Disposition Code	 Definition of Disposition Code
1	The Medicare physician fee schedule (MPFS) abstract file does not contain prices for these codes  they are contractor-priced.  Proper payment for these codes under the MPFS is determined by the A/B MACs.
2	CPT code 97760 should not be reported with CPT code 97116 for the same extremity.
3	"These Healthcare Procedure Coding System/Common Procedural Terminology (HCPCS/CPT) codes are bundled under the MPFS. Regardless of whether they are billed alone or in conjunction with another therapy code, never make payment separately for these codes. If billed alone, these codes shall be denied using the existing MSN language. For remittance advice notices, use group code CO and claim adjustment reason code 97 that says: Payment is included in the allowance for another service/procedure. Use reason code 97 to deny a procedure code that should have been bundled. Alternatively, reason code B15, which has the same intent, may also be used."
4	"If billed by a hospital or a Critical Access Hospital (CAH), these HCPCS/CPT codes are always paid as non-therapy services for hospital or CAH outpatients. Payment for these codes is always made using the respective payment methodology, e.g., Outpatient Prospective Payment System (OPPS) for OPPS hospitals or under the applicable cost-based method for CAHs. "
5	"These codes are always therapy services, regardless of who performs them. These codes always require a therapy modifier ? GP, GO, or GN ? to indicate that they're furnished under a physical therapy, occupational therapy, or speech-language pathology plan of care, respectively.  "
6	"If billed by a hospital or a CAH, these OPPS-designated sometimes therapy HCPCS/CPT codes may be paid as non-therapy services for hospital or CAH outpatients. When these sometimes therapy codes are furnished by a qualified therapist under a therapy plan of care, the requirements for the MPFS-designated sometimes therapy codes, described in disposition 7, apply."
7	"These HCPCS/CPT codes represent sometimes therapy services. However, these codes are always therapy services 
when furnished by a therapist and in this situation require the use of a therapy modifier ? GP, GO or GN ? in order to indicate the service is furnished under a physical therapy, occupational therapy, or speech-language pathology plan of care, respectively.
When these sometimes therapy codes are not considered therapy services, the therapy thresholds and therapy modifiers do not apply. Codes marked 7 are not therapy services when:
  It is not appropriate to bill the service under a therapy plan of care, and
   They are billed by practitioners who are not therapists, e.g., physicians, clinical nurse specialists, nurse practitioners, physician assistants, and psychologists.
While this disposition designates that a particular HCPCS/CPT code will not of itself always indicate that a therapy service was rendered, these codes always represent therapy services when rendered by therapists or by practitioners who are not therapists in situations where the service provided is integral to an outpatient rehabilitation therapy plan of care. For these situations, these codes must always have a therapy modifier.For example, when the service is rendered by either a doctor of medicine or a nurse practitioner (acting within the scope of his or her license when performing such service), with the goal of rehabilitation, a therapy modifier is required. When there is doubt about whether a service should be part of a therapy plan of care, the contractor shall make that determination."
8	"NOTE:  Functional Reporting requirements have been discontinued.  Effective for dates of service on and after January 1, 2019, these HCPCS codes and their severity modifiers are no longer required to be reported on claims or documented in medical records.  The below instructions apply only to dates of service when the Functional Reporting requirements were effective: January 1, 2013 through December 31, 2018.  See related Change Request 11120.  These nonpayble HCPCS G-codes are used only for required Functional Reporting.  These HCPCS G-codes are considered always therapy codes in that they always require the use of a therapy modifier ? GP, GO, or GN ? to indicate they're furnished under a physical therapy, occupational therapy, or speech-language pathology plan of care, respectively.  In addition, these nonpayable G-codes always require a severity modifier, in the range CH through CN, to indicate the applicable percentage of impairment, limitation, or restriction.  See the Medicare Claims Processing Manual, Chapter 5, Section 10.6 for more details on Functional Reporting including severity modifier defintions. "
9	"These evauluation and re-evaluation codes require a specific therapy modifier ? GP, GO, or GN ? to indicate when the evaluative service is furnished under a physical therapy, occupational therapy, or speech-language pathology plan of care, respectively.  See related Change Requests (CR): CR 9698 and CR 10176.  "
10	"The below HCPCS/CPT codes are for services that are either (a) furnished virtually that represent a type of sometimes therapy service that weve collectively termed communication technology-based (CTB) services, or (b) services furnished remotely that are termed remote therapeutic monitoring (RTM) services. CTB Services: Added as permanent codes in the CY 2021 PFS final rule are the E-visits (98970 ? 98972), remote evaluation (G2250), virtual check-ins (G2251).  The telephone assessment and management services (Codes 98966  98968) were effective March 1, 2020 and are valid only for the duration of the COVID-19 public health emergency (PHE)  they were set to expire when the PHE ends but they will continue to be available at least through the end of CY 2024 via CY 2024 PFS rulemaking.  Please see CR12126 or MM12126, CR11791 or MM11791, and CY 2024 PFS final rule (88 FR 78884).  NOTE:  These codes were added to the 2024 SNF/Therapy Part B consolidated billing (CB) Code List. 
RTM Services:  These 5 CPT codes were discussed in the CY 2022 PFS final rule: 98975, 98976, 98977, 98980 and 98981.  These codes are on the SNF therapy/Part B CB Code List.  Prior to CY 2023, RTM services not directly performed by therapists, physicians, or NPPs, had to be furnished under direct supervision; but, we changed direct to general supervision in the CY 2023 PFS final rule for physicians and NPPs. Then we changed direct to general supervision in the CY 2024 PFS final rule for PTs and OTs in private practice (88 FR 78990).  In addition, RTM services that relate to an RTM device that is specific to therapy services, such as the ARIA supply device in CPT code 98977 that includes therapeutic exercises, must also be furnished under a therapy plan of care when provided by physicians and NPPs.  Services delegated by therapists to therapy assistants are subject to the de minimis standard (except the device codes, CPT codes 98976 and 98977).  Please see CR12446 or MM12446 for reference.  Also see the Billing Examples Using CQ/CO Modifiers on the Therapy Services webpage.   See the CY 2024 PFS final rule for the RTM general supervision policy.  NOTE: RTM codes are not paid as therapy under the PFS if furnished in the outpatient hospital due to OPPS payment policy (Bill Types 12X, 13X).      
CTB and RTM services are designated as sometimes therapy but, are always therapy services when furnished by a therapist and in these situations require the use of a therapy modifier ? GP, GO or GN ? in order to indicate the service is furnished under a PT, OT, or SLP plan of care, respectively.  The services of the CTB and RTM codes can be furnished by therapists in private practice (TPPs) and facility-based therapists when and where they are appropriate.  For example, RTM treatment management services (CPT codes 98980 and 98981) are those provided remotely to patients in their homes, or to SNF therapy patients paid under Part B, so these can be appropriately furnished by therapists who are working in rehab agencies, CORFs, HHAs (Bill Type 34X (not under HH POC)), or SNFs (Bill Types 22X, 23X) but, not when the patient is an inpatient of a hospital or SNF.  When a TPP or a facility-based therapist directly furnishes or appropriately supervises a PT or OT assistant who furnishes the service, these services are payable when they meet the code descriptors, follow other RTM and CTBS rules, as well as therapy rules, and the services are medically necessary for the treatment of the patient under a Part B therapy POC.
Codes marked 10 are not therapy services when both of the following conditions are met: (a) It is not appropriate to bill the service under a therapy plan of care, and (b) They are billed by practitioners who are not therapists, such as physicians, CNSs, NPs, PAs, psychologists, social workers, etc., who may also be able to report them.  Also see Disposition 7.  
CTBS and RTM services may be used when the related service is furnished by a therapist who established the therapy plan or who assumes responsibility for the plan.  Although therapists furnish these services virtually or remotely, they must be reasonable and necessary and documented in the medical record."
