§ 51507. Physical Therapy.

(a) Reimbursement for physical therapy services shall be the usual charges made to the general public not to exceed the maximum reimbursement rates listed in this section.

(b) The following definitions shall apply to the reimbursement of physical therapy services under this section.

(1) Modality means any physical therapy treatment, unless listed separately which does not require the continuous attention of the therapist. Examples are:

a. Hot or cold packs	f. Microwave
b. Traction, mechanical	g. Whirlpool
c. Electrical stimulation	h. Diathermy
(unattended)	i. Infrared
d. Vasopneumatic devices	j. Ultraviolet
e. Paraffin bath	k. Ultrasound

(2) Procedure means any physical therapy treatment, unless listed separately which requires the continuous attention of the therapist. Examples are:

a. Therapeutic exercise	h. Electrical stimulation
b. Neuromuscular reeducation	(motor point)
c. Rehabilitation services	i. Ionotophoresis
d. Functional activities	j. Traction, manual
e. Gait training	k. Massage
f. Orthotics training	l. Contrast baths
g. Prosthetics training

(3) Tests and measurements mean individually administered, observed and recorded procedures and include a written report of the tests and measurements involved. Examples are:

a. Orthotic “check out”	c. Activities of daily liv-
b. Prosthetic “check out”	ing “check out”

(4) Case Conference means participation in organized conference with other health team members, who are immediately involved in the care or recovery of the patient, concerning status, or progress, of the patient under treatment and includes required charting entries. Case conferences shall be limited to one per patient per month.

(5) Additional 15-minute period means any 15-minute period or major portion thereof, 7 minutes or more, immediately following the initial 30 minutes.

(6) The maximum allowance for home or long-term care facility visit is payable only for visits to the first patient receiving services at any given location on the same day.

(c) Maximum reimbursement rates for physical therapy services shall be as follows:

Procedure		Maximum
Code		Allowance
X3900	Single modality to one area -initial 30 minutes	$17.04
X3902	Single modality to one area -each additional 15 minutes	3.63
X3904	Single procedure to one area -initial 30 minutes	21.19
X3906	Single procedure to one area -each additional
	15 minutes	6.86
X3908	Treatment including a combination of any modalities
	and procedures (one or more areas) -
	initial 30 minutes	21.19
X3910	Treatment including a combination of any modalities
	and procedures (one or more areas) -each additional
	15 minutes	6.86
X3912	Hubbard Tank -initial 30 minutes	34.84
X3914	Hubbard Tank -each additional 15 minutes	6.86
X3916	Hubbard Tank or pool therapy with therapeutic
	exercise -initial 30 minutes	41.69
X3918	Hubbard Tank or pool therapy with therapeutic
	exercise -each additional 15 minutes	6.86
X3920	Any of the tests and measurements -initial 30 minutes,
	plus report	34.84
X3922	Any of the tests and measurements -each additional
	15 minutes, plus report	17.04
X3924	Physical therapy preliminary evaluation in a rehabilitation
	center, SNF, ICF, or subacute care facility	34.84
X3926	Case conference and report -initial 30 minutes	21.19
X3928	Case consultation and report	21.19
X3930	Case conference and report -each additional
	15 minutes	6.86
X3932	Home or long-term care facility visit -add	6.57
X3934	Mileage, per mile one-way beyond ten-mile radius of
	point of origin (office or home)	1.77
X3936	Unlisted Services	By Report

HISTORY

1. Amendment of subsection (c) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84. For prior history, see Register 81, No. 52.

2. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).

3. Amendment of subsection (c) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.

4. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).

5. Amendment of subsection (c) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.

6. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).

7. Amendment of subsection (c), new subsection (d) and amendment of Note filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52, Items 4260-101-0001 and 0890 (Register 2002, No. 29).

8. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (d), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).

Note

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14105, Welfare and Institutions Code; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; Statutes of 1985, Chapter 111, Items 4260-106-001 and 890; and Statutes of 2000, Chapter 52, Items 4260-101-0001 and 0890.Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14105, Welfare and Institutions Code; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; Statutes of 1985, Chapter 111, Items 4260-106-001 and 890; and Statutes of 2000, Chapter 52, Items 4260-101-0001 and 0890.