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CCIM Super Bill
Date of Service
*
MM slash DD slash YYYY
Patient Name
*
DOB
Month
Day
Year
Total Charges For This Visit
Check Number (leave blank to invoice patient)
Diagnosis Code
*
NO CHANGES TO PREVIOUS DIAGNOSIS (existing patients only)
NO Diagnosis - Wellness Visit
K58 Irritable bowel syndrome Includes: irritable colon spastic colon
K58.0 Irritable bowel syndrome with diarrhea
K58.9 Irritable bowel syndrome without diarrhea Irritable bowel syndrome NOS
K59.0 Constipation Excludes1: fecal impaction (K56.41) incomplete defecation (R15.0)
K59.00 Constipation, unspecified
K59.01 Slow transit constipation
K59.02 Outlet dysfunction constipation
K59.09 Other constipation
K59.1 Functional diarrhea Excludes1: diarrhea NOS (R19.7) irritable bowel syndrome with diarrhea (K58.0)
K59.4 Anal spasm (Proctalgia fugax)
L90.5 Scar conditions and fibrosis of skin (adherent scar, cicatrix, disfigurement of skin due to scar, fibrosis of skin NOS, Scar NOS) Excludes2: hypertrophic scar (L91.0), Keloid scar (L91.0)
M16 Osteoarthritis of hip
M16.11 Unilateral primary osteoarthritis, right hip
M16.12 Unilateral primary osteoarthritis, left hip
M16.2 Bilateral osteoarthritis resulting from hip dysplasia
M16.31 Unilateral osteoarthritis resulting from hip dysplasia, right hip
M16.32 Unilateral osteoarthritis resulting from hip dysplasia, left hip
M16.4 Bilateral post-traumatic osteoarthritis of hip
M16.51 Unilateral post-traumatic osteoarthritis, right hip
M16.52 Unilateral post-traumatic osteoarthritis, left hip
M25.50 Pain in unspecified joint
M25.511 Pain in right shoulder
M25.512 Pain in left shoulder
M25.519 Pain in unspecified shoulder
M25.521 Pain in right elbow
M25.522 Pain in left elbow
M25.529 Pain in unspecified elbow
M25.531 Pain in right wrist
M25.532 Pain in left wrist
M25.539 Pain in unspecified wrist
M25.55 Pain in hip
M25.551 Pain in right hip
M25.552 Pain in left hip
M25.559 Pain in unspecified hip
M25.561 Pain in right knee
M25.562 Pain in left knee
M25.569 Pain in unspecified knee
M25.571 Pain in right ankle and joints of right foot
M25.572 Pain in left ankle and joints of left foot
M25.579 Pain in unspecified ankle and joints of unspecified foot
M25.65 Stiffness of hip, not elsewhere classified
M25.651 Stiffness of right hip, not elsewhere classified
M25.652 Stiffness of left hip, not elsewhere classified Pelvic Injury
M35.7 Hypermobility syndrome (Familial ligamentous laxity)
M51.2: Lumbago due to intervertebral disc displacement
M53.3 Sacrococcygeal disorders, not elsewhere classified (Coccygodynia)
M54.00 Panniculitis affecting regions of neck and back, site unspecified
M54.01 Panniculitis affecting regions of neck and back, occipito-atlanto-axial region
M54.02 Panniculitis affecting regions of neck and back, cervical region
M54.03 Panniculitis affecting regions of neck and back, cervicothoracic region
M54.04 Panniculitis affecting regions of neck and back, thoracic region
M54.05 Panniculitis affecting regions of neck and back, thoracolumbar region
M54.06 Panniculitis affecting regions of neck and back, lumbar region
M54.07 Panniculitis affecting regions of neck and back, lumbosacral region
M54.08 Panniculitis affecting regions of neck and back, sacral and sacrococcygeal region
M54.09 Panniculitis affecting regions, neck and back, multiple sites in spine
M54.10 Radiculopathy, site unspecified
M54.11 Radiculopathy, occipito-atlanto-axial region
M54.12 Radiculopathy, cervical region
M54.13 Radiculopathy, cervicothoracic region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy,lumbosacral region
M54.18 Radiculopathy, sacral and sacrococcygeal region
M54.2 Cervicalgia
M54.3 Sciatica (Excludes1: lesion of sciatic nerve (G57.0) sciatica due to intervertebral disc disorder (M51.1) sciatica with lumbago (M54.4-))
M54.30 Sciatica, unspecified side
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.40 Lumbago with sciatica, unspecified side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side
M54.5: Lumbago with sciatica (DO NOT USE)
M54.6 Pain in thoracic spine
M54.50: Low back pain, unspecified
M54.51: Vertebrogenic low back pain
M54.59: Other low back pain
M54.81 Occipital neuralgia
M54.89 Other dorsalgia
M54.9 Dorsalgia, unspecified
M62.00 Separation of muscle (nontraumatic), unspecified site
M62.011 Separation of muscle (nontraumatic), right shoulder
M62.012 Separation of muscle (nontraumatic), left shoulder
M62.019 Separation of muscle (nontraumatic), unspecified shoulder
M62.021 Separation of muscle (nontraumatic), right upper arm
M62.022 Separation of muscle (nontraumatic), left upper arm
M62.029 Separation of muscle (nontraumatic), unspecified upper arm
M62.031 Separation of muscle (nontraumatic), right forearm
M62.032 Separation of muscle (nontraumatic), left forearm
M62.039 Separation of muscle (nontraumatic), unspecified forearm
M62.041 Separation of muscle (nontraumatic), right hand
M62.042 Separation of muscle (nontraumatic), left hand
M62.049 Separation of muscle (nontraumatic), unspecified hand
M62.051 Separation of muscle (nontraumatic), right thigh
M62.052 Separation of muscle (nontraumatic), left thigh
M62.059 Separation of muscle (nontraumatic), unspecified thigh
M62.061 Separation of muscle (nontraumatic), right lower leg
M62.062 Separation of muscle (nontraumatic), left lower leg
M62.069 Separation of muscle (nontraumatic), unspecified lower leg
M62.071 Separation of muscle (nontraumatic), right ankle and foot
M62.072 Separation of muscle (nontraumatic), left ankle and foot
M62.079 Separation of muscle (nontraumatic), unspecified ankle and foot
M62.08 Separation of muscle (nontraumatic), other site
M62.10 Other rupture of muscle (nontraumatic), unspecified site
M62.111 Other rupture of muscle (nontraumatic), right shoulder
M62.112 Other rupture of muscle (nontraumatic), left shoulder
M62.119 Other rupture of muscle (nontraumatic), unspecified shoulder
M62.121 Other rupture of muscle (nontraumatic), right upper arm
M62.122 Other rupture of muscle (nontraumatic), left upper arm
M62.129 Other rupture of muscle (nontraumatic), unspecified upper arm
M62.131 Other rupture of muscle (nontraumatic), right forearm
M62.132 Other rupture of muscle (nontraumatic), left forearm
M62.139 Other rupture of muscle (nontraumatic), unspecified forearm
M62.141 Other rupture of muscle (nontraumatic), right hand
M62.142 Other rupture of muscle (nontraumatic), left hand
M62.149 Other rupture of muscle (nontraumatic), unspecified hand
M62.151 Other rupture of muscle (nontraumatic), right thigh
M62.152 Other rupture of muscle (nontraumatic), left thigh
M62.159 Other rupture of muscle (nontraumatic), unspecified thigh
M62.161 Other rupture of muscle (nontraumatic), right lower leg
M62.162 Other rupture of muscle (nontraumatic), left lower leg
M62.169 Other rupture of muscle (nontraumatic), unspecified lower leg
M62.171 Other rupture of muscle (nontraumatic), right ankle and foot
M62.172 Other rupture of muscle (nontraumatic), left ankle and foot
M62.179 Other rupture of muscle (nontraumatic), unspecified ankle and foot
M62.18 Other rupture of muscle (nontraumatic), other site
M62.3 Immobility syndrome (paraplegic)
M62.40 Contracture of muscle, unspecified site
M62.411 Contracture of muscle, right shoulder
M62.412 Contracture of muscle, left shoulder
M62.419 Contracture of muscle, unspecified shoulder
M62.50 Muscle wasting and atrophy, not elsewhere classified, unspecified site
M62.511 Muscle wasting and atrophy, not elsewhere classified, right shoulder
M62.512 Muscle wasting and atrophy, not elsewhere classified, left shoulder
M62.519 Muscle wasting and atrophy, not elsewhere classified, unspecified shoulder
M62.521 Muscle wasting and atrophy, not elsewhere classified, right upper arm
M62.522 Muscle wasting and atrophy, not elsewhere classified, left upper arm
M62.529 Muscle wasting and atrophy, not elsewhere classified, unspecified upper arm
M62.531 Muscle wasting and atrophy, not elsewhere classified, right forearm
M62.532 Muscle wasting and atrophy, not elsewhere classified, left forearm
M62.539 Muscle wasting and atrophy, not elsewhere classified, unspecified forearm
M62.541 Muscle wasting and atrophy, not elsewhere classified, right hand
M62.542 Muscle wasting and atrophy, not elsewhere classified, left hand
M62.549 Muscle wasting and atrophy, not elsewhere classified, unspecified hand
M62.551 Muscle wasting and atrophy, not elsewhere classified, right thigh
M62.552 Muscle wasting and atrophy, not elsewhere classified, left thigh
M62.559 Muscle wasting and atrophy, not elsewhere classified, unspecified thigh
M62.561 Muscle wasting and atrophy, not elsewhere classified, right lower leg
M62.562 Muscle wasting and atrophy, not elsewhere classified, left lower leg
M62.569 Muscle wasting and atrophy, not elsewhere classified, unspecified lower leg
M62.571 Muscle wasting and atrophy, not elsewhere classified, right ankle and foot
M62.572 Muscle wasting and atrophy, not elsewhere classified, left ankle and foot
M62.579 Muscle wasting and atrophy, not elsewhere classified, unspecified ankle and foot
M62.58 Muscle wasting and atrophy, not elsewhere classified, other site
M62.59 Muscle wasting and atrophy, not elsewhere classified, multiple sites
M62.81 Muscle weakness (generalized)
M62.82 Rhabdomyolysis
M62.83 Muscle spasm
M62.830 Muscle spasm of back
M62.831 Muscle spasm of calf
M62.838 Other muscle spasm
M62.89 Other specified disorders of muscle
M62.9 Disorder of muscle, unspecified
M75.00 Adhesive capsulitis of unspecified shoulder
M75.01 Adhesive capsulitis of right shoulder
M75.02 Adhesive capsulitis of left shoulder
M75.100 Unspecified rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic
M75.101 Unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic
M75.102 Unspecified rotator cuff tear or rupture of left shoulder, not specified as traumatic
M75.110 Incomplete rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic
M75.111 Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic
M75.112 Incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic
M75.120 Complete rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic
M75.121 Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic
M75.122 Complete rotator cuff tear or rupture of left shoulder, not specified as traumatic
M75.20 Bicipital tendinitis, unspecified shoulder
M75.21 Bicipital tendinitis, right shoulder
M75.22 Bicipital tendinitis, left shoulder
M75.40 Impingement syndrome of unspecified shoulder
M75.41 Impingement syndrome of right shoulder
M75.42 Impingement syndrome of left shoulder
M75.50 Bursitis of unspecified shoulder
M75.51 Bursitis of right shoulder
M75.52 Bursitis of left shoulder
M75.80 Other shoulder lesions, unspecified shoulder
M75.81 Other shoulder lesions, right shoulder
M75.82 Other shoulder lesions, left shoulder
M75.90 Shoulder lesion, unspecified, unspecified shoulder
M75.91 Shoulder lesion, unspecified, right shoulder
M75.92 Shoulder lesion, unspecified, left shoulder
M76.00 Gluteal tendinitis, unspecified hip
M76.01 Gluteal tendinitis, right hip
M76.02 Gluteal tendinitis, left hip
M76.10 Psoas tendinitis, unspecified hip
M76.11 Psoas tendinitis, right hip
M76.12 Psoas tendinitis, left hip
M76.20 Iliac crest spur, unspecified hip
M76.21 Iliac crest spur, right hip
M76.22 Iliac crest spur, left hip
M76.30 Iliotibial band syndrome, unspecified leg
M76.31 Iliotibial band syndrome, right leg
M76.32 Iliotibial band syndrome, left leg
M76.40 Tibial collateral bursitis [Pellegrini-Stieda], unspecified leg
M76.41 Tibial collateral bursitis [Pellegrini-Stieda], right leg
M76.42 Tibial collateral bursitis [Pellegrini-Stieda], left leg
M76.50 Patellar tendinitis, unspecified knee
M76.51 Patellar tendinitis, right knee
M76.52 Patellar tendinitis, left knee
M76.60 Achilles tendinitis, unspecified leg
M76.61 Achilles tendinitis, right leg
M76.62 Achilles tendinitis, left leg
M76.70 Peroneal tendinitis, unspecified leg
M76.71 Peroneal tendinitis, right leg
M76.72 Peroneal tendinitis, left leg
M76.811 Anterior tibial syndrome, right leg
M76.812 Anterior tibial syndrome, left leg
M76.819 Anterior tibial syndrome, unspecified leg
M76.821 Posterior tibial tendinitis, right leg
M76.822 Posterior tibial tendinitis, left leg
M76.829 Posterior tibial tendinitis, unspecified leg
M76.891 Other specified enthesopathies of right lower limb, excluding foot
M76.892 Other specified enthesopathies of left lower limb, excluding foot
M76.899 Other specified enthesopathies of unspecified lower limb, excluding foot
M76.9 Unspecified enthesopathy, lower limb, excluding foot
M77.00 Medial epicondylitis, unspecified elbow
M77.01 Medial epicondylitis, right elbow
M77.02 Medial epicondylitis, left elbow
M77.10 Lateral epicondylitis, unspecified elbow
M77.11 Lateral epicondylitis, right elbow
M77.12 Lateral epicondylitis, left elbow
M77.20 Periarthritis, unspecified wrist
M77.21 Periarthritis, right wrist
M77.22 Periarthritis, left wrist
M77.40 Metatarsalgia, unspecified foot
M77.41 Metatarsalgia, right foot
M77.42 Metatarsalgia, left foot
M79.0 Rheumatism, unspecified
M79.1 Myalgia
M79.2 Neuralgia and neuritis, unspecified
M79.3 Panniculitis, unspecified
M79.4 Hypertrophy of (infrapatellar) fat pad
M79.5 Residual foreign body in soft tissue
M79.601 Pain in right arm
M79.602 Pain in left arm
M79.603 Pain in arm, unspecified
M79.604 Pain in right leg
M79.605 Pain in left leg
M79.606 Pain in leg, unspecified
M79.609 Pain in unspecified limb
M79.621 Pain in right upper arm
M79.622 Pain in left upper arm
M79.629 Pain in unspecified upper arm
M79.631 Pain in right forearm
M79.632 Pain in left forearm
M79.639 Pain in unspecified forearm
M79.641 Pain in right hand
M79.642 Pain in left hand
M79.643 Pain in unspecified hand
M79.644 Pain in right finger(s)
M79.645 Pain in left finger(s)
M79.646 Pain in unspecified finger(s)
M79.651 Pain in right thigh
M79.652 Pain in left thigh
M79.659 Pain in unspecified thigh
M79.661 Pain in right lower leg
M79.662 Pain in left lower leg
M79.669 Pain in unspecified lower leg
M79.671 Pain in right foot
M79.672 Pain in left foot
M79.673 Pain in unspecified foot
M79.674 Pain in right toe(s)
M79.675 Pain in left toe(s)
M79.676 Pain in unspecified toe(s)
M79.7 Fibromyalgia
M79.9 Soft tissue disorder, unspecified
M84.35 Stress fracture, pelvis and femur (Stress fracture, hip)
M84.350 Stress fracture, pelvis
N30.1 Interstitial cystitis (chronic)
N30.10 Interstitial cystitis (chronic) without hematuria
N30.11 Interstitial cystitis (chronic) with hematuria
N31 Neuromuscular dysfunction of bladder, not elsewhere classified- Use additional code to identify any associated urinary incontinence (N39.3-N39.4-) (Excludes1: cord bladder NOS (G95.89), neurogenic bladder due to cauda equina syndrome (G83.4), neuromuscular dysfunction due to spinal cord lesion (G95.89))
N31.9 Neuromuscular dysfunction of bladder, unspecified (Neurogenic bladder dysfunction NOS)
N32.81 Overactive bladder (Detrusor muscle hyperactivity) (Excludes1: frequent urination due to specified bladder condition- code to condition)
N34 Urethritis and urethral syndrome
N34.3 Urethral syndrome, unspecified
N39.0 Urinary tract infection, site not specified
N39.3 Stress incontinence (female) (male) Code also any associated overactive bladder (N32.81) Excludes1: mixed incontinence (N39.46)
N39.41 Urge incontinence (Excludes1: mixed incontinence (N39.46))
N39.42 Incontinence without sensory awareness
N39.43 Post-void dribbling
N39.44 Nocturnal enuresis
N39.45 Continuous leakage
N39.46 Mixed incontinence (Urge and stress incontinence)
N39.490 Overflow incontinence
N39.498 Other specified urinary incontinence
N39.8 Other specified disorders of urinary system
N39.9 Disorder of urinary system, unspecified
N40.1 Enlarged prostate with lower urinary tract symptoms Enlarged prostate with LUTS Use additional code for associated symptoms, when specified: incomplete bladder emptying (R39.14) nocturia (R35.1) straining on urination (R39.16) urinary frequency (R35.0) urinary hesitancy (R39.11) urinary incontinence (N39.4-) urinary obstruction (N13.8) urinary retention (R33.8) urinary urgency (R39.15) weak urinary stream (R39.12)
N42.81 Prostatodynia
N81.0 Urethrocele Excludes1: urethrocele with cystocele (N81.1-), urethrocele with prolapse of uterus (N81.2-N81.4)
N81.10 Cystocele, unspecified (Prolapse of (anterior) vaginal wall NOS)
N81.11 Cystocele, midline
N81.12 Cystocele, lateral
N81.2 Incomplete uterovaginal prolapse (First degree uterine prolapse, Prolapse of cervix NOS, Second degree uterine prolapse) Excludes1: cervical stump prolapse (N81.85)
N81.3 Complete uterovaginal prolapse (Procidentia (uteri), NOS Third degree uterine prolapse)
N81.4 Uterovaginal prolapse, unspecified (Prolapse of uterus NOS)
N81.5 Vaginal Enterocele Excludes1: enterocele with prolapse of uterus (N81.2-N81.4)
N81.6 Rectocele (Prolapse of posterior vaginal wall)
N81.81 Perineocele
N81.82 Incompetence or weakening of pubocervical tissue
N81.83 Incompetence or weakening of rectovaginal tissue
N81.84 Pelvic Muscle Wasting
N81.85 Cervical stump prolapse
N81.89 Other female genital prolapse (deficient perineum, old laceration of muscles of the pelvic floor)
N81.9 Female genital prolapse, unspecified
N94.1 Dyspareunia Excludes1: psychogenic dyspareunia (F52.6) N94.4 Primary dysmenorrhea
N94.2 Vaginismus Excludes1: psychogenic vaginismus (F52.5)
N94.5 Secondary dysmenorrhea
N94.6 Dysmenorrhea, unspecified Excludes1: psychogenic dysmenorrhea (F45.8) N94.810 Vulvar vestibulitis
N94.819 Vulvodynia, unspecified R10.2 Pelvic and perineal pain Excludes1: vulvodynia (N94.81)
Q79.6 Ehlers-Danlos syndrome
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified Peripartum M62.0 Separation of muscle (nontraumatic) (Diastasis of muscle) Excludes1: diastasis recti complicating pregnancy, labor and delivery (O71.8) traumatic separation of muscle- see strain of muscle by body region
R14.0 Abdominal distension (gaseous) Bloating Tympanites (abdominal) (intestinal)
R14.1 Gas pain
R14.3 Flatulence
R15 Fecal incontinence Includes: encopresis NOS Excludes1: fecal incontinence of nonorganic origin (F98.1)
R15.0 Incomplete defecation Excludes1: constipation (K59.0-) fecal impaction (K56.41)
R15.1 Fecal smearing (Fecal soiling)
R15.2 Fecal urgency
R15.9 Full incontinence of feces (Fecal incontinence NOS)
R26.0 Ataxic gait
R26.1 Paralytic gait
R26.2 Difficulty in walking, not elsewhere classified
R26.81 Unsteadiness on feet
R26.89 Other abnormalities of gait and mobility
R26.9 Unspecified abnormalities of gait and mobility
R27.0 Ataxia, unspecified
R27.8 Lack of coordination (muscle incoordination)
R27.9 Unspecified lack of coordination
R35.0 Frequency of micturition
R35.1 Nocturia
R39.11 Hesitancy of micturition
R39.12 Poor/weak stream
R39.13 Splitting of stream
R39.14 Feeling of incomplete bladder emptying
R39.15 Urgency of Urination Excludes1: urge incontinence (N39.41,N39.46)
R39.16 Straining to void
R39.81 Functional urinary incontinence Excludes1: stress incontinence and other specified urinary incontinence (N39.3-N39.4-), urinary incontinence NOS (R32)
R39.89 Bladder pain
R42 Dizziness and giddiness
R52 Pain, unspecified (includes neck, back, general pain)
S33.4 Traumatic rupture of symphysis pubis
S39.012: Low back strain
Z76.89 Persons encountering health services in other specified circumstances
Type of Evaluation
97161 (PT Evaluation Low Complexity) - 60 Minutes
97162 (PT Evaluation Moderate Complexity) - 75 Minutes
97163 (PT Evaluation High Complexity) - 90 Minutes
97002 Re-evaluation
Only select if you did an evaluation.
Evaluation Units
1 Unit = 30 Minutes
2 Unit = 60 Minutes
3 Unit = 90 Minutes
Only fill in this field if you performed an evaluation.
First Therapy Performed
20560 Needle insertions without injections in 1-2 muscles
20561 Needle insertions without injections in 3 or more muscles
90912 Biofeedback training (Initial), perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry
90913 Biofeedback training (Secondary), perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry (must also code 90912 with this code)
97110 Therapeutic Exercise
97110 Therapeutic Exercise AAROM - Active Assisted Range of Motion
97110 Therapeutic Exercise AROM - Active Range of Motion
97110 Therapeutic Exercise BT - Balance Training
97110 Therapeutic Exercise DRHE - Designed/revised home exercise program
97110 Therapeutic Exercise ET - Endurance Training
97110 Therapeutic Exercise FT - Functional Training
97110 Therapeutic Exercise GE - Group Exercise
97110 Therapeutic Exercise HE - Therapist Supervised Home Exercise Training
97110 Therapeutic Exercise PROM - Passive Range of Motion - Patient Generated
97110 Therapeutic Exercise PT - Postural Training
97110 Therapeutic Exercise RE - Resisted Exercise
97110 Therapeutic Exercise RT - Relaxation Training
97112 Neuromuscular Re-education
97116 Gait Training
97140 Manual Therapy - Manual Therapy
97140 Manual Therapy AARM - Active Assisted Range of Motion
97140 Manual Therapy JM - Joint Mobilization
97140 Manual Therapy MT - Massage Therapy
97140 Manual Therapy STM - Soft Tissue Mobilization
97150 Group Therapeutic Exercise
97150 Group Therapy
97350 Patient Education
97530 Therapeutic Activities
97535 Self-Care/Home Management Training
97750 Physical Performance Test or Measurement
Select the first therapy performed on patient.
First Therapy Units
1 Unit = 15 Minutes
2 Unit = 30 Minutes
3 Unit = 45 Minutes
4 Unit = 60 Minutes
Select for first therapy.
Second Therapy Performed
20560 Needle insertions without injections in 1-2 muscles
20561 Needle insertions without injections in 3 or more muscles
90912 Biofeedback training (Initial), perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry
90913 Biofeedback training (Secondary), perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry (must also code 90912 with this code)
97110 Therapeutic Exercise
97110 Therapeutic Exercise AAROM - Active Assisted Range of Motion
97110 Therapeutic Exercise AROM - Active Range of Motion
97110 Therapeutic Exercise BT - Balance Training
97110 Therapeutic Exercise DRHE - Designed/revised home exercise program
97110 Therapeutic Exercise ET - Endurance Training
97110 Therapeutic Exercise FT - Functional Training
97110 Therapeutic Exercise GE - Group Exercise
97110 Therapeutic Exercise HE - Therapist Supervised Home Exercise Training
97110 Therapeutic Exercise PROM - Passive Range of Motion - Patient Generated
97110 Therapeutic Exercise PT - Postural Training
97110 Therapeutic Exercise RE - Resisted Exercise
97110 Therapeutic Exercise RT - Relaxation Training
97112 Neuromuscular Re-education
97116 Gait Training
97140 Manual Therapy - Manual Therapy
97140 Manual Therapy AARM - Active Assisted Range of Motion
97140 Manual Therapy JM - Joint Mobilization
97140 Manual Therapy MT - Massage Therapy
97140 Manual Therapy STM - Soft Tissue Mobilization
97150 Group Therapeutic Exercise
97150 Group Therapy
97350 Patient Education
97530 Therapeutic Activities
97535 Self-Care/Home Management Training
97750 Physical Performance Test or Measurement
Select the second therapy performed on patient.
Second Therapy Units
1 Unit = 15 Minutes
2 Unit = 30 Minutes
3 Unit = 45 Minutes
4 Unit = 60 Minutes
Select for second therapy.
Third Therapy Performed
20560 Needle insertions without injections in 1-2 muscles
20561 Needle insertions without injections in 3 or more muscles
90912 Biofeedback training (Initial), perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry
90913 Biofeedback training (Secondary), perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry (must also code 90912 with this code)
97110 Therapeutic Exercise
97110 Therapeutic Exercise AAROM - Active Assisted Range of Motion
97110 Therapeutic Exercise AROM - Active Range of Motion
97110 Therapeutic Exercise BT - Balance Training
97110 Therapeutic Exercise DRHE - Designed/revised home exercise program
97110 Therapeutic Exercise ET - Endurance Training
97110 Therapeutic Exercise FT - Functional Training
97110 Therapeutic Exercise GE - Group Exercise
97110 Therapeutic Exercise HE - Therapist Supervised Home Exercise Training
97110 Therapeutic Exercise PROM - Passive Range of Motion - Patient Generated
97110 Therapeutic Exercise PT - Postural Training
97110 Therapeutic Exercise RE - Resisted Exercise
97110 Therapeutic Exercise RT - Relaxation Training
97112 Neuromuscular Re-education
97116 Gait Training
97140 Manual Therapy - Manual Therapy
97140 Manual Therapy AARM - Active Assisted Range of Motion
97140 Manual Therapy JM - Joint Mobilization
97140 Manual Therapy MT - Massage Therapy
97140 Manual Therapy STM - Soft Tissue Mobilization
97150 Group Therapeutic Exercise
97150 Group Therapy
97350 Patient Education
97530 Therapeutic Activities
97535 Self-Care/Home Management Training
97750 Physical Performance Test or Measurement
Select the third therapy performed on patient.
Third Therapy Units
1 Unit = 15 Minutes
2 Unit = 30 Minutes
3 Unit = 45 Minutes
4 Unit = 60 Minutes
Select for third therapy.
Fourth Therapy Performed
20560 Needle insertions without injections in 1-2 muscles
20561 Needle insertions without injections in 3 or more muscles
90912 Biofeedback training (Initial), perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry
90913 Biofeedback training (Secondary), perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry (must also code 90912 with this code)
97110 Therapeutic Exercise
97110 Therapeutic Exercise AAROM - Active Assisted Range of Motion
97110 Therapeutic Exercise AROM - Active Range of Motion
97110 Therapeutic Exercise BT - Balance Training
97110 Therapeutic Exercise DRHE - Designed/revised home exercise program
97110 Therapeutic Exercise ET - Endurance Training
97110 Therapeutic Exercise FT - Functional Training
97110 Therapeutic Exercise GE - Group Exercise
97110 Therapeutic Exercise HE - Therapist Supervised Home Exercise Training
97110 Therapeutic Exercise PROM - Passive Range of Motion - Patient Generated
97110 Therapeutic Exercise PT - Postural Training
97110 Therapeutic Exercise RE - Resisted Exercise
97110 Therapeutic Exercise RT - Relaxation Training
97112 Neuromuscular Re-education
97116 Gait Training
97140 Manual Therapy - Manual Therapy
97140 Manual Therapy AARM - Active Assisted Range of Motion
97140 Manual Therapy JM - Joint Mobilization
97140 Manual Therapy MT - Massage Therapy
97140 Manual Therapy STM - Soft Tissue Mobilization
97150 Group Therapeutic Exercise
97150 Group Therapy
97350 Patient Education
97530 Therapeutic Activities
97535 Self-Care/Home Management Training
97750 Physical Performance Test or Measurement
Select the third therapy performed on patient.
Fourth Therapy Units
1 Unit = 15 Minutes
2 Unit = 30 Minutes
3 Unit = 45 Minutes
4 Unit = 60 Minutes
Select for fourth therapy.
Notes to Billing Agent
Please also provide patient email address for billing if this is first visit.
Send Invoice to Patient
Yes
No
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