98940 N 1 $22.00 Chiropractic Manipulative Treatment Spinal, 1 to 2 regions 98941 N 1 $31.51 Chiropractic Manipulative Treatment Spinal, 3 to 4 regions 98942 Chiropractic Manipulative N 1 $41.04 Treatment Spinal, 5 regions 98943 N 1 $21.18 Chiropractic Manipulative Treatment Extra spinal, 1 or more regions Physical Therapy Description Procedure Requires Maximum Maximum Code Pre-Auth Number of Payment Units 97161 Physical Therapy Evaluation, N 1 $69.20 Low complexity, 20 minutes 97162 Physical Therapy Evaluation, N 1 $69.20 Moderate complexity, 30 minutes 97163 Physical Therapy Evaluation, N 1 $69.20 High complexity, 45 97164 Physical Therapy Re-Evaluation, N 1 $47.19 Established plan of care 97010 N 10 $4.77 Application of modality to 1 or more Areas; hot or cold packs (supervised) 97012 Mechanical Traction N 10 $12.67 (supervised) 97014 Electrical Stimulation N 1 $12.52 (unattended) 97016 Vasopneumatic Device N 2 $15.37 97018 Paraffin Bath N 10 $8.76 97022 Whirlpool N 10 $18.81 97024 Diathermy (e.g. microwave) N 10 $5.34 97026 Infrared N 10 $4.77 97028 Ultraviolet Light N 10 $5.87
98940 Chiropractic Manipulative Treatment Spinal, 1 to 2 regions N 1 $22.00 98941 Chiropractic Manipulative Treatment Spinal, 3 to 4 regions N 1 $31.51 98942 Chiropractic Manipulative Treatment Spinal, 5 regions N 1 $41.04 98943 Chiropractic Manipulative Treatment Extra spinal, 1 or more regions N 1 $21.18 Physical Therapy Procedure Code Description Requires Pre-Auth Maximum Number of Units Maximum Payment 97161 Physical Therapy Evaluation, Low complexity, 20 minutes N 1 $69.20 97162 Physical Therapy Evaluation, Moderate complexity, 30 minutes N 1 $69.20 97163 Physical Therapy Evaluation, High complexity, 45 N 1 $69.20 97164 Physical Therapy Re-Evaluation, Established plan of care N 1 $47.19 97010 Application of modality to 1 or more Areas; hot or cold packs (supervised) N 10 $4.77 97012 Mechanical Traction (supervised) N 10 $12.67 97014 Electrical Stimulation (unattended) N 1 $12.52 97016 Vasopneumatic Device N 2 $15.37 97018 Paraffin Bath N 10 $8.76 97022 Whirlpool N 10 $18.81 97024 Diathermy (e.g. microwave) N 10 $5.34 97026 Infrared N 10 $4.77 97028 Ultraviolet Light N 10 $5.87
EPSD-NEW-MANUAL-FINAL-01-01-18.docx