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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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PTP Hospital Edits Q3 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: June 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

    Modalities

    • 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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