Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 339.00 - Rates for Restorative Services
Section 339.04 - Allowable Fees

Service Code

Allowable Fee

Service Description

Special Otorhinolaryngologic Services

92507

$73.64

Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual (maximum one unit per visit)

92508

$31.53

Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals (maximum one unit per visit)

92521

$79.52

Evaluation of speech fluency (e.g., stuttering, cluttering)

92521 HA

$79.52

Evaluation of speech fluency (e.g., stuttering, cluttering) (for patients younger than 21 years old)

92521 TF

$79.52

Evaluation of speech fluency (e.g., stuttering, cluttering) (for developmentally disabled adults 22 years of age or older)

92522

$64.41

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)

92522 HA

$64.41

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) (for patients younger than 21 years old)

92522 TF

$64.41

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) (for developmentally disabled adults 22 years of age or older)

92523

$133.99

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)

92523 HA

$133.99

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) (for patients younger than 21 years old)

92523 TF

$133.99

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) (for developmentally disabled adults 22 years of age or older)

92524

$66.82

Behavioral and qualitative analysis of voice and resonance

92524 HA

$66.82

Behavioral and qualitative analysis of voice and resonance (for patients younger than 21 years old)

92524 TF

$66.82

Behavioral and qualitative analysis of voice and resonance (for developmentally disabled adults 22 years of age or older)

92526

$28.15

Treatment of swallowing dysfunction and/or oral function for feeding (maximum one unit per visit)

Evaluative and Therapeutic Services

92605

$64.41

Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour

92606

$16.11

Therapeutic service(s) for the use of non-speech-generating device, including programming and modification

92607

$64.41

Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour

92608

$32.21

Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure)

92609

$16.11

Therapeutic services for the use of speech-generating device, including programming and modification

92610

$64.41

Evaluation of oral and pharyngeal swallowing function (per hour, maximum of one hour)

92630

$14.68

Auditory rehabilitation; prelingual hearing loss

92633

$14.68

Auditory rehabilitation; postlingual hearing loss

Physical Medicine and Rehabilitation

97161

$64.41

Physical therapy evaluation - Low complex 20 min

97162

$64.41

Physical therapy evaluation - Mod complex - 30 min

97163

$64.41

Physical therapy evaluation High complex - 45 min

97164

$64.41

Physical therapy reevaluation Est. Plan Care - 20 min

97165

$64.41

Occupational therapy evaluation Low complex - 30 min

97166

$64.41

Occupational therapy evaluation Mod complex - 45 min

97167

$64.41

Occupational therapy evaluation High complex - 60 min

97168

$64.41

Occupational therapy re-evaluation Est. Plan Care - 30 min

Modalities - Supervised

97010

$4.27

Application of a modality to one or more areas; hot or cold packs

97012

$12.63

Application of a modality to one or more areas; traction, mechanical

97014

$12.69

Application of a modality to one or more areas; electrical stimulation (unattended)

97016

$13.04

Application of a modality to one or more areas; vasopneumatic devices

97018

$6.47

Application of a modality to one or more areas; paraffin bath

97022

$4.64

Application of a modality to one or more areas; whirlpool

97024

$4.27

Application of a modality to one or more areas; diathermy (e.g., microwave)

97026

$5.24

Application of a modality to one or more areas; infrared

97028

$4.27

Application of a modality to one or more areas; ultraviolet

Modalities - Constant Attendance

97032

$14.68

Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes

97033

$14.68

Application of a modality to one or more areas; iontophoresis, each 15 minutes

97034

$14.68

Application of a modality to one or more areas; contrast baths, each 15 minutes

97035

$14.68

Application of a modality to one or more areas; ultrasound, each 15 minutes

97036

$14.68

Application of a modality to one or more areas; Hubbard tank, each 15 minutes

97039

$14.68

Unlisted modality (specify type and time if constant attendance)

Therapeutic Procedures

97110

$16.11

Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

97112

$16.11

Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

97113

$16.11

Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercises

97116

$16.11

Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing)

97124

$16.11

Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)

97139

$16.11

Unlisted therapeutic procedure (specify) (each 15 minutes)

97140

$16.11

Manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes

97150

$25.56

Therapeutic procedure(s), group (two or more individuals) (services delivered under an outpatient plan of care) (maximum one unit per visit)

97530

$16.11

Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes

97532

$14.68

Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes

97533

$14.68

Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes

97535

$16.11

Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes

97537

$14.68

Community/work reintegration training (e.g., shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment) direct one-on-one contact, each 15 minutes

97542

$14.68

Wheelchair management (e.g., assessment, fitting, training), each 15 minutes

97545

$117.41

Work hardening/conditioning; initial two hours

97546

$58.70

Work hardening/conditioning; each additional hour (list separately in addition to code for primary procedure) (use in conjunction with 97545)

Active Wound Care Management

97597

$47.06

Debridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 square centimeters or less

97598

$58.90

Debridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq. cm., or part thereof (list separately in addition to code for primary procedure)

97602

I.C.

Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session

97605

$30.44

Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters

97606

$32.58

Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters

Tests and Measurements

97750

$14.68

Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes

97755

$14.68

Assistive technology assessment (e.g., to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 15 minutes

Orthotic Management and Prosthetic Management

97760

$16.11

Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes

97761

$16.11

Prosthetic training, upper and/or lower extremity(s), each 15 minutes

97762

$14.68

Checkout for orthotic/prosthetic use, established patient, each 15 minutes

Other Procedures

97799

$16.11

Unlisted physical medicine/rehabilitation service or procedure (each 15 minutes, maximum six units per visit)

Evaluation and Management - Office or Other Outpatient Services

99203

$84.41

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components:

- a detailed history;

- a detailed examination; and

- medical decision making of low complexity

99205

$160.33

Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components (written report required):

- a comprehensive history;

- a comprehensive examination; and

- medical decision making of high complexity

99212

$34.20

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components:

- a problem focused history;

- a problem focused examination; and

- straightforward medical decision making

99214

$82.96

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components (written report required):

- a detailed history;

- a detailed examination; and

- medical decision making of moderate complexity

99215

$112.01

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components (written report required):

- a comprehensive history;

- a comprehensive examination; and

- medical decision making of high complexity

Rehabilitation Center Physical Therapist

$64.41/hr.

Rehabilitation Center Occupational Therapist

$64.41/hr.

Rehabilitation Center Speech Therapist

$64.41/hr.

Restorative Physical Therapy office visit

$64.41/hr.

Restorative Occupational Therapy office visit

$64.41/hr.

Restorative Speech Therapy office visit

$64.41/hr.

Restorative Physical Therapy out-of-office visit

$74.07/hr.

Restorative Occupational Therapy out-of-office visit

$74.07/hr.

Restorative Speech Therapy out-of-office visit

$74.07/hr.