Payment for 95992 (canalith repositioning procedures)

[Guest guest]

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