Press Wound tx >50 cm
      • Low Frequency, Non-Contact, Ultrasound 
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