Physical Therapy Description Code Physical N 1 $69.20 Therapy Evaluation, of 97162 Physical N 1 $69.20 P Low Therapy complexity, Evaluation, 20 97163 Physical N 1 $69.20 Moderate Therapy complexity, Evaluation, 30 97164 Physical N 1 $47.19 High Therapy complexity, 45 97010 N 10 $4.77 Established of plan of care to 1 97012 Mechanical N 10 $12.67 or more Traction 97014 Electrical N 1 $12.52 (supervised) Stimulation hot or (unattended) 97016 N 2 $15.37 cold Device packs 97018 Paraffin Bath N 10 $8.76 Whirlpool N 10 $18.81 97024 Diathermy N 10 $5.34 (e.g. 97026 Infrared N 10 $4.77 microwave) 97028 Ultraviolet N 10 $5.87 Light 97032 Attended N 4 $14.96 Electrical 97033 Iontophoresis, N 4 $17.48 each 15 each 15 97034 Contrast N 4 $14.17 minutes Bath, each 97035 Ultrasound, N 4 $9.90 15-minutes each 97036 Hubbard N 4 $26.01 minutes Tanks, each 97110 Therapeutic N 4 $29.03 15-minutes Procedure, each 97112 N 4 $26.58 minutes 97113 Aquatic N 4 $33.98 Reeducation Therapy 97116 Gait Training N 4 $22.08 97124 Therapeutic N 4 $20.46
Physical Therapy Code Description of Physical Therapy Evaluation, Low complexity, 20 N 1 $69.20 97162 Physical Therapy Evaluation, Moderate complexity, 30 N 1 $69.20 97163 Physical Therapy Evaluation, High complexity, 45 N 1 $69.20 97164 Physical Therapy Established plan of care N 1 $47.19 97010 of to 1 or more hot or cold packs N 10 $4.77 97012 Mechanical Traction (supervised) N 10 $12.67 97014 Electrical Stimulation (unattended) N 1 $12.52 97016 Device N 2 $15.37 97018 Paraffin Bath N 10 $8.76 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 97032 Attended Electrical each 15 N 4 $14.96 97033 Iontophoresis, each 15 minutes N 4 $17.48 97034 Contrast Bath, each 15-minutes N 4 $14.17 97035 Ultrasound, each N 4 $9.90 97036 Hubbard Tanks, each 15-minutes N 4 $26.01 97110 Therapeutic Procedure, each N 4 $29.03 97112 Reeducation N 4 $26.58 97113 Aquatic Therapy N 4 $33.98 97116 Gait Training N 4 $22.08 97124 Therapeutic N 4 $20.46 minutes minutes P
Audiology,%20Physical%20Therapy,%20and%20EPSDT%20Provider%20Manual%206%2021%2018.docx