IMPORTANT NOTE: While all attempts are made to keep this information current, we strongly suggest that you consult with experts in coding and reimbursement to determine specifics regarding your practice. Please review our disclaimer concerning the content of this page. (REV 1/2015)

Coding and Reimbursement Guidelines For TheraBand, Biofreeze and Cramer Products

Payors require specific documentation for reimbursement of rehabilitation services and supplies. Clinicians may legally bill for services and supplies based on their state's practice acts. You should contact payors to determine approved provider types, coverage & benefits, authorization requirements, as well as codes allowed and forms necessary to submit a claim.

*NOTE: Therapeutic exercise (97110) and therapeutic activities (97530) both require direct one-on-one provision of service according to Medicare guidelines. Therapeutic Exercise includes activities related to strengthening, endurance training, range of motion, and flexibility. Therapeutic Activities utilize dynamic activities to improve functional performance; these are also referred to as the "-ing" codes, for example, "lifting," "pulling," "pushing," "running," and "jumping."

**Aquatic therapy may require extra documentation. Aquatic therapy has suffered poor reimbursement because of confusion between therapy and exercise. Patients should be appropriately selected for aquatic interventions. Aquatic therapy should be differentiated from aquatic exercise as a skilled intervention by a licensed therapist to improve function. Document a timely plan for transition from water to land and integrate functional land components. Provide specific reasons that aquatic therapy is required, including the special properties of water. The therapist must be present, providing one-on-one contact with the patient, but does not have to be physically in the pool.

Reimbursement for Self-Care Products at Home

Home exercise programs are commonly prescribed in addition to in-clinic rehabilitation. There is no specific CPT code for home exercise instruction. The time spent in educating the patient in a home exercise program for strengthening & stretching activities should be designated as therapeutic exercise, 97110. Training for home exercises involving functional activities should use 97530. Remember that these codes are subject to the 'time' rule.

Medicare and most other insurers do not reimburse for exercise equipment used by the patient at home. The products used to deliver the service in the clinic, such as elastic bands, are considered "bundled" in the fee for service and cannot be billed separately. However, patients using these products for home exercise programs under the supervision of a healthcare professional may be billed for the cost of the items. In the unlikely event that an insurer reimburses for these products, check with the payor for specific coding requirements. Provide a full explanation of the supplies and equipment provided, being as specific as possible in regards to the patients limitations and needs. Letters of medical necessity are particularly helpful.

*Portable paraffin bath units and supplies may be covered when the patient has undergone a successful trial period of paraffin therapy ordered by a provider and the patient's condition is expected to be relieved by long-term use of this modality.