http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage.
Two of the designations that are used for therapy services are: “always therapy” and
“sometimes therapy.” An “always therapy” service must be performed by a qualified
therapist under a certified therapy plan of care, and a “sometimes therapy” service may
be performed by physician or a non-physician practitioner outside of a certified therapy
plan of care.
Under the OPPS, separate payment is provided for certain services designated as
“sometimes therapy” services if these services are furnished to hospital outpatients as a
non-therapy service, that is, without a certified therapy plan of care. Specifically, to be
paid under the OPPS for a non-therapy service, hospitals SHOULD NOT append the
therapy modifier GP (physical therapy), GO (occupational therapy), or GN (speech
language pathology), or report a therapy revenue code 042x, 043x, or 044x in association
with the “sometimes therapy” codes listed in the table below.
To receive payment under the MPFS, when “sometimes therapy” services are performed
by a qualified therapist under a certified therapy plan of care, providers should append
the appropriate therapy modifier GP, GO, or GN, and report the charges under an
appropriate therapy revenue code, specifically 042x, 043x, or 044x. This instruction does
not apply to claims for “sometimes therapy” codes furnished as non-therapy services in
the hospital outpatient department and paid under the OPPS.
Effective January 1, 2015, two HCPCS codes designated as “Sometimes Therapy”
services, G0456 (Negative pressure wound therapy, (e.g. vacuum assisted drainage
collection) using a mechanically-powered device, not durable medical equipment,
including provision of cartridge and dressing(s), topical application(s), wound
assessment, and instructions for ongoing care, per session; total wounds(s) surface area
less than or equal to 50 square centimeters) and G0457 (Negative pressure wound
therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device,
not durable medical equipment, including provision of cartridge and dressing(s), topical
application(s), wound assessment, and instructions for ongoing care, per session; total
wounds(s) surface area greater than 50 square centimeters) would be terminated and
replaced with two new CPT codes 97607 (Negative pressure wound therapy, (eg, vacuum
assisted drainage collection), utilizing disposable, non-durable medical equipment
including provision of exudate management collection system, topical application(s),
wound assessment, and instructions for ongoing care, per session; total wounds(s) surface
area less than or equal to 50 square centimeters) and 97608 (Negative pressure wound
therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable
medical equipment including provision of exudate management collection system, topical
application(s), wound assessment, and instructions for ongoing care, per session; total
wounds(s) surface area greater than 50 square centimeters).
The list of HCPCS codes designated as “sometimes therapy” services that may be paid as
non-therapy services when furnished to hospital outpatients is displayed in the table
below.