HCPCS	Code Description and Claim Line   Outlier/Edit Details	2006 Status	Timed or Untimed	Current Therapy HCPCS	SLP Facilities	SLP Professionals	SLP Hospital	SLP SNF	SLP CORF	SLP ORF	SLP HHA	SLP Physician 	SLP NPP
64550	Apply neurostimulator												
	Threshold at 98th percentile	A	U	Yes	1	~	1	~	~	~	~	~	~
	Threshold at 99th percentile				1	~	1	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$2,644"	$0							
90901	"Biofeedback train, any meth"												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				$62	$0							
92506	Speech/hearing evaluation												
	Threshold at 98th percentile	A	U	Yes	1	1	1	1	1	2	5	1	~
	Threshold at 99th percentile				2	1	2	2	2	4	6	1	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$224,248"	$377							
92507	Speech/hearing therapy												
	Threshold at 98th percentile	A	U	Yes	2	1	2	1	4	4	4	1	~
	Threshold at 99th percentile				3	1	4	2	4	5	4	1	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$2,297,298"	"$2,845"							
92508	Speech/hearing therapy												
	Threshold at 98th percentile	A	U	Yes	1	1	1	1	~	1	~	1	~
	Threshold at 99th percentile				2	4	2	2	~	1	~	4	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$37,647"	$576							
92526	Oral function therapy												
	Threshold at 98th percentile	A	U	Yes	1	1	2	1	1	3	8	1	~
	Threshold at 99th percentile				2	1	3	2	1	4	9	1	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$4,190,893"	$469							
92597	Oral speech device eval												
	Threshold at 98th percentile	A	U	Yes	1	1	1	3	~	~	~	1	~
	Threshold at 99th percentile				2	1	2	4	~	~	~	1	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$8,617"	$0							
92605	Eval for nonspeechdevice rx												
	Threshold at 98th percentile	B	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				$0	$0							
92606	Nonspeech device service												
	Threshold at 98th percentile	B	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				$483	$0							
92607	"Ex for speech device rx, 1hr"												
	Threshold at 98th percentile	A	T	Yes	1	1	1	2	~	2	~	1	~
	Threshold at 99th percentile				2	1	2	2	~	2	~	1	~
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$5,903"	$0							
92608	"Ex for speech device rx, addl"												
	Threshold at 98th percentile	A	T	Yes	6	~	5	4	~	4	~	~	~
	Threshold at 99th percentile				6	~	6	4	~	4	~	~	~
	Stakeholder suggestion range				3-6	3-6	3-6	3-6	3-6	3-6	3-6	3-6	3-6
	Example Edit				6	6	6	6	6	6	6	6	6
	Estimated impact of example edit				$64	$347							
92609	Use of speech device service												
	Threshold at 98th percentile	A	U	Yes	3	2	3	3	4	1	~	2	~
	Threshold at 99th percentile				4	4	4	4	4	2	~	4	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$35,023"	$250							
92610	Evaluate swallowing function												
	Threshold at 98th percentile	A	U	Yes	1	1	1	1	2	1	4	1	~
	Threshold at 99th percentile				2	1	2	2	2	2	5	1	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$382,940"	$0							
92611	Motion fluroscopy/swallow												
	Threshold at 98th percentile	A	U	Yes	1	1	1	1	1	1	~	1	~
	Threshold at 99th percentile				2	1	2	2	1	1	~	1	~
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$200,773"	$4							
92612	Endoscopy swallow tst (fees)												
	Threshold at 98th percentile	A	U	Yes	1	1	1	1	~	~	~	1	~
	Threshold at 99th percentile				2	1	1	2	~	~	~	1	~
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$5,920"	$0							
92614	Laryngoscopic sensory test												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				$0	$0							
92616	Fees w/laryngeal sense test												
	Threshold at 98th percentile	A	U	Yes	1	1	1	~	~	~	~	1	~
	Threshold at 99th percentile				2	1	2	~	~	~	~	1	~
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				$267	$0							
95831	"Limb muscle testing, manual"												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
95832	"Limb muscle testing, manual"												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
95833	"Limb muscle testing, manual"												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
95834	"Limb muscle testing, manual"												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
95851	Range of motion measurements												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$15							
95852	Range of motion measurements												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
96105	Assessment of aphasia												
	Threshold at 98th percentile	A	T	Yes	4	~	2	4	~	4	~	~	~
	Threshold at 99th percentile				4	~	4	4	~	6	~	~	~
	Stakeholder suggestion range				2-4	2-4	2-4	2-4	2-4	2-4	2-4	2-4	2-4
	Example Edit				4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$1,189"	$0							
96110	"Developmental test, lim"												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				$240	$0							
96111	"Developmental test, extend"												
	Threshold at 98th percentile	A	U	Yes	4	~	3	~	~	~	~	~	~
	Threshold at 99th percentile				4	~	4	~	~	~	~	~	~
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$1,586"	$0							
97001	PT evaluation												
	Threshold at 98th percentile	A	U	Yes	~	1	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	1	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$4,698"	"$40,035"							
97002	PT re-evaluation												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	"$2,237"							
97003	OT evaluation												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$4,984"	$66							
97004	OT re-evlauation												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$110	$92							
97010	Hot or cold packs therapy												
	Threshold at 98th percentile	B	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
	Example Edit				N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
	Estimated impact of example edit				0	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A
97012	Mechanical traction therapy												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$11							
97016	Vasopneumatic device therapy												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$12	$42							
97018	Paraffin bath therapy												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$9	$0							
97022	Whirlpool therapy												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$22	$13							
97024	"Diathermy eg, microwave"												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$12	$19							
97026	Infrared therapy												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$49	$0							
97028	Ultraviolet therapy												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$10							
97032	Electrical stimulation												
	Threshold at 98th percentile	A	T	Yes	4	2	4	4	~	4	~	2	~
	Threshold at 99th percentile				4	3	4	4	~	4	~	3	~
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				$248	$0							
97033	Electric current therapy												
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$162	$0							
97034	Contrast bath therapy												
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
97035	Ultrasound therapy												
	Threshold at 98th percentile	A	T	Yes	~	1	~	~	~	~	~	1	~
	Threshold at 99th percentile				~	2	~	~	~	~	~	2	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$110	"$5,921"							
97036	Hydrotherapy												
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
97039	Physical therapy treatment												
	Threshold at 98th percentile	C		Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Example Edit				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Estimated impact of example edit				$0	$0							
97110	Therapeutic exercises												
	Threshold at 98th percentile	A	T	Yes	3	4	3	3	~	3	~	4	~
	Threshold at 99th percentile				4	4	4	4	~	4	~	4	~
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$10,491"	"$1,881"							
97112	Neuromuscular reeducation												
	Threshold at 98th percentile	A	T	Yes	4	4	4	4	~	4	~	4	~
	Threshold at 99th percentile				4	4	4	4	~	4	~	4	~
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$6,028"	$0							
97113	Aquatic therapy/exercises												
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
97116	Gait training therapy												
	Threshold at 98th percentile	A	T	Yes	3	~	~	3	~	~	~	~	~
	Threshold at 99th percentile				3	~	~	3	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$2,954"	$122							
97124	Massage therapy												
	Threshold at 98th percentile	A	T	Yes	~	2	~	~	~	~	~	1	~
	Threshold at 99th percentile				~	2	~	~	~	~	~	1	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$178	"$2,201"							
97139	Physical medicine procedure												
	Threshold at 98th percentile	C		Yes	4	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				5	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Example Edit				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Estimated impact of example edit				$0	$0							
97140	Manual therapy												
	Threshold at 98th percentile	A	T	Yes	~	2	~	~	~	~	~	2	~
	Threshold at 99th percentile				~	2	~	~	~	~	~	2	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$2,988"	"$4,654"							
97150	Group therapeutic procedures												
	Threshold at 98th percentile	A	U	Yes	4	~	3	1	~	6	~	~	~
	Threshold at 99th percentile				4	~	4	2	~	8	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$152,309"	$0							
97530	Therapeutic activities												
	Threshold at 98th percentile	A	T	Yes	4	5	4	4	~	4	~	5	~
	Threshold at 99th percentile				4	5	4	4	~	4	~	5	~
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$6,340"	$0							
97532	Cognitive skills development												
	Threshold at 98th percentile	A	T	Yes	4	6	4	4	4	6	~	6	~
	Threshold at 99th percentile				5	6	5	5	4	6	~	6	~
	Stakeholder suggestion range				4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5
	Example Edit				5	5	5	5	5	5	5	5	5
	Estimated impact of example edit				"$91,851"	"$2,236"							
97533	Sensory integration												
	Threshold at 98th percentile	A	T	Yes	4	~	2	4	~	3	~	~	~
	Threshold at 99th percentile				4	~	3	4	~	3	~	~	~
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$1,464"	$0							
97535	Self care mngment training												
	Threshold at 98th percentile	A	T	Yes	3	~	4	3	~	4	~	~	~
	Threshold at 99th percentile				4	~	4	3	~	4	~	~	~
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				$806	$0							
97537	Community/work reintegration												
	Threshold at 98th percentile	A	T	Yes	5	~	8	4	~	~	~	~	~
	Threshold at 99th percentile				8	~	8	4	~	~	~	~	~
	Stakeholder suggestion range				6-10	6-10	6-10	6-10	6-10	6-10	6-10	6-10	6-10
	Example Edit				8	8	8	8	8	8	8	8	8
	Estimated impact of example edit				$92	$0							
97542	Wheelchair mngment training												
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$1,069"	$0							
97597	Active wound care =< 20 cm												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$439	$0							
97598	Active wound care > 20 cm												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$46	$0							
97602	Wound(s) care non-selective												
	Threshold at 98th percentile	B	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
	Example Edit				N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
	Estimated impact of example edit				0	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A
97605	"Neg press wound tx, < 50 cm"												
	Threshold at 98th percentile	A		Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
97606	"Neg press wound tx, > 50 cm"												
	Threshold at 98th percentile	A		Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
97750	Physical performance test												
	Threshold at 98th percentile	A	T	Yes	4	4	4	~	~	~	~	4	~
	Threshold at 99th percentile				4	4	4	~	~	~	~	4	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$7,602"	"$10,030"							
97755	Assistive technology assess												
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$4,135"	$0							
97760	Orthotic mgmt and training												
	Threshold at 98th percentile	A	T	Yes	3	~	~	3	~	~	~	~	~
	Threshold at 99th percentile				3	~	~	3	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$6,223"	$105							
97761	Prosthetic training												
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$385	$350							
97762	C/O for orthotic/prosth use												
	Threshold at 98th percentile	A	T	Yes	6	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				6	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				"$4,047"	"$1,682"							
97799	Physical medicine procedure												
	Threshold at 98th percentile	C		Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Example Edit				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Estimated impact of example edit				$0	$0							
0029T	Magnetic tx for incontinence												
	Threshold at 98th percentile	C	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
G0281	Elec stim unattend for press												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$799							
G0283	Elec stim other than wound												
	Threshold at 98th percentile	A	U	Yes	3	1	3	1	~	~	~	1	~
	Threshold at 99th percentile				3	1	3	1	~	~	~	1	~
	Stakeholder suggestion range				0-4	0-4	0-4	0-4	0-4	0-4	0-4	0-4	0-4
	Example Edit				1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				$792	$0							
G0329	Electromagnetic tx for ulcers												
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0
	Example Edit				0	0	0	0	0	0	0	0	0
	Estimated impact of example edit				$0	$0							
													
Key:													
A = Active HCPCS code													
B = Payment always bundled into payment for other services													
C = Carrier priced HCPCS code													
N/A = Not applicable or insufficient information available													
XXX = Not included due to carrier priced HCPCS code													
~ = Not reported due to fewer than 100 claim lines of data													
