RESNA TECHNICAL ASSISTANCE PROJECT
REPORTS ON CPT CODES AND ASSISTIVE TECHNOLOGY

By Marka G. Hayes

January 2001

Providing Technical Assistance and Information to the Projects Funded

Under the Assistive Technology Act of 1998

January 2001

Produced by

RESNA Technical Assistance Project
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<http://www.resnaprojects.org/nattap>

This publication is available in alternative formats.

The RESNA Technical Assistance Project, Grant #H224B99005, is an activity funded by the National Institute on Disability and Rehabilitation Research (NIDRR), U.S. Department of Education (ED), under the Assistive Technology Act of 1998. The information contained herein does not necessarily reflect the position or policy of NIDRR/ED or the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), and no official endorsement of the materials should be inferred.

RESNA is an interdisciplinary association of people with a common interest in technology and disability. RESNA is the grantee funded under the Assistive Technology Act to provide technical assistance and information to the Assistive Technology Act projects.

CPT Codes and Assistive Technology

It is important that assistive technology (AT) professionals understand Current Procedural Terminology (CPT) codes and how they impact reimbursement for AT in both the public and private insurance systems. This document provides an overview of CPT codes to AT professionals, including AT service providers and those involved in policy related to AT. It is designed to be helpful to the 56 AT Act Projects funded through the Assistive Technology Act of 1998.

This document has three parts. The first part discusses what CPT codes are and how they are developed and revised. The second part of the document illustrates how CPT codes are applied to some seating and mobility services and provides insights into how coding decisions are made. It should be helpful to a broad range of AT professionals. The third part describes how AT professionals can influence CPT code development to better support AT services. In addition, a glossary of key abbreviations and a diagram detailing the "CPT Code Update and Revision Process" can be found in Appendix 1 and 2, respectively.

PART 1: Questions and Answers About CPT Coding

What are CPT Codes?

Current Procedural Terminology (CPT)™ "… is a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services…" (Footnote AMA web site at http://www.ama-assn.org/med-sci/cpt/template.htm) CPT is trademarked by the American Medical Association (AMA). CPT was first published in 1966.

Why are CPT codes important to AT professionals?

CPT codes are important to AT professionals for many reasons. CPT codes are used to report medical services for private and public health insurance systems for purposes of reimbursement, including claims processing. CPT also provides uniformity in language to provide reliable nationwide data collection. One use of this data collection is cost control and management in both private and public health care systems. (Footnote? RESNA Instructional Class.)

The Health Care Financing Administration (HCFA) has adopted CPT as part of its Health Care Financing Administrations Common Procedure Coding System (HCPCS) for use in reporting medical services in Medicare and Medicaid. Examples of Medicare services in which the use of HCPCS is required are hospital outpatient services, skilled nursing facilities outpatient services, occupational therapy and physical therapy services offered in private settings, and services offered in comprehensive outpatient rehabilitation facilities. HCFA has also required Medicaid agencies to report some services using HCPCS since the late 1980’s. Footnote AMA website.

The CPT coding system has a large impact on public and private health insurance reimbursements. Medicare’s payment schedule is based on what is called a Resource-Based Relative Value Scale (RBRVS), which in turn, is based on CPT coding. The RBRVS has replaced the practice previously used by many insurers that based payments on a percentage of billed charges, often called "a usual and customary" payment system. The RBRVS is used by most private health insurers, many state Medicaid agencies and several state workers compensation plans to determine reimbursements. The RBRVS will be discussed further in a section titled "How is a Relative Value Unit Assigned to a Code?".

Who can document their services using CPT?

Any licensed provider operating within his or her scope of practice can use most CPT codes. There are a few codes that are restrictive. For example, code 97001, a physical therapy evaluation code, is an example of a code that is restrictive. Only physical therapists may use this code. <Linda Botten as reported in December 14 Private Insurance Work Group Meeting Notes >

Sometimes an insurer’s payer policy restricts the codes a type of professional can use for reimbursement. Payer policies sometimes also vary reimbursement rates among professions. This differential in reimbursement rates can be seen with some services nurse practitioners and medical doctors perform. Some payer policies dictate that the nurse practitioner is paid less for his or her services. (Footnote RESNA Instructional Course)

Are there other coding systems used with AT services and devices?

Two other coding systems that are commonly discussed in association with AT are HCPCS, as mentioned already, and International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM).

ICD-9-CM describes diseases, conditions and related issues. This classification system is used to assign diagnosis codes that are required to submit claims to public and private insurers. (Footnote Quick Coding Guide, page 2) The CPT codes that are then used to document the services, for this same claimant, must be appropriate for that diagnosis. AT professionals need to be sure that the AT services that are billed using CPT are reasonable for the ICD-9-CM diagnosis code indicated.

HCPCS codes contain three levels of codes. Level I codes are CPT codes. Level II is composed of national codes developed by HCFA to describe services and supplies not included in CPT. These are also known as "alpha numeric codes." Durable medical equipment is included in these Level II codes. Level III codes are local codes developed by carriers for new services or supplies for which there are no Level I or II codes. (OT Quick Coding Guide page 3)

One distinction between the CPT coding system and the HCPCS coding system is that CPT codes only document services, not devices. The HCPCS coding system has codes for devices and services.

How are CPT Codes updated and revised?

CPT Codes are updated through a deliberative process of adding, deleting, and revising codes. CPT codes are updated and revised by the AMA’s CPT Editorial Panel, on an annual basis. According to the AMA, "The Panel is comprised of 16 members, 11 nominated by the AMA and one each from the Blue Cross and Blue Shield Association, the Health Insurance Association of America, HCFA, the American Hospital Association, and the co-chair of the Health Care Professionals Advisory Committee (HCPAC). AMA's Board of Trustees appoints the Panel members. Of the 11 AMA seats on the Panel, eight are regular seats, having a maximum tenure of two four-year terms, or a total of eight years for any one individual. The five remaining seats, called rotating seats, have two two-year terms. These rotating seats allow for more multi-disciplinary input." Footnote (http://www.ama-assn.org/med-sci/cpt/template.htm

It is significant that one member of the HCPAC sits on the Editorial Panel. The HCPAC was established in 1983 to represent the interests of non-physician groups to the AMA. This was done at HCFA’s urging to allow for non-physician participation in the CPT code revision and update process. <Footnote CPT Instructional Course> Professional organizations represented on the HCPAC include the American Physical Therapy Association (APTA), American Occupational Therapy Association (AOTA), American Speech-Language Hearing Association (ASHA), American Psychological Association, American Nurses Association, American Podiatric Medical Association, American Chiropractic Association, and the American Optometric Association. <Footnote AMA CPT >

Physicians, medical societies, state medical associations, and others who can speak to whether CPT coding reflects current practice can propose new codes or revisions to existing codes. <Footnote: http://www.ama-assn.org/med-sci/cpt/template.htm> Requests for changes to CPT generally undergo an AMA staff screening process to ensure that the issue is one that has not already been acted on before and that the requestor’s documentation is complete. The documentation requirements are extensive. Documentation must include a detailed explanation regarding why the change is necessary, the wording for the new or revised code, and a clinical vignette of the typical person benefiting from the service. Supporting medical literature must be provided that indicates how the service is utilized. The complete request form can be found on the AMA web site. at (Footnote http://www.ama-assn.org/med-sci/cpt/req_for.rtf

If the request passes the AMA staff review it is forwarded to the CPT Advisory Committee. Depending on the outcome of the CPT Advisory Committee’s review, the request is forwarded to CPT Editorial Panel for its decision.

The CPT Advisory Committee is currently comprised of about 90 physicians representing medical specialties. Most are medical doctors, a few are Doctors of Osteopathic Medicine (DOs). (footnote AMA CPT Book) The work of the CPT Advisory Committee is to support the work of the CPT Editorial panel. This Advisory Committee’s duties include giving advice to the Editorial Panel on issues related to their specialty, suggesting revisions to CPT Codes, and assisting in the development of educational materials and articles pertaining to CPT. (Footnote http://www.ama-assn.org/med-sci/cpt/template.htm

Once the new or revised code is approved by the CPT Editorial Panel, it must have a "relative value" assigned to it. Proposing a new code or revising a code that must then have a relative value attached is a lengthy process. The RESNA Technical Assistance Project’s CPT Work Group, whose work will be discussed more in subsequent sections, estimated that it would take six months to two years to move a new AT-related code through the process.

A small change to a CPT code, one that is considered an editorial revision, can be accomplished by a letter to the AMA from a professional association. Since it does not involve an assignment of a new relative value, it is a quicker process. (Footnote? Helene Fearon, CPT Code Work Group minutes 5-4-99)

What is the Relative Value Unit of a Code?

The relative value unit (RVU) of a CPT code is one factor that determines what Medicare will pay for the service described by that code. HCFA multiplies the code’s RVU by a monetary conversion factor and the result is essentially the amount Medicare will pay for the service. (There are some adjustments made for geographic differences in resource costs.)

HCFA determines its monetary conversion factor annually. The Balanced Budget Act of 1997 tied this complex monetary conversion factor to increases in the Gross Domestic Product. (Footnote AMA News Article, 1998) The conversion factor for 2000 is $36.61, for 2001 it is $38.26. (AMA News Article, 2000)

In 1992, Medicare changed the way it paid for healthcare services. A standardized payment schedule was developed that is based on the cost of providing the service. This payment schedule is based on what is called a Resource-Based Relative Value Scale (RBRVS). Most private insurers and several state Medicaid systems and workers compensation plans have since adopted the RBRVS. Therefore, the RBRVS is used to determine payments in both public and private health insurance systems.

The RBRVS requires that a RVU be assigned to CPT codes. RVU’s are based on three components related to the cost of providing the service described in each CPT code: a physician/practitioner work component, a practice expense component and a professional liability insurance expense component. The RBRVS is updated annually, resulting in adjustments to RVU’s . (Footnote: Instructional Course)

How is a RVU Assigned to a CPT Code?

Assigning the RVU to new or revised CPT codes is a complex proposition with far-reaching consequences because of its use to determine payments in public and private insurance systems. With respect to Medicare, it is important to realize that the Medicare system is essentially one pot of money that does not grow much in real terms. The approval of a new code with its RVU assignment simply causes a redistribution of the available payments within the system. A gain for one provider group represents a loss to another provider group. Utilization also figures in to the relative value of the code. The more a code is utilized the less its value. (Footnote RESNA Conference session)

In 1991, the AMA formed a committee called the Relative Value Scale Updating Committee (RUC) to make recommendations to HCFA regarding the relative value of new or revised CPT Codes. After a new code or a code revision that requires a RVU assignment is approved by the Editorial Panel, it is forwarded to the RUC for its recommendation. According to the AMA, HCFA's acceptance rate for the RUC's recommendations has increased to more than 90% annually between the years 1993-1998. This is important because it shows that the AMA has a powerful role in determining RVU’s. (Footnote http://www.ama-assn.org/med-sci/cpt/annual.htm and related pages)

In 1994, a RUC Health Care Professionals Advisory Committee Review Board ( RUC HCPAC) was established to make relative value recommendations for non-physician provider CPT Codes. The same 10 groups including AOTA, ASHA and APTA that have representatives on the HCPAC also have representatives on the HCPAC RUC Review Board. If RESNA were to propose a code, its relative value recommendation would likely come from the RUC HCPAC Review Board. The RUC HCPAC Review Board’s recommendations go directly to HCFA. (Footnote Instructional Course)

The RUC (or the RUC HCPAC) makes a determination regarding the relative value of a code through a complex process that includes surveying the specialty groups that the code to be valued is likely to impact. The survey includes a clinical vignette that describes the service that would be provided to the "average" person under the proposed new code. Practitioners responding to the survey are asked questions that help the RUC determine both how much work is involved in the service described in the new code and estimate the utilization of the new code. In this process of determining a relative value of the code, the RUC is deciding the best way to redistribute the payments that are available to Medicare providers.

( Footnote RESNA Conference Instructional Course)

Although there are annual updates and reviews of the RBRVS every five years that may cause changes to RVU’s, the initial assignment of the work component of the RVU is very important because it usually does not change much.

The above paragraphs provide a simplified review of the RUC survey process. More information is available on the AMA web site. at http://www.ama-assn.org/med-sci/cpt/survey.htm

Please see Appendix 2 for a diagram of the CPT code update and revision process.

PART 2: Coding for AT Services Related to Seating and Mobility

This section provides an overview of how CPT coding is used for reimbursement of AT services. <Footnote: This section uses material presented at a RESNA 2000 Conference sessions. Barbara Levy and Linda Botton RESNA session> The seating and mobility examples presented in this section The seating and mobility examples presented in this section are used to provide some insights into how CPT codes would be applied to other AT services.are used to provide some insights into how CPT codes would be applied to other AT services.

The information provided in this section is based on a presentation by Linda Botten, Occupational Therapist (OT), member of the AMA’s HCPAC, and Barbara Levy, Physical Therapist (PT) at the RESNA 2000 Annual Conference.

<Footnote: These CPT codes are found within the physical medicine section of the AMA’s CPT 2001 book published by AMA>

<Footnote: This section does not present all the issues a practitioner needs to address when using CPT. Coding correctly does not mean a service is reimbursable, many factors contribute to this including payer policy.>

Table 1 lists many of the common CPT codes primarily used by physical and occupational therapists when providing seating and mobility services. For example these codes describe self care training (97535), wheelchair propulsion training (97542) and community/work integration training (97537).

Most of the seating and mobility codes listed in Table 1 have a unit of time specified in their description. These timed codes link the amount the provider is paid to time. If for example, the time unit is 15 minutes and the provider spends a half-hour performing the service, she or he can bill for two units of time. Practitioners must be sure that the total therapy session is consistent with the total treatment units. (Footnote Quick Coding Guide p.4)

The evaluation codes listed are not timed. This means the amount the provider is paid for the service is not tied to time. For example, the OT performing an OT evaluation code (97003) will be paid the same if the evaluation takes 30 minutes or 45 minutes.

Sometimes it is possible for a practitioner to add a component to a service that will make it possible to use a code with a higher relative value. Using a code of a higher relative value may mean that the service is reimbursable at a higher level. For example, code 97542, the wheelchair propulsion code has a .50 RVU. If the practitioner added a training component that involved going outside to learn how to negotiate curbs, grass, gravel and inclines, then code 97537, the community/work integration code could be used. The latter code has a higher RVU of .73. A word of caution here is, any code that is used must describe the services rendered. Choosing a code simply because it has a higher RVU is called ‘up-coding’ and is fraud. (footnote? 7-1 presentation an audience member suggested this, Linda added the caution)

In addition, practitioners should avoid coding in a way that is duplicative of another member of the AT team because third-party payers will likely not reimburse duplicative services. Also, evaluation codes and timed codes may be used on the same day.

A note about the codes, code descriptions and RVU’s presented in Table 1: the code and code descriptions are documented in the AMA’s Current Procedural Terminology: CPT 2001. The RVU’s in this chart are applicable to services rendered in "non-facility" settings, including those in private practice. The non-facility RVU’s also usually apply to those services offered in outpatient rehabilitation settings. (Footnote instructional course Linda Botten)

Table 1 CPT Codes Used for Seating and Mobility

CPT #	Code Descriptions	RVU for 2001
97112	Neuromuscular reeducation of movement, balance coordination, kinesthetic sense, posture and proprioception, each 15 minutes	.73
97504	Orthotics fitting and training, upper and/or lower extremities, each 15 minutes	.74
97530	Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to increase functional performance), each 15 minutes	.64
97535	Self care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment) direct one on one contact by provider, each 15 minutes	.74
97537	Community/work reintegration training (e.g., shopping, transportation, money management, avocational activities and/or work environment / modification analysis, work task analysis) direct one on one contact by provider, each 15 minutes	.73
97542	Wheelchair management/propulsion training, each 15 minutes	.50
97703	Checkout for orthotic/prosthetic use, established patient, each 15 minutes	.43
97750	Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes	.72
97116	Gait training (includes stair climbing), each 15 minutes	.68
97003	Occupational therapy evaluation	1.85
97001	Physical therapy evaluation	1.82
97002	Physical therapy re-evaluation	.91
97004	Occupational therapy re-evaluation	.95

Application of Codes to Seating and Mobility

Each code from Table 1 is listed along with a description of how the code might apply to AT services for seating and mobility.

97112 Nueromuscular Reeducation: This code is used for seating and access intervention that includes neuromuscular training to improve postural stability/control for function, and/or access issues. This code could be used for the placement of lateral trunk pads, for example.

97504 Orthotics Fitting and Training: This code is utilized for interventions involving splints, corsets, or the fabrication of custom-molded seating systems. This code is used for the hands-on application of the orthotic component, whether for the body or the chair. This code can also be used for training in the use of the custom device.

97530 Therapeutic Activities: This code is utilized for exercise to improve manual wheelchair propulsion, transfers, and posture. This functional code that can be for functional-related wheelchair activities and the practitioner’s documentation should be clear about the functional outcome.

97535 Self Care: This code is utilized for fitting of AT and/or training/positioning which will affect activities of daily life (ADL) and safety. This code may also be used for home environment and modification analysis. This code can be used for power wheelchair training. It is also used for parent/caregiver training.

97537 Community/Work Integration: This code is utilized for access and/or control training involving AT devices, transportation issues, and worksite assessments. It is also used for wheelchair training related to the outdoors, such as negotiating curbs, grass, gravel, inclines, etc.

97542 Wheelchair Management: This code is used for fitting and training of users or caretakers in the use of mobility and seating equipment. This code includes propulsion skills. Due to the low RVU for this code, it is not currently used often, as the reimbursement may not cover the therapist’s actual treatment time costs.

97703 Checkout for Orthotic/Prosthetic Use: This code is used with an established client to make adjustments to the orthotic or prosthetic, such as adjusting a strap or harness.

97750 Physical Performance Test or Measurement: This code is used for functional performance tests to assess needs and to identify problems. This code is used for the AT assessment, client measurements, seating simulator and pressure measurement. The results of these assessments are used to specify sizes and models of AT. It also may be used for time needed to document medical necessity of AT for third-party payers. However, the documentation must be completed while the patient is in attendance. This code requires a written report.

97116 Gait Training: This code can be used when training a client in using mobility aids, usually associated with ambulation. The training needs to include stair climbing because stair climbing is included in the code description.

CPT code numbers 97001-97004, listed below, are restrictive codes. The evaluation services described in 97001and 97002 can only be performed by a physical therapist (PT). The evaluation services described in 97003 and 97004 can only be performed by an occupational therapist (OOT). Note that these codes are not timed and provide a fixed reimbursement regardless of the time spent completing the evaluation.

97003 OT Evaluation or 97001 PT Evaluation: These evaluation codes may be used for the first visit. These codes are not recommended for use on the same day of service if CPT codes 97504, 97542, or 97750 are used. However, PTs and OTs may bill for evaluation services on the same day if they have different goals and/or different ICD-9-CM codes. Also, these codes are not recommended for use for services covering two days. If there is a second day of evaluative service, the 97750 test and measurement code can be used if it accurately describes the service.

97002 PT re-evaluation and 97004 OT re-evaluation: These codes may be used for subsequent visits of an established client every 30 days. Documentation of the service must reflect changes in examination findings, goals, and plan of care. This code is not recommended on the same day of service if 97504, 97542, 97703, or 97750 codes are used.

PART 3: Influencing CPT Code Development to Support AT Services

AT Professionals can influence CPT Code development to better support AT services. There are several options including the following:

• Collaborating with Other Groups with Related Coding Interests
• Revising CPT Codes and Developing New Codes to Better Include AT

• Educating AT professionals on Correct CPT Code Usage
• Advocating and Collaborating with HCFA on Coding and Payment Issues Related to AT

Collaborating with Other Groups with Related Coding Interests

Collaborating with professional groups with coding interests related to AT is one method of influencing CPT Code development to better support AT services. Building collaborations is essential in a system that impacts payments among providers.

Since April of 1999, RESNA, the RESNA Technical Assistance Project, the American Occupational Therapy Association (AOTA) and the American Physical Therapy Association (APTA) have formed a CPT Work Group to improve CPT coding for AT. This Work Group’s goal is to improve both reimbursements through the private and public insurance systems and data collection for AT services.

Linda Botten, AOTA and Helene Fearon, APTA, are members of the AMA HCPAC and have helped guide the group’s efforts. Ms. Fearon has recently been appointed Co-Chair of the HCPAC. It may be helpful to AT professionals that someone with knowledge of AT issues is in this position. Another member of the RESNA Technical Assistance Project’s CPT Work Group is Mary Foto, an Occupational Therapist and Certified Case Manager, who is Past President of the American Occupational Therapy Association. Ms. Foto. is on the RUC HCPAC and represents all non-physicians to the Practice Expense Committee.

The involvement of RESNA and the RESNA Technical Assistance Project with individuals who are involved in the AMA’s HCPAC and the HCPAC RUC, is exciting because it means concerns related to AT are communicated to parties involved in the editorial development of CPT codes and the valuation process.

Through the valuable collaboration that RESNA and the RESNA Technical Assistance Project has developed with AOTA and APTA, RESNA is helping AT professionals negotiate the CPT process.

As a result of this group’s activities to date, three editorial revisions for CPT codes have been submitted to the AMA. These revisions will help the code better describe the service or services provided and support AT.

There are other ways to influence CPT Code development through collaboration. One example is assisting other professional groups, such as ASHA, to conduct surveys used to determine RVU’s for AT services.

Revising CPT Codes and Developing New Codes to Better Support AT

The CPT Code Work Group developed editorial revisions to three existing CPT Codes. These are small wording changes that the group does not feel requires the code to be revalued, yet if the editorial changes are made AT service providers will be able to more accurately describe their services. AOTA and APTA sent a letter to the AMA requesting these changes and RESNA sent a letter of support. The group is waiting for the AMA’s response to the request. The changes that were requested are as follows:

Table 2 Chart of Proposed Editorial Revisions

Code #	Current Description	Editorial Revisions (in bold)
97112	Neuromuscular reeducation of movement, balance coordination, kinesthetic sense, posture and proprioception, each 15 minutes	Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, seated stability, functional control and proprioception, each 15 minutes
97504	Orthotics fitting and training, upper and/or lower extremities, each 15 minutes	Orthotics fitting and training upper extremity, and/or lower extremity, and/or trunk, each 15 minutes
97535	Self -care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment) direct one on one contact by provider, each 15 minutes	Self c-Care/hHome Mmanagement training (e.g., activities of daily living (ADLs) and compensatory training, meal preparation, safety procedures, and instructions in the use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider, each 15 minutes

All the requested editorial revisions support AT service delivery. For example, with respect to code 97112, some claims reviewers have interpreted the current code description to imply standing and deny claims for "seated" neuromuscular treatment. The proposed editorial change simply clarifies that this code can be used for seated neuromuscular treatment as well. Adding the term "functional control" clarifies that this code can be used for teaching upper extremity activities, such as activities of daily living and the operation of assistive technology devices.

Current wording of code 97504 does not include many orthotics designed for the trunk. The editorial change adds the word trunk and thus includes more orthotics. Adding the term assistive technology updates the terms used in code 97535 to specifically include AT.

The CPT Work Group is developing a new code. Since the work on this code is in the preliminary stages, it will not be discussed in further detail here. RESNA members and AT Act Projects may contact the RESNA Technical Assistance Project for more details on this process. The group is also deciding how to proceed in obtaining codes for Rehabilitation Engineers.

Educating AT Professionals on Correct CPT Code Usage

The RESNA Technical Assistance Project sponsored two sessions at the RESNA 2000 Annual Conference on CPT Coding for AT professionals. Educational efforts such as these should help these AT professionals code correctly and thus increase reimbursement for AT through both the public and private insurance systems.

Advocating and Collaborating with HCFA on Coding and Payment Issues Related to AT

The RESNA Technical Assistance Project has sponsored a Medicaid/Medicare Work Group of AT project representatives that has been advocating and collaborating with HCFA on coding and payment issues related to improving reimbursement for AT. The group has provided comments on some of HCFA’s proposed policies regarding Medicare reimbursements for AT.

Since private health insurance companies often mirror the public insurance systems reimbursement policies, advocating and educating HCFA on issues related to AT reimbursement is important.

Resources for CPT or HCPCS Coding Questions

AT professionals who have questions about how to code a particular service correctly may contact the AMA CPT Coding Helpline at 800-634-6922. Payment is usually required for this service and one option available is to pay $35 per faxed inquiry. Call the Helpline for additional details. Questions about HCPCS equipment codes can be directed to the Statistical Analysis Durable Medical Regional Carrier (SADMRC) at 803-736-6809.

Summation

AT professionals need to understand CPT codes and be involved in the development and revision of these codes because of the important role CPT plays in data collection and reimbursement for AT services under both the public and private insurance systems.

Appendix 1: Glossary of Key Abbreviations

AMA: The American Medical Association

APTA: The American Physical Therapy Association

AOTA: The American Occupational Therapy Association

AT: Assistive Technology

CPT: Current Procedural Terminology™ "… is a listing of descriptive terms and identifying codes for reporting medical services and procedures." This is the AMA’s definition. CPT is trademarked by the AMA™.

HCFA: The Heath Care Financing Administration

HCPAC: Health Care Professional Advisory Committee. This AMA committee represents the interests of non-physician groups to the AMA.

HCPCS: The Health Care Financing Administration’s Common Procedure Coding System. It encompasses CPT codes and has codes for devices and services not included in CPT codes.

ICD-9-CM: The International Classification of Diseases Ninth Revision Clinical Modification. The ICD-9-CM is a coding system that describes diseases, conditions and related issues.

RESNA Technical Assistance Project: The Rehabilitation Engineering and Assistive Technology Society of North America Technical Assistance Project. The Technical Assistance Project is funded through a grant from the Department of Education’s National Institute on Disability and Rehabilitation Research.

RBRVS: The Resource Based Relative Value Scale. A standardized payment schedule based on the cost of providing a service. Medicare, many Medicaid programs and private insurers use it to determine payments for medical services.

RUC: Relative Value Scale Updating Committee. The RUC makes recommendations to HCFA regarding the relative value of a CPT code for codes to be used primarily by physicians.

RUC HCPAC: Relative Value Scale Updating Committee Health Care Professional Advisory Committee. This committee makes relative value recommendations to HCFA for CPT codes used primarily by non-physician providers.

RVU: Relative value unit. The RVU of a CPT code is one factor that determines what Medicare, many Medicaid programs and private insurers will pay for the service described by that code. The RVU has three components: a physician/practitioner work component, a practice expense component and a professional liability component. The RBRVS requires that a RVU be attached to CPT codes.

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