MPN DC FEE SCHEDULE EVALUATION AND MANAGEMENT 99201 New Patient Exam; Problem Focused $50.00 99202 New Patient Exam; Expanded $50.00 99203 New Patient Exam; Detailed $50.00 99204 New Patient Exam; Comprehensive $50.00 99213 Established Patient Eval; Expanded $45.00 99214 Established Patient Eval; Detailed $45.00 CHIROPRACTIC MANIPULATIVE THERAPY 98940 Spinal Manipulation (regions one to two) $25.00 98941 Spinal Manipulation (regions three to four) $31.00 98942 Spinal Manipulation (regions five) $39.00 MODALITIES Modalities are reimbursed at a per diem rate CPT DESCRIPTION G0281 G0282 G0283 Electrical Stimulation, unattended, one or more areas, for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan. Electrical Stimulation, unattended, one or more areas, for wound care other than described in G0281 Electrical Stimulation, unattended, to one or more areas for indication(s) ZONE 2 $16.00 other than wound care, as part of a therapy plan of care. 97012 Traction, mechanical 97022 Whirlpool 97024 Diathermy 97032 Electrical stimulation, requiring direct one on one contact 97033 Iontophoresis, requiring direct one on one contact 97035 Ultrasound, requiring direct one on one contact PROCEDURES Procedures are reimbursed individually, each 15 minutes 97110 Therapeutic exercise $16.00 97112 Neuromuscular reeducation $16.00 97124 Massage, including effleurage, petrissage, and/or tapotement $16.00 97140 Manual therapy techniques (e.g., mobilization, manipulation, manual $16.00 lymphatic drainage, manual traction), one or more regions 97530 Therapeutic/dynamic activities requiring direct one on one contact $16.00 97532 Cognitive Therapy $16.00 97535 Self care/home management training requiring direct one on one contact $16.00 Rev 6/18/2008 - RLM 1 of 5
Global Fees (Technical and Professional Component) 71100 Ribs; unilateral, 2 views $43.00 71110 Ribs; bilateral, 3 views $57.00 71130 Sternoclavicular joints; minimum of 3 views $48.00 72010 Spine; entire survey study, AP + LAT $80.00 72020 Spine; single view $31.00 72040 Cervical; AP + LAT $44.00 72050 Cervical; complete, minimum of 4 views $64.00 72052 Cervical; complete plus flex/ext $79.00 72069 Thoracolumbar; standing (scoliosis) $39.00 72070 Thoracic; AP + LAT $46.00 72072 Thoracic; AP + LAT, plus swimmer s view $50.00 72074 Thoracic; AP + LAT plus obliques, minimum of 4 views $58.00 72080 Thoracolumbar; AP + LAT $47.00 72090 Scoliosis study; supine & erect studies $51.00 72100 Lumbosacral; AP + LAT $47.00 72110 Lumbosacral; complete, with oblique views $65.00 72114 Lumbosacral; complete; plus bending views $81.00 72120 Lumbosacral; minimum of 4 bending views $58.00 72170 Pelvis; AP only $36.00 72190 Pelvis; complete, minimum of 3 views $46.00 72200 Sacroiliac joints; less than 3 views $37.00 72202 Sacroiliac joints; minimum of 3 views $43.00 72220 Sacrum and coccyx; minimum of 2 views $39.00 73000 Clavicle; complete $36.00 73010 Scapula; complete $37.00 73020 Shoulder; one view $33.00 73030 Shoulder; complete $39.00 73050 Acro-clavicular joints; bilateral $45.00 73060 Humerus; minimum of 2 views (inc. one joint) $39.00 Rev 6/18/2008 - RLM 2 of 5
Global Fees (Technical and Professional Component) Continued 73070 Elbow; AP + LAT $35.00 73080 Elbow; minimum of 3 views $39.00 73090 Forearm; AP + LAT (inc. One joint) $36.00 73100 Wrist; AP + LAT $34.00 73110 Wrist; complete (minimum of 3 views) $37.00 73120 Hand; 2 views $34.00 73130 Hand; minimum 3 views $37.00 73140 Finger(s); minimum of 2 views $29.00 73500 Hip; unilateral, single view $34.00 73510 Hip; complete, minimum of 2 views $42.00 73520 Hip; bilateral, minimum of 2 views inc. AP pelvis $50.00 73550 Femur; AP + LAT, including one joint $39.00 73560 Knee; AP + LAT $36.00 73562 Knee; AP + LAT t, with oblique(s) $40.00 73564 Knee; complete, (minimum 4 views) $45.00 73565 Both knees; standing, anteroposterior $35.00 73590 Tibia and fibula; AP + LAT, including one joint $36.00 73600 Ankle; AP + LAT $34.00 73610 Ankle; complete $37.00 73620 Foot; 2 views $34.00 73630 Foot; complete, minimum of 3 views $37.00 73650 Os calcis (heel); minimum, of 2 views $33.00 73660 Toe(s); minimum of 2 views $29.00 Rev 6/18/2008 - RLM 3 of 5
(Professional Component) Reimbursable when films are taken off site and not previously read Reimbursement is factored as a percentage of global reimbursement 71100-26 Ribs; unilateral, 2 views 40% 71110-26 Ribs; bilateral, 3 views 35% 71130-26 Sternoclavicular joints; minimum of 3 views 30% 72010-26 PC - Spine; entire survey study, AP + lat 40% 72020-26 PC - Spine: single view 35% 72040-26 PC - Cervical; AP + LAT 35% 72050-26 PC - Cervical; complete, minimum of 4 views 35% 72052-26 PC - Cervical; complete plus flex/ext 30% 72069-26 PC - Thoracolumbar; standing (scoliosis) 40% 72070-26 PC - Thoracic; AP + LAT 35% 72072-26 PC - Thoracic; AP + LAT, and swimmer s view 30% 72074-26 PC - Thoracic; AP + LAT and obliques, minimum of 4 views 25% 72080-26 PC - Thoracolumbar; AP + LAT 30% 72090-26 PC - Scoliosis study; supine & erect studies 40% 72100-26 PC - Lumbosacral; AP + LAT 30% 72110-26 PC - Lumbosacral; complete, with obliques 35% 72114-26 PC - Lumbosacral; complete; plus bending views 30% 72120-26 PC - Lumbosacral; minimum of 4 bending views 25% 72170-26 PC - Pelvis; AP only 30% 72190-26 PC - Pelvis; complete, minimum of 3 views 30% 72200-26 PC - Sacroiliac joints; less than 3 views 30% 72202-26 PC - Sacroiliac joints; 3 or more views 30% 72220-26 PC - Sacrum and coccyx; minimum of 2 views 30% 73000-26 PC - Clavicle; complete 30% 73010-26 PC - Scapula; complete 30% 73020-26 PC - Shoulder; one view 30% 73030-26 PC - Shoulder; complete 30% 73050-26 PC - Acro-clavicular joints; bilateral 30% 73060-26 PC - Humerus; minimum of 2 views (inc.one joint) 30% Rev 6/18/2008 - RLM 4 of 5
(Professional Component) - Continued Reimbursable when films are taken off site and not previously read Reimbursement is factored as a percentage of global reimbursement 73070-26 PC Elbow; AP + LAT 30% 73080-26 PC Elbow; minimum of 3 views 30% 73090-26 PC Forearm; AP + LAT (inc. one joint) 30% 73100-26 PC Wrist; AP + LAT 30% 73110-26 PC Wrist; complete (minimum of 3 views) 30% 73120-26 PC Hand; 2 views 30% 73130-26 PC Hand; minimum of 3 views 30% 73140-26 PC Finger(s); minimum of 2 views 30% 73500-26 PC Hip; unilateral, single view 35% 73510-26 PC Hip; complete, minimum of 2 views 35% 73520-26 PC Hip; bilateral, minimum of 2 views inc. pelvis 35% 73550-26 PC Femur; AP + LAT, including one joint 30% 73560-26 PC Knee; AP + LAT 30% 73562-26 PC Knee; AP + LAT, with oblique(s) 30% 73564-26 PC Knee; complete (minimum of 4 views) 35% 73565-26 PC Both knees; standing, anteroposterior 35% 73590-26 PC Tibia and fibula; AP + LAT, inc. one joint 30% 73600-26 PC Ankle; AP + LAT 30% 73610-26 PC Ankle; complete 30% 73620-26 PC Foot; 2 views 30% 73630-26 PC Foot; complete, minimum of 3 views 30% 73650-26 PC Os calcis (heel); minimum of 2 views 35% 73660-26 PC Toe(s); minimum of 2 views 30% Rev 6/18/2008 - RLM 5 of 5