CPT 97014 / G0283 , 97032, G0281, G0282, G0295 – Electosimulation

CPT/HCPCS Codes


Group 1 Codes:

64450 INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH

Group 2 Paragraph: Note: Use of the following Physical Medicine and Rehabilitation CPT/HCPCS Codes for these treatments is inappropriate:

97032 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES

97139 UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)

G0282 ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN DESCRIBED IN G0281

G0283 ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE

 Electric stimulation – CPT 97014/G0283, CPT 97032, 97033

Electric stimulation. Three codes exist that relate to electric stimulation — CPT 97014/G0283, supervised electric stimulation; CPT 97032, attended manual electric stimulation; and CPT 97033, iontopheresis. average fee amount – $12 – $18

CPT 97014/G0283 is appropriate for pad-based e-stim, which requires supervision only. Although this is not a time-based service, accepted protocols require 15 minutes to as much as 30 minutes of treatment.

97014 Application of a modality to one or more areas; electrical stimulation (unattended) is an invalid code for Medicare.

* For unattended electrical stimulation, HCPCS G0281 and G0283 have replaced CPT code 97014.
* For attended electrical stimulation, please refer to CPT 97032.

CPT 97032 can only be used when stimulation is manually applied. The requirement for constant attendance is derived from the manual-application requirement.

Usually a probe or other hand-held device is used and must be held for the entire therapy. This is a time-based service reported in 15-minute units.

97032 Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes

Background

Nerve blocks, injections of local anesthetic solutions, cause the temporary interruption of conduction of impulses in peripheral nerves or nerve trunks.

There are also early studies using electrostimulation with or without nerve blocks for treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases.

Limitations

The use of nerve blocks with or without the use of electrostimulation, and the use of electrostimulation alone for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not considered medically reasonable and necessary. Medical management using systemic medications is clinically indicated for the treatment of these conditions.

At present, the literature and scientific evidence supporting the use of peripheral nerve blocks with or without the use of electrostimulation, and the use of electrostimulation alone for neuropathies or peripheral neuropathies caused by underlying systemic diseases, is insufficient to warrant coverage. These procedures are considered investigational and are not eligible for coverage for the treatment of neuropathies or peripheral neuropathies caused by underlying systemic diseases.

This modality includes the following types of electrical stimulation:

* Transcutaneous electrical nerve stimulation (TENS) is used primarily for pain control. No more than a single office session will be allowed for the purpose of training for in-home use.

* Neuro-muscular stimulation: Used for retraining weak muscles following surgery or injury.

* Muscle stimulation: This type of stimulation is taken to the point of visible muscle contraction.

* High voltage pulsed current, also called electrogalvanic stimulation, may be useful for reducing swelling and control of pain.

* Interferential current/medium current: These units use a frequency that allows the current to go deeper. IFC is used to control swelling and pain.

* These uses may be necessary during the initial phase of treatment, but there must be an expectation of improvement in function, and must be utilized with appropriate therapeutic procedures (e.g., 97110) to effect continued improvement.

* Electrical stimulation is typically used in conjunction with therapeutic exercises. A limited number of visits without a therapeutic procedure may be medically necessary for treatment of muscle spasm and swelling.

* Treatment would not be expected to exceed 4 treatments per week no longer than one month when used as adjunctive therapy or for muscle retraining.

* When electrical stimulation is used for muscle strengthening or retraining, the nerve supply to the muscle must be intact. It is not medically necessary for motor nerve disorders such as Bell’s Palsy (Ref: Medicare National Coverage Determination Manual, Pub. 100-3, Section 160.15 and 150.4; formerly CIM 35-72 and 35.77). It is not medically necessary when there is limited potential for restoration of function.

* Microamperage E-stimulation (MENS) has not been proven effective and will be denied as such. It is inappropriate to use the CPT code 97032 for MENS therapy. Please refer to the procedure code 97799 for further instructions.

* E-Stim (Vital Stim) has not been proven effective and will be denied as such. It is inappropriate to use the CPT code 97032 for E-Stim (Vital Stim). Please refer to the procedure code 97799 for further instructions.

Electrical stimulation (HCPCS code G0283; CPT code 97032) is considered not reasonable and necessary and is excluded from Medicare coverage for the following:

a. motor nerve disorders such as Bell’s Palsy. (ICD-9 code 351.0)

b. TENS treatments and related services (i.e. CPT code 64550), furnished in physicians/NPP or therapist’s office. (See CMS Pub.100-2 Ch.16 §180, CMS Pub.100-3 §160.3)

c. Electrical Stimulation is not medically necessary for the treatment of strokes when there is no potential for restoration of function.

 CPT CODE G0283 – Billing and Coding Guidelines

97014 — electrical stimulation unattended (NOTE: 97014 is not recognized by Medicare. Use G0283 when reporting unattended electrical stimulation for other than wound care purposes as described in G0281 and G0282.)

Key Points

This Special Edition article outlines the method that is in place to remedy the error as follows:

• The modifier indicator for the 92526/G0283 code pair will be corrected and changed to a “1” with the OPPS OCE July 2006 Release.

• On July 3, 2006, the “1” indicator will permit the use of modifier -59 with G0283 for reporting of this service with CPT 92526 when performed by different therapy disciplines in outpatient providers of Part B therapy services.

• In addition to the OPPS hospitals (billing with bill types 12X and 13X), this edit was effective on January 1, 2006, for the following providers:

• Skilled nursing facilities (bill types 22X and 23X)

• Comprehensive outpatient rehabilitation facilities (bill types 75X)

• Outpatient physical therapy and speech language pathology service providers (74X)

• Home health agencies (bill type 34X)

Note: After the implementation of the July 2006 OPPS OCE, FIs and RHHIs shall begin to reprocess claims where payment for HCPCS G0283 was rejected based on the “0” indicator. Until the OPPS OCE is updated in July 2006, providers should continue to bill this code pair as the CCI indicates—without a modifier—and .should NOT hold claims.

• G0283 Scenarios:

– Any time you apply estim to a patient and you are not spending one-on-one time with the patient (Pain management)

– 20 minutes of e-stim (PENS) is applied to a patient’s elbow extensors while the patient is doing sit-to-stand push-ups from the arms of the chair during the extension phase of the e-stim ¾ Code the first 5 minutes (set-up time) to (G0283) and 15 minutes to therapeutic exercise (97110)

¾ Combo unit application, which includes estim and ultrasound: Split the time between supervised e-stim (G0283) and ultrasound 97035 for the application time (remember 97035 must show at least 8 minutes to be billed).

Reimbursement Guidelines

Optum will not reimburse for CPT code 97014. Unattended electrical stimulation will remain a reimbursable service however providers utilizing this modality will not be reimbursed for CPT code 97014. In accordance with CMS National Coding Policy, providers should submit the appropriate HCPCS G-code which more accurately represents the service rendered.

In December of 2002, the Federal Register was updated to reflect the addition of three new G-codes. The purpose of the G-code additions was to:

** Provide CMS more accurate tracking, trending, and data retrieval ability relative to provider specific use of electrical stimulation.

** Provide more specificity to the generalized CPT 97014 electrical stimulation code definition to better enable more accurate tracking, trending, and data retrieval ability relative to provider specific use of electrical stimulation.

** Provide language which details indication for electrical stimulation in the treatment of wound care management – stages lll and lV only, 30 days of documented failed trial of conventional care, etc.

Coding:

There are no specific CPT codes describing interferential current stimulation. The following CPT codes might be used: 64550, 97014

The following HCPCS code might also be used:

G0283: Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care.

The G-codes more accurately describe electrical stimulation application. Per the AMA CPT coding instructional which can be referenced in the Introduction section of the CPT manual, “select the name of the procedure or service that accurately identifies the service being performed. Do not select a CPT code that merely approximates the service provided.”

Effective with CMS National Coding Policy, January 1, 2003, CPT 97014 unattended electrical stimulation was cross-walked to new G codes.

The evidence base for the use of electrotherapy as practiced by PT’s is robust and insurance generally covers its use. In a fee-for-service payment structure either CPT code 97032 (attended electrical stimulation; in 15 minutes increments) or CPT code 97014 (unattended electrical stimulation; untimed; Medicare requires CPT code G0283 to be used instead) is used.

CPT 97033 is appropriate only when iontopheresis — the introduction of ions of soluble salts into the body by an electric current — is applied. Applying topical gels to the skin prior to application of the electric stimulation pads is not considered iontopheresis.

Although the pads used in this treatment are similar to those used in supervised e-stim, constant attendance is required because of the potential for burning the patient’s skin during therapy.

97033 Application of a modality to one or more areas; iontophoresis, each 15 minutes

* Because there is no convincing evidence from published, controlled clinical studies demonstrating the efficacy of this as a physical medicine modality, this service will be denied as not proven effective. An Advance Beneficiary Notice (ABN) should be obtained when iontophoresis is utilized.

CPT 97014 – Electrical stimulation (unattended) (to one or more areas)


CPT 97014 is not a Medicare recognized code. See HCPCS code G0283 for electrical stimulation (unattended).


CPT 97032 – electrical stimulation (manual) (to one or more areas), each 15 minutes

Most non-wound care electrical stimulation treatment provided in therapy should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/auxiliary personnel) without constant, direct contact required throughout the treatment.

97032 is a constant attendance electrical stimulation modality that requires direct (one-on-one) manual patient contact by the qualified professional/auxiliary personnel. Because the use of a constant, direct contact electrical stimulation modality is less frequent, documentation should clearly describe the type of electrical stimulation provided, as well as the medical necessity of the constant contact to justify billing 97032 versus G0283. Devices delivering high voltage stimulation may require one-on-one patient contact (e.g., MicroVas, when applied in a high voltage mode).

• If providing an electrical stimulation modality that is typically considered supervised (G0283) to a patient requiring constant attendance for safety reasons due to cognitive deficits, do not bill as 97032. This type of monitoring may be done by non-skilled personnel.

•Non-Implantable Pelvic Floor Electrical Stimulation (CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, section 230.8.)

Non-implantable pelvic floor electrical stimulators provide neuromuscular electrical stimulation through the pelvic floor with the intent of strengthening and exercising pelvic floor musculature. Stimulation delivered by vaginal or anal probes connected to an external pulse generator may be billed as 97032. Stimulation delivered via electrodes should be billed as G0283.

* The methods of pelvic floor electrical stimulation vary in location, stimulus frequency (Hz), stimulus intensity or amplitude (mA), pulse duration (duty cycle), treatments per day, number of treatment days per week, length of time for each treatment session, overall time period for device use, and between clinic and home settings. In general, the stimulus  frequency and other parameters are chosen based on the patient’s clinical diagnosis.

* Pelvic floor electrical stimulation with a non-implantable stimulator is covered for the treatment of stress and/or urge urinary incontinence in cognitively intact patients who have failed a documented trial of pelvic muscle exercise (PME) training.

* A failed trial of PME training is defined as no clinically significant improvement in urinary continence after completing 4 weeks of an ordered plan of pelvic muscle exercises designed to increase periurethral muscle strength.

* The patient’s medical record must indicate that the patient receiving a non-implantable pelvic floor electrical stimulator was cognitively intact, motivated, and had failed a documented trial of pelvic muscle exercise (PME) training.

Code G0283 is classified as a “supervised” modality, even though it is labeled as “unattended.” A supervised modality does not require direct (one-on-one) patient contact by the provider. Most electrical stimulation conducted via the application of electrodes is considered unattended electrical stimulation. Examples of unattended electrical stimulation modalities include Interferential Current (IFC), Transcutaneous Electrical Nerve Stimulation (TENS), cyclical muscle stimulation  (Russian stimulation).

Documentation must clearly support the need for electrical stimulation more than 12 visits. Some patients can be trained in the use of a home TENS unit for pain control. Only 1-2 visits should be necessary to complete the training (which may be billed as 97032). Once training is completed, code G0283 should not be billed as a treatment modality in the clinic.

Non-Implantable Pelvic Floor Electrical Stimulation

(CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, section 230.8.) Non-implantable pelvic floor electrical stimulators provide neuromuscular electrical stimulation through the pelvic floor with the intent of strengthening and exercising pelvic floor musculature.

Stimulation delivered by vaginal or anal probes connected to an external pulse generator may be billed as 97032. Stimulation delivered via electrodes should be billed as G0283.

The charges for the electrodes are included in the practice expense portion of code G0283. Do not bill the Medicare contractor or the patient for electrodes used to provide electrical stimulation as a clinic modality.

Do not bill Medicare for unattended electrical stimulation using code 97014.

Supportive Documentation Requirements (required at least every 10 visits) for G0283

Horizontal Therapy

• This service should be coded using 97014.
• The unit of service is limited to one, regardless of the time spent or the number of areas treated.
• When electrical stimulation 97014 and ultrasound 97035 are performed at the same time, using the same machine, only one modality should be billed.
• The electrodes and other supplies used to administer any modality are content of service of the modality.

EXAMPLES OF RED FLAGS:

• Duplicative services
• Misuse of CPT codes
• Billing/use of 97124 and 97140 for the same body part on the same DOS
• # of units / treatment greater than BCBSKS policy allowable
• Billing/use of 97002 for DOS before Jan. 1, 2017 or 97164 for DOS after Jan. 1, 2017 on each DOS billed
• Upcoding (e.g. 97032 instead of 97014)
• Use of unlisted procedure and modality codes
• Billing/use of two or more superficial heating modalities to the same body part –Use of 97010, 97014, 97035 same body part, same session with no documented rationale and objective data to support necessity for each modality
• Continued use of modalities for periods greater than 10 treatment sessions with no documented rationale and objective data to support patient improvement and ongoing treatment.

Nationally Covered Indications (CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, section 270.1): Electrical stimulation (ES) and electromagnetic therapy for the treatment of wounds are considered adjunctive therapies, and will only be covered for chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers. Chroniculcers are defined as ulcers that have not healed within 30 days of occurrence. ES or electromagnetic therapy will be covered only after appropriate standard wound therapy has been provided

• electrical stimulation or electromagnetic therapy when used as an initial treatment modality;

• continued treatment with ES or electromagnetic therapy if measurable signs of healing have not been demonstrated within any 30-day period of treatment;

• wounds that demonstrate a 100% epithelialized wound bed;

• a patient in the home setting, as unsupervised use by patients in the home has not been found to be medically reasonable and necessary.

• Etiology and duration of wound

• Type of prior treatments by a physician, non-physician practitioner, nurse and/or therapist that failed, including the duration of the failed treatment

• Stage of wound

• Description of wound: length, width, depth, grid drawing and/or photographs

• Amount, frequency, color, odor, type of exudate

• Evidence of infection, undermining, or tunneling

• Nutritional status

• Comorbidities (e.g., diabetes mellitus, peripheral vascular disease)

• Pressure support surfaces in use

• Patient’s functional level

• Skilled plan of treatment, including specific frequency of the modality

• Changing plan of treatment based on clinical judgment of the patient’s response or lack of response to treatment

• Frequent skilled observation and assessment of wound healing (at least weekly, but preferably with each treatment session) 30 days and there are no measurable signs of healing. This 30-day period may begin while the wound is acute.

Billing – CPT Codes: Not Permitted

In the same 15-minute (or other) time period, a therapist cannot bill any of the following pairs of CPT codes for outpatient therapy services provided to the same, or to different patients.

Examples include:

a. Any two CPT codes for modalities requiring “constant attendance” and direct one-on-one patient contact (CPT codes 97032 – 97039);

b. Any CPT code for modalities requiring constant attendance (CPT codes 97032 – 97039) with the group therapy CPT code (97150). For example: group therapy (97150) with ultrasound (97035);

c. Any untimed evaluation or reevaluation code (CPT codes 97001-97004) with any other timed or untimed CPT codes, including constant attendance modalities (CPT codes 97032 – 97039), therapeutic procedures (CPT codes 97110-97542) and group therapy (CPT code 97150)

Carrier Billing Instructions Applicable HCPCS Codes

• G0281 – Electrical stimulation, (unattended), to one or more areas, for chronic stage III and stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care.

• G0282 – Electrical stimulation, (unattended), to one or more areas, for wound care other than described in G0281 (Not covered by Medicare) Short descriptor: Elect stim wound care not pd

• G0295 – Electromagnetic stimulation, to one or more areas (Not covered) Short descriptor: electromagnetic therapy one

 97014 — electrical stimulation unattended. (NOTE: 97014 is not recognized by  Medicare. Use G0283 when reporting unattended electrical stimulation for other than wound care purposes as described in G0281 and G0282.)

97032 — Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes. (NOTE: 97032 should NOT be reported for wound care of any sort because electrical stimulation for wound care does not require constant attendance.)

97014 –  This code is one or more areas so the unit of service is limited to one regardless of the time spent or the number of areas treated. Use this code for Horizontal Therapy.

When electrical stimulation 97014 and ultrasound 97035 are performed at the same time using the same machine, only one modality should be billed.

The electrodes and other supplies used to administer any modality are content of service of the modality.

Billing of electrodes

The electrodes and other supplies used to administer any modality are content of service of the modality and should not be billed to the patient.