Re: Payment for 95992 (canalith repositioning procedures)

[Guest guest]

Please keep in mind that many Medicare contractors are not timely with updating

their software and LCD's in regards to Medicare payment and regulatory changes.

I would recommend you contact your specific contractor and provide them with the

references.

Rick Gawenda, PT

President

Gawenda Seminars

http://www.gawendaseminars.com

On Feb 9, 2011, at 11:44 AM, " Horton "

wrote:

> Has anyone successfully received payment for 95992 since CMS instructed

> therapists to start using it again beginning January 2011?? My denials

> state " we cannot pay for this when performed during the same session as a

> previously processed service for the patient. " I have not billed for

> canalith repositioning in isolation. I have billed it along with 97001 or

> 97112 or 97535 or 97116. I included the 59 modifier. Any suggestions???

>

> History of 95992 as presented by Dr Sue Whitney:

>

> In 2009, CMS introduced a CPT code, 95992 (Canalith repositioning

> procedure(s) (eg, Epley maneuver, Semont maneuver), per day), to be used by

> physicians and therapists to report canalith repositioning. However, the

> agency assigned the code a bundled status because it believed that canalith

> repositioning would be paid through the E/M service that it would accompany.

> Because therapists do not bill E/M service codes, CMS subsequently issued

> guidance instructing therapists to bill 97112 when providing canalith

> repositioning services. In the 2010 Physician Fee Schedule Final Rule, CMS

> changed the status of 95992 from bundled to " not recognized for payment

> under Medicare. " Since its creation, CMS has continued to receive feedback

> from the provider community encouraging it to reconsider its decision to not

> separately reimburse for 95992 as it is a separate and distinct service from

> E/M codes and other CPT codes.

>

> As a result, in the final rule CMS changes the status of 95992 in CY 2011

> once again to make it " active. " This would allow physicians and therapists

> to bill for canalith repositioning using 95992 beginning January 1, 2011.

> CMS adopts a work RVU value of 0.75.

>

> Horton

>

> Carolina Balance and Rehabilitation Center

>

> Raleigh, NC

>

>