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97530 VS 97110

Susan Posted Tue 01st of March, 2011 18:21:18 PM

Is it allowable to bill Medicare for "97530" and "97110" on the same day? I don't see any CCI edit on doing so but did see in an article that 97110 would be used for 1 expected outcome and 97530 would be used for more than 1 outcome. Opinions? Would the multiple procedure reduction formula apply?

SuperCoder Answered Wed 02nd of March, 2011 06:43:07 AM

I have referred to:
http://www.cms.gov/TherapyServices/Downloads/11_Part_B_Billing_Scenarios_for_PTs_and_OTs.pdf
Refer to "Team Therapy".

http://www.cms.gov/manuals/downloads/clm104c05.pdf
(please search on cpt 97530.

The above links cover a wide range of things on the CPTs 97530 and 97110. But doesn't say anything on the concept that you are talking about. Please have a go through above links.

Susan Posted Wed 02nd of March, 2011 18:38:32 PM

Thanks, Sanjit! I can't find anything to support what the article said about using 1 code for single outcome and the other for multiple outcomes. The outcomes for 97110 are "different" than the outcomes for 97530 - not just "more". ~S

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