Presumptive Authorization Codes

Documentation must support services billed and DLI rules/guidance followed.

CPT Code Description
71045 - 71048 Chest - up to 4 views
71100 - 71111 Ribs - up to 3 views
72020 Spine; 1 view - specify level
72040 - 72052 Spine; cervical up to 6 views
72070 - 72074 Spine; thoracic - up to 4 views
72100 - 72110 Spine;  lumbosacral - up to 4 views
72125 - 72126 CT; spine; cervical with and without contrast
72128 - 72129 CT; spine; thoracic with and without contrast
72131 -72132 CT; spine; lumbar with and without contrast
72141 - 72142 MRI; spine; cervical spinal canal and contents with and without contrast
72146 - 72147 MRI; spine; thoracic; spinal canal and contents; with and without contrast
72148 - 72149 MRI; spine; lumbar; spinal canal and contents; with anda without contrast
72170 - 72190 Pelvis; up to 3 views
72192 - 72193 CT; pelvis; with and without contrast
72195 - 72196 MRI; pelvis; with and without contrast
73000 Clavicle complete
73010 Scapula complete
73020 Shoulder; 1 view
73030 Shoulder; complete
73040 Shoulder; arthrography w/ supervision and interpretation
73060 Humerus, minimum of 2 views
73070 Elbow; 2 views
73080 Elbow; complete minimum of 3 views
73085 Elbow, arthrography w/ supervision and interpretation
73090 Forearm; 2 views
73100 Wrist; 2 views
73110 Wrist; complete, minimum of 3 views
73115 Wrist; arthrography w/ supervision and interpretation
73120 Hand; 2 views
73130 Hand - minimum of 3 views
73140 Finger; minimum of 2 views
73200 - 73202 CT - upper extremity
73218 - 73222 MRI - upper extremity
73501 Hip unilateral w/pelvis when performed; 1 view
73502 Hip;  2-3 views
73503 Hip; minimum of 4 views
73521 Hips; bilateral w/ pelvis when performed; 2 views
73522 Hips; 3-4 views
73523 Hips; minimum of 5 views
73525 Hip, arthrography w/ supervision and interpretation
73551 Femur; 1 view
73552 Femur; 2 views
73560 - 73564 Knee
73580 Knee; arthorography w/ supervisiona and interpretation
73590 Tibia/fibula; 2 views
73600 - 73610 Ankle
73615 Ankle; arthorgraphy w/ supervision and interpretation
73620 - 73660 Foot/toe(s)
73700 - 73702 CT - lower extremity
73718 - 73722 MRI - lower extremity

CPT Code Description
95905 Motor and/or sensory newve conduction, using preconfigured electrode array(s), amplitude and latecy/velocity study, each limb, includs F-wave study when performed, w/ interp and report
95907 Nerve conduction studies; 1-2 studies
95908 Nerve conduction studies; 3-4 studies
95909 Nerve conduction studies; 5-6 studies
95910 Nerve conduction studies; 7-8 studies
95911 Nerve conduction studies; 9-10 studies
95912 Nerve conduction studies; 11-12 studies
95913 Nerve conduction studies; 13 or studies

CPT Code Description
99202 Evaluation and Management; New Patient
99203 Evaluation and Management; New Patient
99204 Evaluation and Management; New Patient
99205 Evaluation and Management; New Patient
99211 Evaluation and Management; Establised Patient
99212 Evaluation and Management; Establised Patient
99213 Evaluation and Management; Establised Patient
99215 Evaluation and Management; Establised Patient
99242 Office or Other Outpatient Consultation
99243 Office or Other Outpatient Consultation
99244 Office or Other Outpatient Consultation
99245 Office or Other Outpatient Consultation

CPT Code Description
29105 Application of long arm splint (shoulder to hand)
29125 Application of short arm splintn (shoulder to hand); static
29126 Application of short arm splintn (shoulder to hand); dynamic
97130 Application of finger splint; static
97131 Application of finger splint; dynamic
29345 Application of long leg cast (thigh to toes)
29355 Application of long leg cast; walker or ambulatory type
29358 Application of long leg cast brace
29405 Application of short leg cast (below knee to ankle)
29425 Application of short leg cast; walking or ambulatory type
29505 Application of long leg s;pint (thigh to ankle or toes)
29515 Application of short leg splint (calf to foot)
26600 - 26605 Closed tx of metacarpal fx; single with and without manipulation; each bone
26641 Closed tx of carpometacarpal dislocation; thumb, w/ manipulation
26645 Closed tx of carpometacarpal fracture dislocation; thumb, w/ manipulation
26670 Closed tx of carpometacarpal dislocation; other than thu
26700 - 26705 Closed tx of metacaropphalangeal dislocation, single with manipulation; w/o anesthesia or w/ anesthesia
26720 Closed tx of phalangeal shaft fx; proximal or middle phalanx, finger or thumb; w/o manipulation
26740 - 26742 Closed tx of articular fx, involving metacarpophalangeal or interphalangeal joint without manipulation or w/ manipulation
26750 - 26755 Closed tx of distal phalangeal fx, finger or thumb; w/o manipulation or with manipulation
26770 - 26775 Closed tx of interphalangeal joint dislocation, single with manipulation; w/o anesthesia or requiring anesthesia

CPT Code Description
20550 Injection; single tendon sheath, or ligament
20551 Injection; single tendon origin/insertion
20552 Injection; single or multiple trigger poing(s), 1 or 2 muscle(s)
20553 Injection, single or multiple trigger point(s), 3 or more muscles
20560 Needle insertion(s) without injections; 1 or 2 muscles (used for trigger point and dry needling)
20561 Needle insertion(s) without injections; 3 or more muscles (used for trigger point and dry needling)
20600 - 20604 Arthrocentesis, aspiration and/or injection; small joint or bursa (fingers, toes) w/o or w ultrasound guidance
20605 - 20606 Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa) w/o or w ultrasound guidance
20610 - 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (shoulder, hip, knee, subacromial bursa) w/o or with ultrasound guidance.

CPT Code Description
97161 Physical therapy eval; low complexity
97162 Physical therapy eval; moderate complexity
97163 Physical therapy eval; high complexity
97164 Re-evaluation of physical therapy established plan of care
97165 Occupational therapy eval; low complexity
97166 Occupational therapy eval; moderate complexity
97167 Occupational therapy eval; high complexity
97168 Re-evaluation of occupational  therapy established plan of care
97010 Hot or cold packs – one or more regions
97012 Traction – mechanical
97014 Electrical stimulation (unattended)
97016 Vasopneumatic devices
97018 Paraffin bath
97022 Whirlpool
97024 Diathermy (e.g. microwave)
97026 Infrared
97028 Ultraviolet
97032 Electrical stimulation (manual) one or more areas, ea 15 minutes
97033 Iontophoresis, ea 15 minutes
97034 Contrast Baths, ea 15 minutes
97035 Ultrasound, ea 15 minutes
97036 Hubbard tank, ea 15 minutes
97039 Unlisted modality, specify type and time if constant attendance
97110 Therapeutic Procedure, 1 or more areas, ea 15 minutes.  Therapeutic exercises to develop strength, endurance, range of motion and flexibility.
97112 Neuromuscular re-education, ea 15 minutes
97113 Aquatic therapy with therapeutic exercises, ea 15 minutes
97116 Gait training (includes stair climbing), ea 15 minutes
97124 Massage, ea 15 minutes
97139 Unlisted therapeutic procedure.  ** Passive or Active will depend upon the procedure.
97140 Manual therapy, ea 15 minutes.  NOTE:  This is passive unless billed with an active procedure – in that case it would be considered active.
97150 Therapeutic procedure(s), group (2 or more individuals)
97530 Therapeutic activities, direct (one-on-one) pt contact, ea 15 minutes.
97532 Development of cognitive skills to improve attention, memory, problem solving, direct (one-on-one) pt contact, ea 15 minutes.
97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) pat contact, ea 15 minutes.
97535 Self-care/home management training, direct (one-on-one) pt contact, ea 15 minutes. 
97537 Community/Work reintegration training, direct (one-on-one) pt contact, ea 15 minutes.
97542 Wheelchair management ea 15 minutes
97545 Work hardening/conditioning, initial 2 hours
97546 Work hardening/conditioning, ea addl hour
97799 97799 Unlisted physical medicine/rehabilitation service or procedure.  **Passive or Active will depend upon the procedure.
98940 Chiropractic manipulative treatment, spinal 1-2 regions
98941 Chiropractic manipulative treatment, spinal 3-4 regions
98942 Chiropractic manipulative treatment, spinal 5 regions
98943 Extraspinal, 1 or more regions