HCPCS	Code Description and Claim Line   Outlier/Edit Details	2006 Status	Timed or Untimed	Current Therapy HCPCS	PT Facilities	PT Professionals	PT Hospital	PT SNF	PT CORF	PT ORF	PT HHA	PT PTPP	PT Physician 	PT NPP	
64550	Apply neurostimulator														
	Threshold at 98th percentile	A	U	Yes	2	2	2	2	1	2	1	1	2	~	
	Threshold at 99th percentile				2	2	2	2	1	2	1	2	2	~	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$18,798"	"$16,811"									
90901	"Biofeedback train, any method"														
	Threshold at 98th percentile	A	U	Yes	2	1	2	~	~	1	~	2	1	1	
	Threshold at 99th percentile				2	2	2	~	~	1	~	2	1	1	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$2,080"	"$4,841"									
92506	Speech/hearing evaluation														
	Threshold at 98th percentile	A	U	Yes	~	1	~	~	~	~	~	1	1	~	
	Threshold at 99th percentile				~	1	~	~	~	~	~	1	1	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$5,033"	"73,815"									
92507	Speech/hearing therapy														
	Threshold at 98th percentile	A	U	Yes	4	2	~	~	~	~	~	3	~	~	
	Threshold at 99th percentile				4	4	~	~	~	~	~	4	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$12,265"	"49,861"									
92508	Speech/hearing therapy														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$885	$25									
92526	Oral function therapy														
	Threshold at 98th percentile	A	U	Yes	2	1	3	1	~	~	~	1	~	~	
	Threshold at 99th percentile				3	1	3	2	~	~	~	1	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$25,589"	"$42,818"									
92597	Oral speech device eval														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$0	"$1,801"									
92605	Eval for nonspeechdevice rx														
	Threshold at 98th percentile	B	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$0	$0									
92606	Nonspeech device service														
	Threshold at 98th percentile	B	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$0	$0									
92607	"Ex for speech device rx, 1hr"														
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$147	$0									
92608	"Ex for speech device rx, addl"														
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$14	$0									
92609	Use of speech device service														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$0	$52									
92610	Evaluate swallowing function														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$7,932"	"$8,954"									
92611	Motion fluroscopy/swallow														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$5,931"	"$1,473"									
92612	Endoscopy swallow tst (fees)														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$0	$0									
92614	Laryngoscopic sensory test														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$0	$0									
92616	Fees w/laryngeal sense test														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$116	$0									
95831	"Limb muscle testing, manual"														
	Threshold at 98th percentile	A	U	Yes	1	4	1	2	1	1	~	2	6	~	
	Threshold at 99th percentile				1	6	2	2	1	1	~	2	6	~	
	Stakeholder suggestion range				4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5	
	Example Edit				4	4	4	4	4	4	4	4	4	4	
	Estimated impact of example edit				$0	"$12,327"									
95832	"Limb muscle testing, manual"														
	Threshold at 98th percentile	A	U	Yes	2	2	~	~	~	1	~	2	2	~	
	Threshold at 99th percentile				2	2	~	~	~	1	~	2	2	~	
	Stakeholder suggestion range				2	2	2	2	2	2	2	2	2	2	
	Example Edit				2	2	2	2	2	2	2	2	2	2	
	Estimated impact of example edit				$34	$0									
95833	"Limb muscle testing, manual"														
	Threshold at 98th percentile	A	U	Yes	1	1	1	1	~	~	~	~	~	~	
	Threshold at 99th percentile				2	1	2	1	~	~	~	~	~	~	
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1	1	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				$244	$0									
95834	"Limb muscle testing, manual"														
	Threshold at 98th percentile	A	U	Yes	1	1	~	~	~	1	~	1	~	~	
	Threshold at 99th percentile				2	1	~	~	~	1	~	1	~	~	
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1	1	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				$143	$35									
95851	Range of motion measurements														
	Threshold at 98th percentile	A	U	Yes	2	6	2	2	2	1	~	1	6	2	
	Threshold at 99th percentile				2	6	2	2	3	1	~	2	6	2	
	Stakeholder suggestion range				4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5	
	Example Edit				4	4	4	4	4	4	4	4	4	4	
	Estimated impact of example edit				$0	"$19,727"									
95852	Range of motion measurements														
	Threshold at 98th percentile	A	U	Yes	1	2	2	~	~	1	~	1	~	~	
	Threshold at 99th percentile				2	2	2	~	~	1	~	1	~	~	
	Stakeholder suggestion range				2	2	2	2	2	2	2	2	2	2	
	Example Edit				2	2	2	2	2	2	2	2	2	2	
	Estimated impact of example edit				$0	$0									
96105	Assessment of aphasia														
	Threshold at 98th percentile	A	T	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$405	$434									
96110	"Developmental test, lim"														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				$777	$18									
96111	"Developmental test, extend"														
	Threshold at 98th percentile	A	U	Yes	~	~	~	~	~	~	~	~	~	~	
	Threshold at 99th percentile				~	~	~	~	~	~	~	~	~	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$1,021"	$0									
97001	PT evaluation														
	Threshold at 98th percentile	A	U	Yes	1	1	1	1	1	1	6	1	1	1	
	Threshold at 99th percentile				1	1	1	1	1	1	6	1	1	1	
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1	1	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$848,752"	"$109,925"									
97002	PT re-evaluation														
	Threshold at 98th percentile	A	U	Yes	1	1	1	1	2	1	4	1	1	~	
	Threshold at 99th percentile				1	1	1	2	2	1	4	1	1	~	
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1	1	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$70,949"	"$3,271"									
97003	OT evaluation														
	Threshold at 98th percentile	A	U	Yes	2	1	1	2	~	1	~	1	1	~	
	Threshold at 99th percentile				2	1	2	3	~	2	~	1	1	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$91,625"	"$309,453"									
97004	OT re-evaluation														
	Threshold at 98th percentile	A	U	Yes	2	1	~	~	~	~	~	1	1	~	
	Threshold at 99th percentile				2	1	~	~	~	~	~	1	1	~	
	Stakeholder suggestion range				0	0	0	0	0	0	0	0	0	0	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$5,545"	"$28,969"									
97010	Hot or cold packs therapy														
	Threshold at 98th percentile	B	U	Yes	1	~	1	1	~	1	~	~	~	~	
	Threshold at 99th percentile				1	~	1	1	~	1	~	~	~	~	
	Stakeholder suggestion range				N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$10,506"	$54									
97012	Mechanical traction therapy														
	Threshold at 98th percentile	A	U	Yes	1	2	1	2	1	1	~	1	2	1	
	Threshold at 99th percentile				1	2	1	2	1	2	~	1	2	1	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$44,745"	"$158,684"									
97016	Vasopneumatic device therapy														
	Threshold at 98th percentile	A	U	Yes	2	2	2	4	2	1	~	1	2	1	
	Threshold at 99th percentile				2	2	2	5	2	1	~	1	2	1	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$36,324"	"$32,450"									
97018	Paraffin bath therapy														
	Threshold at 98th percentile	A	U	Yes	2	2	1	1	2	1	~	1	2	~	
	Threshold at 99th percentile				2	2	2	1	2	2	~	1	3	~	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$3,391"	"$18,991"									
97022	Whirlpool therapy														
	Threshold at 98th percentile	A	U	Yes	1	1	1	2	1	1	~	1	1	~	
	Threshold at 99th percentile				2	1	2	2	2	1	~	1	1	~	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$27,307"	"$5,160"								
97024	"Diathermy eg, microwave"													
	Threshold at 98th percentile	A	U	Yes	2	1	1	2	1	1	~	1	1	1
	Threshold at 99th percentile				2	2	2	2	1	1	~	1	2	1
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$21,163"	"$2,235"								
97026	Infrared therapy													
	Threshold at 98th percentile	A	U	Yes	2	2	2	2	3	2	3	2	2	1
	Threshold at 99th percentile				2	8	2	2	3	3	4	8	3	1
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$78,689"	"$207,062"								
97028	Ultraviolet therapy													
	Threshold at 98th percentile	A	U	Yes	1	2	1	3	~	1	~	1	2	~	
	Threshold at 99th percentile				2	2	1	3	~	1	~	1	4	~	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$1,662"	$627									
97032	Electrical stimulation														
	Threshold at 98th percentile	A	T	Yes	2	3	2	3	2	2	3	2	4	8	
	Threshold at 99th percentile				3	4	3	4	2	2	4	2	6	9	
	Stakeholder suggestion range				2-4	2-4	2-4	2-4	2-4	2-4	2-4	2-4	2-4	2-4	
	Example Edit				4	4	4	4	4	4	4	4	4	4	
	Estimated impact of example edit				"$24,491"	"$321,052"									
97033	Electric current therapy														
	Threshold at 98th percentile	A	T	Yes	2	3	2	3	2	2	~	2	4	1	
	Threshold at 99th percentile				2	4	2	3	3	2	~	4	4	1	
	Stakeholder suggestion range				2-4	2-4	2-4	2-4	2-4	2-4	2-4	2-4	2-4	2-4	
	Example Edit				4	4	4	4	4	4	4	4	4	4	
	Estimated impact of example edit				$968	"$38,995"									
97034	Contrast bath therapy														
	Threshold at 98th percentile	A	T	Yes	1	3	2	4	1	1	~	2	4	~	
	Threshold at 99th percentile				2	4	2	4	1	2	~	2	4	~	
	Stakeholder suggestion range				2	2	2	2	2	2	2	2	2	2	
	Example Edit				2	2	2	2	2	2	2	2	2	2	
	Estimated impact of example edit				$754	"$7,335"									
97035	Ultrasound therapy														
	Threshold at 98th percentile	A	T	Yes	1	2	1	2	1	1	2	2	2	3	
	Threshold at 99th percentile				2	2	2	2	1	2	2	2	2	3	
	Stakeholder suggestion range				2-3	2-3	2-3	2-3	2-3	2-3	2-3	2-3	2-3	2-3	
	Example Edit				2	2	2	2	2	2	2	2	2	2	
	Estimated impact of example edit				"$55,974"	"$103,029"									
97036	Hydrotherapy														
	Threshold at 98th percentile	A	T	Yes	4	1	4	4	1	2	~	2	1	~	
	Threshold at 99th percentile				4	2	4	4	1	2	~	2	1	~	
	Stakeholder suggestion range				4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5	4-5		
	Example Edit				4	4	4	4	4	4	4	4	4	4		
	Estimated impact of example edit				$493	$0										
97039	Physical therapy treatment															
	Threshold at 98th percentile	C		Yes	3	2	2	4	3	3	~	2	3	~		
	Threshold at 99th percentile				3	3	2	5	3	3	~	2	3	~		
	Stakeholder suggestion range				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX		
	Example Edit				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX		
	Estimated impact of example edit				$0	$0										
97110	Therapeutic exercises															
	Threshold at 98th percentile	A	T	Yes	4	4	4	3	4	4	5	4	4	4		
	Threshold at 99th percentile				4	4	4	4	5	4	8	4	4	4		
	Stakeholder suggestion range				4-6	4-6	4-6	4-6	4-6	4-6	4-6	4-6	4-6	4-6		
	Example Edit				4	4	4	4	4	4	4	4	4	4		
	Estimated impact of example edit				"$4,346,258"	"$1,110,344"										
97112	Neuromuscular reeducation															
	Threshold at 98th percentile	A	T	Yes	3	3	4	2	3	3	4	3	3	2		
	Threshold at 99th percentile				3	3	4	3	3	3	5	3	3	3		
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4		
	Example Edit				4	4	4	4	4	4	4	4	4	4		
	Estimated impact of example edit				"$470,363"	"$57,110"										
97113	Aquatic therapy/exercises															
	Threshold at 98th percentile	A	T	Yes	4	4	4	4	5	4	~	4	4	4		
	Threshold at 99th percentile				4	5	4	5	5	5	~	5	4	4		
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4		
	Example Edit				4	4	4	4	4	4	4	4	4	4		
	Estimated impact of example edit				"$168,244"	"$209,408"										
97116	Gait training therapy															
	Threshold at 98th percentile	A	T	Yes	2	2	3	2	2	2	4	2	2	1		
	Threshold at 99th percentile				3	3	3	3	3	3	4	3	2	1		
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4		
	Example Edit				3	3	3	3	3	3	3	3	3	3		
	Estimated impact of example edit				"$1,092,710"	"$96,312"									
97124	Massage therapy														
	Threshold at 98th percentile	A	T	Yes	2	3	2	2	2	2	2	2	3	4	
	Threshold at 99th percentile				2	4	2	3	2	2	2	2	4	4	
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4	
	Example Edit				2	2	2	2	2	2	2	2	2	2	
	Estimated impact of example edit				"$83,810"	"$541,859"									
97139	Physical medicine procedure														
	Threshold at 98th percentile	C		Yes	3	2	3	6	2	2	~	1	2	~	
	Threshold at 99th percentile				4	2	4	7	2	2	~	2	3	~	
	Stakeholder suggestion range				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	
	Example Edit				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	
	Estimated impact of example edit				$0	$0									
97140	Manual therapy														
	Threshold at 98th percentile	A	T	Yes	3	3	4	3	2	3	3	3	3	4	
	Threshold at 99th percentile				4	4	4	4	3	3	4	4	4	4	
	Stakeholder suggestion range				4-6	4-6	4-6	4-6	4-6	4-6	4-6	4-6	4-6	4-6
	Example Edit				4	4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$680,301"	"$283,542"								
97150	Group therapeutic procedures													
	Threshold at 98th percentile	A	U	Yes	2	2	2	2	2	1	~	2	2	1
	Threshold at 99th percentile				3	3	3	3	2	2	~	3	3	1
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2
	Example Edit				1	1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$689,501"	"$323,885"								
97530	Therapeutic activities													
	Threshold at 98th percentile	A	T	Yes	3	4	4	3	2	3	4	4	2	3
	Threshold at 99th percentile				4	4	4	4	3	4	8	5	3	3
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$934,470"	"$45,295"								
97532	Cognitive skills development													
	Threshold at 98th percentile	A	T	Yes	3	4	4	3	2	4	~	3	4	~	
	Threshold at 99th percentile				4	4	4	4	2	4	~	4	4	~	
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4	
	Example Edit				4	4	4	4	4	4	4	4	4	4	
	Estimated impact of example edit				"$1,290"	$117									
97533	Sensory integration														
	Threshold at 98th percentile	A	T	Yes	3	2	3	2	2	2	~	2	2	~	
	Threshold at 99th percentile				3	2	4	2	2	2	~	2	3	~	
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4	
	Example Edit				4	4	4	4	4	4	4	4	4	4	
	Estimated impact of example edit				$28	$62									
97535	Self care management training														
	Threshold at 98th percentile	A	T	Yes	3	2	4	3	2	2	4	2	3	2	
	Threshold at 99th percentile				4	3	4	4	2	2	4	3	3	3	
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4	
	Example Edit				4	4	4	4	4	4	4	4	4	4	
	Estimated impact of example edit				"$40,213"	"$7,563"									
97537	Community/work reintegration														
	Threshold at 98th percentile	A	T	Yes	7	4	6	7	~	8	~	4	~	~	
	Threshold at 99th percentile				8	4	9	8	~	8	~	4	~	~	
	Stakeholder suggestion range				4-6	4-6	4-6	4-6	4-6	4-6	4-6	4-6	4-6	4-6	
	Example Edit				8	8	8	8	8	8	8	8	8	8	
	Estimated impact of example edit				"$1,684"	$0									
97542	Wheelchair management training														
	Threshold at 98th percentile	A	T	Yes	4	5	8	4	7	4	7	5	6	~	
	Threshold at 99th percentile				5	6	8	4	8	5	8	6	6	~	
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4	
	Example Edit				8	8	8	8	8	8	8	8	8	8	
	Estimated impact of example edit				"$9,482"	$0									
97597	Active wound care =< 20 cm														
	Threshold at 98th percentile	A	U	Yes	2	2	2	2	3	2	~	2	1	~	
	Threshold at 99th percentile				2	2	2	3	3	2	~	3	2	~	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$442,516"	"$27,761"									
97598	Active wound care > 20 cm														
	Threshold at 98th percentile	A	U	Yes	2	2	2	2	1	2	~	2	~	~	
	Threshold at 99th percentile				3	2	2	3	1	2	~	2	~	~	
	Stakeholder suggestion range				1	1	1	1	1	1	1	1	1	1	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$158,886"	"$4,958"									
97602	Wound(s) care non-selective														
	Threshold at 98th percentile	B	U	Yes	2	~	2	~	~	~	~	~	~	~	
	Threshold at 99th percentile				2	~	2	~	~	~	~	~	~	~	
	Stakeholder suggestion range				N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	
	Example Edit				0	0	0	0	0	0	0	0	0	0	
	Estimated impact of example edit				"$13,395"	$0									
97605	"Neg press wound tx, < 50 cm"														
	Threshold at 98th percentile	A		Yes	2	2	1	10+	~	1	~	2	1	~	
	Threshold at 99th percentile				3	2	2	10+	~	2	~	2	1	~	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$15,363"	$668									
97606	"Neg press wound tx, > 50 cm"														
	Threshold at 98th percentile	A		Yes	4	1	3	7	~	~	~	~	1	~	
	Threshold at 99th percentile				5	1	4	8	~	~	~	~	1	~	
	Stakeholder suggestion range				1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	1-2	
	Example Edit				1	1	1	1	1	1	1	1	1	1	
	Estimated impact of example edit				"$13,478"	$0									
97750	Physical performance test														
	Threshold at 98th percentile	A	T	Yes	5	4	5	3	3	5	~	4	5	1	
	Threshold at 99th percentile				6	6	7	4	8	5	~	4	6	2	
	Stakeholder suggestion range				8-16	8-16	8-16	8-16	8-16	8-16	8-16	8-16	8-16	8-16	
	Example Edit				8	8	8	8	8	8	8	8	8	8	
	Estimated impact of example edit				"$22,443"	"$9,295"								
97755	Assistive technology assess													
	Threshold at 98th percentile	A	T	Yes	10+	8	10+	8	~	8	~	10+	4	~
	Threshold at 99th percentile				10+	9	10+	8	~	8	~	10+	6	~
	Stakeholder suggestion range				Unl-6	Unl-6	Unl-6	Unl-6	Unl-6	Unl-6	Unl-6	Unl-6	Unl-6	Unl-6
	Example Edit				8	8	8	8	8	8	8	8	8	8
	Estimated impact of example edit				"$2,575"	$793								
97760	Orthotic mgmt and training													
	Threshold at 98th percentile	A	T	Yes	4	4	4	4	4	4	~	4	3	~
	Threshold at 99th percentile				4	4	5	4	5	4	~	5	4	~
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$43,047"	"$3,697"								
97761	Prosthetic training													
	Threshold at 98th percentile	A	T	Yes	4	4	4	4	4	4	~	4	4	~
	Threshold at 99th percentile				4	5	4	5	4	4	~	6	4	~
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$17,061"	"$3,084"								
97762	C/O for orthotic/prosth use													
	Threshold at 98th percentile	A	T	Yes	3	3	3	3	~	3	~	4	3	~
	Threshold at 99th percentile				4	3	4	4	~	4	~	4	3	~
	Stakeholder suggestion range				4	4	4	4	4	4	4	4	4	4
	Example Edit				4	4	4	4	4	4	4	4	4	4
	Estimated impact of example edit				"$2,308"	$152								
97799	Physical medicine procedure													
	Threshold at 98th percentile	C		Yes	4	3	4	~	~	~	~	2	~	~
	Threshold at 99th percentile				10+	5	10+	~	~	~	~	2	~	~
	Stakeholder suggestion range				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Example Edit				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Estimated impact of example edit				$0	$0								
0029T	Magnetic tx for incontinence													
	Threshold at 98th percentile	C	U	Yes	~	1	~	~	~	~	~	~	1	~
	Threshold at 99th percentile				~	1	~	~	~	~	~	~	1	~
	Stakeholder suggestion range				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Example Edit				XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX	XXX
	Estimated impact of example edit				$0	$0								
G0281	Elec stim unattend for press													
	Threshold at 98th percentile	A	U	Yes	2	1	1	2	4	1	~	1	1	~
	Threshold at 99th percentile				3	1	1	3	4	1	~	1	3	~
	Stakeholder suggestion range				2	2	2	2	2	2	2	2	2	2
	Example Edit				1	1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$31,768"	$463								
G0283	Elec stim other than wound													
	Threshold at 98th percentile	A	U	Yes	1	1	1	1	1	1	~	1	1	1
	Threshold at 99th percentile				1	1	1	2	1	1	~	1	1	1
	Stakeholder suggestion range				2	2	2	2	2	2	2	2	2	2
	Example Edit				1	1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$245,050"	"$146,101"								
G0329	Electromagnetic tx for ulcers													
	Threshold at 98th percentile	A	U	Yes	4	~	~	4	~	~	~	~	~	~
	Threshold at 99th percentile				4	~	~	4	~	~	~	~	~	~
	Stakeholder suggestion range				2	2	2	2	2	2	2	2	2	2
	Example Edit				1	1	1	1	1	1	1	1	1	1
	Estimated impact of example edit				"$46,845"	$0								
														
Key:														
A = Active HCPCS code														
B = Payment always bundled into payment for other services														
C = Carrier priced HCPCS code														
N/A = Not applicable or insufficient information available														
XXX = Not included due to carrier priced HCPCS code														
~ = Not reported due to fewer than 100 claim lines of data														
