Diagnostic Codes for Insurance
Need Insurance To Cover OT for SPD? Try These Codes!
The first section of this information is available in the SENSORY INTEGRATION - SPECIAL INTEREST SECTION QUARTERLY Volume 22, number 1 March, 1999. Published by the American Occupational Therapy Association, Inc.
"Insurance Reimbursement Survey Results"
Use of Codes for Diagnosis and Treatment
ICD-9 Diagnostic Codes:
299.0 — Autism
299.8 — Pervasive Developmental Disorder/Asperger's Syndrome
314.0 — Attention Deficit Disorder
314.01— Attention Deficit Disorder with Hyperactivity
315.4 — Developmental Coordination Disorder
315.8 — Delay in Development (specified)
315.9 — Delay in Development (unspecified)
343.9 — Cerebral Palsy
759.83— Fragile X Syndrome
781.3 — Lack of Coordination
784.69— Motor Apraxis
742.9 — Unspecified Anomaly of the Brain, Spinal Cord and Nervous System
349.9 — Unspecified Disorders of the Nervous System
782.0 — Disturbance of Skin Sensation
781.0 — Tremors Nervous system
348.3 — Encephalopathy
382.9 — Otitis Media
CPT Codes For Billing:
97110 — Therapeutic Exercises (procedures)
97112 — Neuromuscular Re-Education
97530 — Therapeutic Exercises (activities)
97770 — Self-Care/Home Management
In a sample Private OT, these are the evaluation and treatment codes most frequently used...
Evaluation Codes:
96110 — OT Eval- developmental assessment interpretation, report
96111 — OT Eval- extended standardized developmental instruments
96115 — Neurobehavioral status exam with interpretation report
96117 — Neuropsychological testing with interpretation report
97003 — Medicaid/CMS Evaluation
Treatment Codes:
97110 — Therapeutic Procedure - develop strength/endurance. ROM/flex
97112 — Neuro-muscular Re-Education - balance, coordination, proprioception
97250 — Myofascial Release/Mobilization - hand, wrist
97265 — Joint Mobilization - hand, wrist
97504 — Orthotics Fitting - upper/lower extremity