Read this before you use the table

This page was compiled by an AI system from public Oregon rules and fee schedule tables and then spot-checked, not reviewed by a lawyer, certified coder or the Workers' Compensation Division. It is a reference aid only. It is not legal, billing, coding or compliance advice, it is not an authoritative list, and it must not be relied on for legal purposes.

Amounts are the fee schedule's maximum allowable for the office (non-facility) setting. Insurers, MCOs and other payers may pay less, require authorisation, or apply their own edits.
Descriptions are paraphrased. The AMA CPT code set and CMS HCPCS remain the controlling descriptors.
Fee schedule amounts change at least annually. Confirm every figure against the current OAR 436-009 tables before billing.

The basics

What has to be true before any code in the ledger is payable on an Oregon workers' compensation claim.

Scope comes first
Only treatment inside the chiropractic licence is payable on a workers' compensation claim. Oregon's scope covers adjusting, physiotherapy, electrotherapy, hydrotherapy, minor surgery, diagnosis and the ordering and reading of imaging. It does not cover acupuncture or injections (Board Out of Scope list) or dry needling (Court of Appeals, 2014; rule repealed).
OAR 436-009-0010(1)(a); ORS 684.010; OBCE Guide, Out of Scope list; OAR 811-015-0036 (repealed)
The type B clock: 60 days or 18 visits
A chiropractic physician may be the attending physician for a cumulative 60 days or 18 visits from the first visit on the initial claim with any type B provider (a chiropractic or naturopathic physician), whichever comes first, and may authorise time loss for only 30 days. Before treating, the DC must certify to the director that they have reviewed the division's materials packet. After the limit, care is payable only on referral or prescription from the attending physician or an authorized nurse practitioner.
ORS 656.005(12)(b)(B); OAR 436-010-0210(2)
Form 827 within 72 hours
The first provider and the patient complete and sign Form 827 and the provider sends it to the insurer within 72 hours of the first visit (weekends and holidays excluded), with Form 3283 handed to the worker. A provider who later becomes the attending physician sends a new 827 within five days. Completing the form is not billable.
OAR 436-010-0241; ORS 656.248(10)
Tell the worker at the first visit
Every provider must tell the patient at the first visit how they can provide compensable care and authorise time loss, and that the patient may be personally liable for non-compensable services.
OAR 436-010-0230(3)
What the bill must carry
A CMS-1500 (or electronic equivalent) with the worker's full name, date of injury, employer, claim number if known, NPI, ICD-10 codes and the provider's usual fee charged to the general public. Legible chart notes that identify who performed each service must accompany every original paper bill.
OAR 436-009-0010(1)(b), (1)(c), (3), (7)
Deadlines
Bill within 60 days of the date of service (or of learning who the insurer is). Bills sent within 12 months cannot be reduced for lateness; bills after 12 months are not payable. The insurer must pay or send an explanation of benefits within 45 days of a proper bill.
OAR 436-009-0010(2); 436-009-0030(3)
How much: lesser of the table or your usual fee
For every listed code the insurer pays the lower of the Appendix B non-facility amount and the provider's usual fee. Codes the table marks '80% of billed', unlisted HCPCS codes and services with no code pay 80% of the usual fee.
OAR 436-009-0040(1)(a)
Physical medicine: three codes a day, 8-minute units
Modalities and therapeutic procedures are limited to three separately payable CPT codes per day per provider tax ID (extra units of the same code do not count). Timed codes follow the 8-minute table: 8 to 22 minutes is one unit, 23 to 37 two, 38 to 52 three. Chart notes must show start and stop times or minutes for every constant-attendance service. Hot packs, traction and the other 97010 to 97028 modalities are not payable unless performed with a service that needs constant attendance or the licensed provider's knowledge and skill. Extra units of the same code do not count as separate codes, and when more than three are billed the insurer pays the three that pay most.
OAR 436-009-0040(6)
Therapy frequency guideline
The usual range for therapy visits is up to 20 visits in the first 60 days and four a month after that; insurers use it as a guideline, not a hard cap. Once the worker is medically stationary, palliative care must be prescribed by a type A attending physician and approved by the insurer in a written plan of no more than 180 days; a chiropractic physician can be the provider named in that plan.
OAR 436-010-0230(9)(a); 436-010-0290
Not separately payable
Completing Form 827, sending chart notes with the bill, writing the treatment plan, progress notes, work-release forms, no-shows (unless the patient signed a written policy that applies to all patients), more than three mechanical muscle-testing sessions, and dietary supplements without a proven compensable deficiency.
OAR 436-009-0010(11), (13)
Excluded treatments
Surface EMG, thermography, prolotherapy, Rolfing and IDET are not compensable, whatever code is used; DMSO is excluded except for compensable interstitial cystitis.
OAR 436-009-0010(12)
Progress reports and imaging requests
While time loss is authorised the insurer may require a progress report every 15 days (chart notes usually suffice), and a requested narrative is due within 14 days. Advanced imaging other than plain films needs a written request to the insurer, which must answer within 14 days.
OAR 436-010-0240(6); 436-010-0230(12)
No NCCI edits in the rule
Oregon workers' compensation adopts CPT codes and descriptors but not CMS edits, status indicators or National Correct Coding Initiative pairs. Modifiers 25 and 59 follow CPT conventions rather than an Oregon rule, and no AT or GP modifier is required. Insurers can still return or down-code a bill that claims a higher service than the notes show, and MCO contracts may add their own review.
OAR 436-009-0004(5)(a); 436-009-0030(2)(c)
Impairment findings
Type B providers may not make impairment findings, except a chiropractic physician who is the attending physician at claim closure. That DC bills the closing exam and report with Oregon codes CE001 and CR001.
OAR 436-010-0210(2)(d); 436-009-0060
Telehealth
Real-time audio-video visits use place of service 02 or 10 and modifier 95 (not needed on 98000 to 98007) and are paid at the non-facility rate. Audio-only or online digital services use POS 02 or 10 without modifier 95. Any appropriate service may be delivered by telehealth; it is not limited to CPT Appendix P.
OAR 436-009-0012
Supplies and orthotics
DME, orthotics and supplies are paid from Appendix E: new items at the lesser of the table amount or usual fee, used items at 75%, rentals at 10% a month, unlisted items at 80% of the usual fee. Fifteen rental items, including cervical traction unit E0849, have fixed monthly rates instead. Bill with the HCPCS code and the NU, UE or RR modifier.
OAR 436-009-0080(6)

How the schedule sets the amount

Appendix B lists a dollar maximum for each code directly. The insurer pays the lesser of that amount or the provider's usual fee.

Situation	Payment	Rule
Listed code, performed in the office	Lesser of Appendix B non-facility amount or usual fee	Every CPT, HCPCS and Oregon-specific code in Appendix B; the column used for all amounts on this page. OAR 436-009-0040(1)(a)
Listed code, performed outside the office	Lesser of Appendix B facility amount or usual fee	Hospital or facility settings. Outpatient therapy always uses the non-facility column.
Codes the table marks '80% of billed'	80% of usual fee	Reports (99080), unlisted modalities (97039, 97139), supplies (99070), closing exam codes, and similar.
HCPCS code not in the schedule	80% of usual fee	Also any service with no CPT, OSC or HCPCS code, billed with an unlisted code and a description.
DMEPOS in Appendix E	New: lesser of table or usual fee · Used: 75% · Rental: 10% per month	Braces, TENS units, supplies. Unlisted items pay 80% of usual fee. OAR 436-009-0080(6)
Radiology	Global, professional (-26) and technical (-TC) amounts	Only diagnostic-quality films with a written report are payable; 14 by 36 inch lateral views are not. OAR 436-009-0040(4)
Telehealth, distant-site provider	Non-facility rate	POS 02 or 10; modifier 95 for audio-video except 98000 to 98007. Originating-site fee Q3014 is $35.70 per 15 minutes. OAR 436-009-0012
Modifier 22, unusual service	125% of Appendix B	Surgical codes with a 0, 10 or 90 day global period only, with documentation of the extra work. OAR 436-009-0010(5)(b)
Additional surgical procedures, same session	50% of Appendix B (add-on codes exempt)	Rarely relevant to chiropractic minor procedures. OAR 436-009-0040(3)
Oregon-specific codes with no dollar amount	As billed, or 80% of usual fee, per Appendix B	Depositions, insurer consultations and IME responses are paid as billed; closing exams and record reviews at 80%.

The ledger

212 codes grouped by category. Search by code, word or dollar figure. Open "Full notes, modifiers and bundling" on any row for the fine print.

Code	Description	Units	WC max allowable	Required to bill it
Evaluation & management (10)
99202CPT	New patient office visit, straightforward decision making or 15-29 min total time	Per visit (1 per date)	$164.05	Level by MDM or total time on the date; document history/exam, assessment and plan; new = not seen by you or your group in 3 years; same-day CMT needs modifier 25 and separately identifiable work Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Level is chosen by medical decision making (number/complexity of problems, data reviewed, risk) OR by total practitioner time on the date of service (2021+ office E/M rules). Document history/exam as clinically appropriate, the assessment, and the plan. A new patient is one not seen by you (or another DC in your group) within the past 3 years. When billed on the same day as CMT or therapy, the E/M must be significant and separately identifiable from the pre-/post-service work built into those codes (typically new patient, new injury/complaint, exacerbation, or a scheduled re-examination/re-evaluation). Modifiers: 25 when billed on the same date as CMT (98940-98943) or physical medicine services; under NCCI (Medicare and payers that adopt it) the E/M is otherwise bundled into the CMT; Oregon workers' compensation does not adopt NCCI but still expects a separately identifiable visit; GY on Medicare claims (E/M by a DC is statutorily non-covered); 95 (or 93 audio-only) with POS 02/10 when delivered by telehealth to payers that use 99202-99215 for telehealth (e.g., Medicare) rather than 98000-98015 Bundling: Bundled into CMT by NCCI unless modifier 25 and separately identifiable documentation; a new-patient E/M cannot be reported by a provider of the same specialty in the same group who saw the patient within 3 years. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: In scope; diagnosis and E/M are core chiropractic services in Oregon (ORS 684.010). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per the OAR 436-009 Appendix B physician fee schedule; bill your usual fee on a CMS-1500 with legible chart notes. A DC is a Type B attending physician: may serve as attending physician for a cumulative total of 60 days or 18 visits (whichever comes first) counted from the first visit with any Type B provider on the claim, and may authorize temporary disability for only 30 days from that first visit (ORS 656.005, OAR 436-010-0210). After that, care is payable only when authorized by the attending physician (of any type) under a treatment plan the chiropractic office sends to the prescribing provider and insurer within seven days (OAR 436-010-0230(7)). Form 827 goes to the insurer within 72 hours of the first visit, not counting weekends and legal holidays; a provider who later becomes attending physician sends a new 827 within five days (OAR 436-010-0241).
99203CPT	New patient office visit, low-complexity decision making or 30-44 min total time	Per visit (1 per date)	$256.64	Level by MDM or total time on the date; document history/exam, assessment and plan; new = not seen by you or your group in 3 years; same-day CMT needs modifier 25 and separately identifiable work Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Level is chosen by medical decision making (number/complexity of problems, data reviewed, risk) OR by total practitioner time on the date of service (2021+ office E/M rules). Document history/exam as clinically appropriate, the assessment, and the plan. A new patient is one not seen by you (or another DC in your group) within the past 3 years. When billed on the same day as CMT or therapy, the E/M must be significant and separately identifiable from the pre-/post-service work built into those codes (typically new patient, new injury/complaint, exacerbation, or a scheduled re-examination/re-evaluation). Modifiers: 25 when billed on the same date as CMT (98940-98943) or physical medicine services; under NCCI (Medicare and payers that adopt it) the E/M is otherwise bundled into the CMT; Oregon workers' compensation does not adopt NCCI but still expects a separately identifiable visit; GY on Medicare claims (E/M by a DC is statutorily non-covered); 95 (or 93 audio-only) with POS 02/10 when delivered by telehealth to payers that use 99202-99215 for telehealth (e.g., Medicare) rather than 98000-98015 Bundling: Bundled into CMT by NCCI unless modifier 25 and separately identifiable documentation; a new-patient E/M cannot be reported by a provider of the same specialty in the same group who saw the patient within 3 years. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: In scope; diagnosis and E/M are core chiropractic services in Oregon (ORS 684.010). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per the OAR 436-009 Appendix B physician fee schedule; bill your usual fee on a CMS-1500 with legible chart notes. A DC is a Type B attending physician: may serve as attending physician for a cumulative total of 60 days or 18 visits (whichever comes first) counted from the first visit with any Type B provider on the claim, and may authorize temporary disability for only 30 days from that first visit (ORS 656.005, OAR 436-010-0210). After that, care is payable only when authorized by the attending physician (of any type) under a treatment plan the chiropractic office sends to the prescribing provider and insurer within seven days (OAR 436-010-0230(7)). Form 827 goes to the insurer within 72 hours of the first visit, not counting weekends and legal holidays; a provider who later becomes attending physician sends a new 827 within five days (OAR 436-010-0241).
99204CPT	New patient office visit, moderate-complexity decision making or 45-59 min total time	Per visit (1 per date)	$387.15	Level by MDM or total time on the date; document history/exam, assessment and plan; new = not seen by you or your group in 3 years; same-day CMT needs modifier 25 and separately identifiable work Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Level is chosen by medical decision making (number/complexity of problems, data reviewed, risk) OR by total practitioner time on the date of service (2021+ office E/M rules). Document history/exam as clinically appropriate, the assessment, and the plan. A new patient is one not seen by you (or another DC in your group) within the past 3 years. When billed on the same day as CMT or therapy, the E/M must be significant and separately identifiable from the pre-/post-service work built into those codes (typically new patient, new injury/complaint, exacerbation, or a scheduled re-examination/re-evaluation). Modifiers: 25 when billed on the same date as CMT (98940-98943) or physical medicine services; under NCCI (Medicare and payers that adopt it) the E/M is otherwise bundled into the CMT; Oregon workers' compensation does not adopt NCCI but still expects a separately identifiable visit; GY on Medicare claims (E/M by a DC is statutorily non-covered); 95 (or 93 audio-only) with POS 02/10 when delivered by telehealth to payers that use 99202-99215 for telehealth (e.g., Medicare) rather than 98000-98015 Bundling: Bundled into CMT by NCCI unless modifier 25 and separately identifiable documentation; a new-patient E/M cannot be reported by a provider of the same specialty in the same group who saw the patient within 3 years. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: In scope; diagnosis and E/M are core chiropractic services in Oregon (ORS 684.010). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per the OAR 436-009 Appendix B physician fee schedule; bill your usual fee on a CMS-1500 with legible chart notes. A DC is a Type B attending physician: may serve as attending physician for a cumulative total of 60 days or 18 visits (whichever comes first) counted from the first visit with any Type B provider on the claim, and may authorize temporary disability for only 30 days from that first visit (ORS 656.005, OAR 436-010-0210). After that, care is payable only when authorized by the attending physician (of any type) under a treatment plan the chiropractic office sends to the prescribing provider and insurer within seven days (OAR 436-010-0230(7)). Form 827 goes to the insurer within 72 hours of the first visit, not counting weekends and legal holidays; a provider who later becomes attending physician sends a new 827 within five days (OAR 436-010-0241).
99205CPT	New patient office visit, high-complexity decision making or 60-74 min total time	Per visit (1 per date); add 99417 for each additional 15 minutes beyond 74	$516.93	Level by MDM or total time on the date; document history/exam, assessment and plan; new = not seen by you or your group in 3 years; same-day CMT needs modifier 25 and separately identifiable work Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Level is chosen by medical decision making (number/complexity of problems, data reviewed, risk) OR by total practitioner time on the date of service (2021+ office E/M rules). Document history/exam as clinically appropriate, the assessment, and the plan. A new patient is one not seen by you (or another DC in your group) within the past 3 years. When billed on the same day as CMT or therapy, the E/M must be significant and separately identifiable from the pre-/post-service work built into those codes (typically new patient, new injury/complaint, exacerbation, or a scheduled re-examination/re-evaluation). Modifiers: 25 when billed on the same date as CMT (98940-98943) or physical medicine services; under NCCI (Medicare and payers that adopt it) the E/M is otherwise bundled into the CMT; Oregon workers' compensation does not adopt NCCI but still expects a separately identifiable visit; GY on Medicare claims (E/M by a DC is statutorily non-covered); 95 (or 93 audio-only) with POS 02/10 when delivered by telehealth to payers that use 99202-99215 for telehealth (e.g., Medicare) rather than 98000-98015 Bundling: Bundled into CMT by NCCI unless modifier 25 and separately identifiable documentation; a new-patient E/M cannot be reported by a provider of the same specialty in the same group who saw the patient within 3 years. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: In scope; diagnosis and E/M are core chiropractic services in Oregon (ORS 684.010). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per the OAR 436-009 Appendix B physician fee schedule; bill your usual fee on a CMS-1500 with legible chart notes. A DC is a Type B attending physician: may serve as attending physician for a cumulative total of 60 days or 18 visits (whichever comes first) counted from the first visit with any Type B provider on the claim, and may authorize temporary disability for only 30 days from that first visit (ORS 656.005, OAR 436-010-0210). After that, care is payable only when authorized by the attending physician (of any type) under a treatment plan the chiropractic office sends to the prescribing provider and insurer within seven days (OAR 436-010-0230(7)). Form 827 goes to the insurer within 72 hours of the first visit, not counting weekends and legal holidays; a provider who later becomes attending physician sends a new 827 within five days (OAR 436-010-0241).
99211CPT	Minimal established-patient visit (e.g., staff BP recheck); no MDM or time requirement	Per visit	$53.22	Face-to-face service by clinical staff under direct supervision; medically necessary; not on the same day as another E/M or a CMT/therapy visit by the same provider (bundled); many payers deny Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Must be a face-to-face service by clinical staff under direct supervision, medically necessary, and not on the same day as another E/M or a CMT/therapy visit by the same provider (it is bundled). Rarely appropriate in a chiropractic office; many payers deny. Modifiers: 25 is not typically accepted with 99211 for same-day CMT; most payers bundle it; GY on Medicare Bundling: Bundled into any same-day procedure; Medicare and many commercial payers will not pay 99211 with CMT. Oregon scope: Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per the OAR 436-009 Appendix B physician fee schedule; bill your usual fee on a CMS-1500 with legible chart notes. A DC is a Type B attending physician: may serve as attending physician for a cumulative total of 60 days or 18 visits (whichever comes first) counted from the first visit with any Type B provider on the claim, and may authorize temporary disability for only 30 days from that first visit (ORS 656.005, OAR 436-010-0210). After that, care is payable only when authorized by the attending physician (of any type) under a treatment plan the chiropractic office sends to the prescribing provider and insurer within seven days (OAR 436-010-0230(7)). Form 827 goes to the insurer within 72 hours of the first visit, not counting weekends and legal holidays; a provider who later becomes attending physician sends a new 827 within five days (OAR 436-010-0241).
99212CPT	Established patient visit, straightforward decision making or 10-19 min total time	Per visit (1 per date)	$129.78	Level by MDM or total time on the date; document history/exam, assessment and plan; same-day E/M with CMT needs modifier 25 and a separate reason (new complaint, exacerbation, scheduled re-exam) Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Level is chosen by medical decision making (number/complexity of problems, data reviewed, risk) OR by total practitioner time on the date of service (2021+ office E/M rules). Document history/exam as clinically appropriate, the assessment, and the plan. A new patient is one not seen by you (or another DC in your group) within the past 3 years. When billed on the same day as CMT or therapy, the E/M must be significant and separately identifiable from the pre-/post-service work built into those codes (typically new patient, new injury/complaint, exacerbation, or a scheduled re-examination/re-evaluation). For established patients, a same-day E/M is usually justified only by a new complaint, an exacerbation, a significant change requiring re-evaluation, or a periodic re-examination (commonly every 30 days / 12 visits in payer guidelines). Modifiers: 25 when billed on the same date as CMT (98940-98943) or physical medicine services; under NCCI (Medicare and payers that adopt it) the E/M is otherwise bundled into the CMT; Oregon workers' compensation does not adopt NCCI but still expects a separately identifiable visit; GY on Medicare claims (E/M by a DC is statutorily non-covered); 95 (or 93 audio-only) with POS 02/10 when delivered by telehealth to payers that use 99202-99215 for telehealth (e.g., Medicare) rather than 98000-98015 Bundling: Bundled into CMT unless modifier 25 with separately identifiable documentation; routine pre-adjustment assessment is part of the CMT. Oregon scope: In scope. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per the OAR 436-009 Appendix B physician fee schedule; bill your usual fee on a CMS-1500 with legible chart notes. A DC is a Type B attending physician: may serve as attending physician for a cumulative total of 60 days or 18 visits (whichever comes first) counted from the first visit with any Type B provider on the claim, and may authorize temporary disability for only 30 days from that first visit (ORS 656.005, OAR 436-010-0210). After that, care is payable only when authorized by the attending physician (of any type) under a treatment plan the chiropractic office sends to the prescribing provider and insurer within seven days (OAR 436-010-0230(7)). Form 827 goes to the insurer within 72 hours of the first visit, not counting weekends and legal holidays; a provider who later becomes attending physician sends a new 827 within five days (OAR 436-010-0241).
99213CPT	Established patient visit, low-complexity decision making or 20-29 min total time	Per visit (1 per date)	$207.79	Level by MDM or total time on the date; document history/exam, assessment and plan; same-day E/M with CMT needs modifier 25 and a separate reason (new complaint, exacerbation, scheduled re-exam) Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Level is chosen by medical decision making (number/complexity of problems, data reviewed, risk) OR by total practitioner time on the date of service (2021+ office E/M rules). Document history/exam as clinically appropriate, the assessment, and the plan. A new patient is one not seen by you (or another DC in your group) within the past 3 years. When billed on the same day as CMT or therapy, the E/M must be significant and separately identifiable from the pre-/post-service work built into those codes (typically new patient, new injury/complaint, exacerbation, or a scheduled re-examination/re-evaluation). For established patients, a same-day E/M is usually justified only by a new complaint, an exacerbation, a significant change requiring re-evaluation, or a periodic re-examination (commonly every 30 days / 12 visits in payer guidelines). Modifiers: 25 when billed on the same date as CMT (98940-98943) or physical medicine services; under NCCI (Medicare and payers that adopt it) the E/M is otherwise bundled into the CMT; Oregon workers' compensation does not adopt NCCI but still expects a separately identifiable visit; GY on Medicare claims (E/M by a DC is statutorily non-covered); 95 (or 93 audio-only) with POS 02/10 when delivered by telehealth to payers that use 99202-99215 for telehealth (e.g., Medicare) rather than 98000-98015 Bundling: Bundled into CMT unless modifier 25 with separately identifiable documentation; routine pre-adjustment assessment is part of the CMT. Oregon scope: In scope. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per the OAR 436-009 Appendix B physician fee schedule; bill your usual fee on a CMS-1500 with legible chart notes. A DC is a Type B attending physician: may serve as attending physician for a cumulative total of 60 days or 18 visits (whichever comes first) counted from the first visit with any Type B provider on the claim, and may authorize temporary disability for only 30 days from that first visit (ORS 656.005, OAR 436-010-0210). After that, care is payable only when authorized by the attending physician (of any type) under a treatment plan the chiropractic office sends to the prescribing provider and insurer within seven days (OAR 436-010-0230(7)). Form 827 goes to the insurer within 72 hours of the first visit, not counting weekends and legal holidays; a provider who later becomes attending physician sends a new 827 within five days (OAR 436-010-0241).
99214CPT	Established patient visit, moderate-complexity decision making or 30-39 min total time	Per visit (1 per date)	$296.01	Level by MDM or total time on the date; document history/exam, assessment and plan; same-day E/M with CMT needs modifier 25 and a separate reason (new complaint, exacerbation, scheduled re-exam) Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Level is chosen by medical decision making (number/complexity of problems, data reviewed, risk) OR by total practitioner time on the date of service (2021+ office E/M rules). Document history/exam as clinically appropriate, the assessment, and the plan. A new patient is one not seen by you (or another DC in your group) within the past 3 years. When billed on the same day as CMT or therapy, the E/M must be significant and separately identifiable from the pre-/post-service work built into those codes (typically new patient, new injury/complaint, exacerbation, or a scheduled re-examination/re-evaluation). For established patients, a same-day E/M is usually justified only by a new complaint, an exacerbation, a significant change requiring re-evaluation, or a periodic re-examination (commonly every 30 days / 12 visits in payer guidelines). Modifiers: 25 when billed on the same date as CMT (98940-98943) or physical medicine services; under NCCI (Medicare and payers that adopt it) the E/M is otherwise bundled into the CMT; Oregon workers' compensation does not adopt NCCI but still expects a separately identifiable visit; GY on Medicare claims (E/M by a DC is statutorily non-covered); 95 (or 93 audio-only) with POS 02/10 when delivered by telehealth to payers that use 99202-99215 for telehealth (e.g., Medicare) rather than 98000-98015 Bundling: Bundled into CMT unless modifier 25 with separately identifiable documentation; routine pre-adjustment assessment is part of the CMT. Oregon scope: In scope. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per the OAR 436-009 Appendix B physician fee schedule; bill your usual fee on a CMS-1500 with legible chart notes. A DC is a Type B attending physician: may serve as attending physician for a cumulative total of 60 days or 18 visits (whichever comes first) counted from the first visit with any Type B provider on the claim, and may authorize temporary disability for only 30 days from that first visit (ORS 656.005, OAR 436-010-0210). After that, care is payable only when authorized by the attending physician (of any type) under a treatment plan the chiropractic office sends to the prescribing provider and insurer within seven days (OAR 436-010-0230(7)). Form 827 goes to the insurer within 72 hours of the first visit, not counting weekends and legal holidays; a provider who later becomes attending physician sends a new 827 within five days (OAR 436-010-0241).
99215CPT	Established patient visit, high-complexity decision making or 40-54 min total time	Per visit (1 per date); add 99417 for each additional 15 minutes beyond 54	$419.96	Level by MDM or total time on the date; document history/exam, assessment and plan; same-day E/M with CMT needs modifier 25 and a separate reason (new complaint, exacerbation, scheduled re-exam) Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Level is chosen by medical decision making (number/complexity of problems, data reviewed, risk) OR by total practitioner time on the date of service (2021+ office E/M rules). Document history/exam as clinically appropriate, the assessment, and the plan. A new patient is one not seen by you (or another DC in your group) within the past 3 years. When billed on the same day as CMT or therapy, the E/M must be significant and separately identifiable from the pre-/post-service work built into those codes (typically new patient, new injury/complaint, exacerbation, or a scheduled re-examination/re-evaluation). For established patients, a same-day E/M is usually justified only by a new complaint, an exacerbation, a significant change requiring re-evaluation, or a periodic re-examination (commonly every 30 days / 12 visits in payer guidelines). Modifiers: 25 when billed on the same date as CMT (98940-98943) or physical medicine services; under NCCI (Medicare and payers that adopt it) the E/M is otherwise bundled into the CMT; Oregon workers' compensation does not adopt NCCI but still expects a separately identifiable visit; GY on Medicare claims (E/M by a DC is statutorily non-covered); 95 (or 93 audio-only) with POS 02/10 when delivered by telehealth to payers that use 99202-99215 for telehealth (e.g., Medicare) rather than 98000-98015 Bundling: Bundled into CMT unless modifier 25 with separately identifiable documentation; routine pre-adjustment assessment is part of the CMT. Oregon scope: In scope. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per the OAR 436-009 Appendix B physician fee schedule; bill your usual fee on a CMS-1500 with legible chart notes. A DC is a Type B attending physician: may serve as attending physician for a cumulative total of 60 days or 18 visits (whichever comes first) counted from the first visit with any Type B provider on the claim, and may authorize temporary disability for only 30 days from that first visit (ORS 656.005, OAR 436-010-0210). After that, care is payable only when authorized by the attending physician (of any type) under a treatment plan the chiropractic office sends to the prescribing provider and insurer within seven days (OAR 436-010-0230(7)). Form 827 goes to the insurer within 72 hours of the first visit, not counting weekends and legal holidays; a provider who later becomes attending physician sends a new 827 within five days (OAR 436-010-0241).
99417CPT	Prolonged office E/M time, each added 15 min beyond 99205 or 99215 on the same date	Per 15 minutes (add-on to 99205/99215 only)	$69.02	Only with 99205 or 99215 chosen by time, not MDM; first unit at 75 min total (99205) or 55 min (99215), one more per full 15 min; document total time and work done; not with 99358/99359 same date Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Only with 99205 or 99215 selected by TIME (not MDM). CPT 2025 threshold: report the first unit at 75 minutes total for 99205 and 55 minutes for 99215; each full additional 15 minutes is another unit. Document total time and what was done. Medicare and Medicare Advantage do not accept 99417; they use G2212, which starts 15 minutes after the MAXIMUM time of the level-5 code (89 min new / 69 min established). Modifiers: No modifier; list with the primary E/M; GY on Medicare (and Medicare does not recognize 99417 anyway) Bundling: Cannot be reported with 99358/99359 on the same date. Oregon scope: Rarely reached in chiropractic practice; expect payer scrutiny. Verify each payer's threshold (AMA 99417 vs CMS G2212 rules). Workers' comp: Oregon WC: paid per Appendix B when documented; time must be documented in the chart note.
Chiropractic manipulation (4)
98940CPT	Spinal adjustment, 1 or 2 spinal regions	1 unit per visit (code selection by number of spinal regions treated)	$66.97	Treated regions named with a segmental diagnosis each plus a symptomatic diagnosis; only treated regions count; plan of care with goals, active not maintenance; 97140/97124 bundled in a manipulated region Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Document the specific spinal regions treated (cervical, thoracic, lumbar, sacral, pelvic) and the segmental diagnosis for each (e.g., M99.0x) plus a supporting symptomatic/neuromusculoskeletal diagnosis. Region count drives code selection; regions that are merely evaluated do not count. Medicare requires a documented subluxation (P.A.R.T. exam: at least 2 of Pain, Asymmetry, Range-of-motion abnormality, Tissue changes, one of which must be A or R), the initial-visit plan of care with goals and expected duration, and evidence the care is active/corrective rather than maintenance. Pre-manipulation assessment, the adjustment, and post-service work are included in the code; do not bill a separate E/M for the routine pre-adjustment check. Modifiers: AT (Medicare) when treatment is active/corrective; omit AT for maintenance care and use GA with a signed ABN (GA also for other expected denials); 25 goes on the E/M, not the CMT, when a separately identifiable E/M is billed the same day; 59 or XS goes on 97140/97124/97112 etc. (the column-2 code), not on the CMT, when those are performed in a different region Bundling: NCCI: 97140 (manual therapy), 97124 (massage) and 97112 are bundled into CMT when performed in a spinal region that was manipulated; they are separately reportable only for a different, non-contiguous region with 59/XS and documentation of the distinct region. Office E/M codes are bundled into CMT unless a separately identifiable E/M is documented and billed with modifier 25. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: Core in-scope service (ORS 684.010(2)). Medicare covers 98940-98942 only for treatment of subluxation with AT modifier; maintenance care is non-covered (use GA with ABN). Workers' comp: Oregon WC: 98940-98942 are paid per Appendix B. Type B attending-physician limits apply (60 days / 18 visits; 30 days of time-loss authorization). Insurers may not deny solely on the OAR 436-010-0230 frequency benchmarks (about 20 visits in the first 60 days, then 4 per month) but treatment beyond them needs clinical justification; after medically stationary status, palliative care requires insurer approval. Legible chart notes identifying who performed the service must accompany every bill.
98941CPT	Spinal adjustment, 3 or 4 spinal regions	1 unit per visit	$93.75	Treated regions named with a segmental diagnosis each plus a symptomatic diagnosis; only treated regions count; plan of care with goals, active not maintenance; each region needs its own findings and diagnosis Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Document the specific spinal regions treated (cervical, thoracic, lumbar, sacral, pelvic) and the segmental diagnosis for each (e.g., M99.0x) plus a supporting symptomatic/neuromusculoskeletal diagnosis. Region count drives code selection; regions that are merely evaluated do not count. Medicare requires a documented subluxation (P.A.R.T. exam: at least 2 of Pain, Asymmetry, Range-of-motion abnormality, Tissue changes, one of which must be A or R), the initial-visit plan of care with goals and expected duration, and evidence the care is active/corrective rather than maintenance. Pre-manipulation assessment, the adjustment, and post-service work are included in the code; do not bill a separate E/M for the routine pre-adjustment check. Each of the 3-4 regions must have its own documented diagnosis and findings. Modifiers: AT (Medicare) when treatment is active/corrective; omit AT for maintenance care and use GA with a signed ABN (GA also for other expected denials); 25 goes on the E/M, not the CMT, when a separately identifiable E/M is billed the same day; 59 or XS goes on 97140/97124/97112 etc. (the column-2 code), not on the CMT, when those are performed in a different region Bundling: NCCI: 97140 (manual therapy), 97124 (massage) and 97112 are bundled into CMT when performed in a spinal region that was manipulated; they are separately reportable only for a different, non-contiguous region with 59/XS and documentation of the distinct region. Office E/M codes are bundled into CMT unless a separately identifiable E/M is documented and billed with modifier 25. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: Core in-scope service. Medicare-covered with AT when active treatment of documented subluxations in each region billed. Workers' comp: Oregon WC: 98940-98942 are paid per Appendix B. Type B attending-physician limits apply (60 days / 18 visits; 30 days of time-loss authorization). Insurers may not deny solely on the OAR 436-010-0230 frequency benchmarks (about 20 visits in the first 60 days, then 4 per month) but treatment beyond them needs clinical justification; after medically stationary status, palliative care requires insurer approval. Legible chart notes identifying who performed the service must accompany every bill.
98942CPT	Spinal adjustment, all 5 spinal regions	1 unit per visit	$119.65	Treated regions named with a segmental diagnosis each plus a symptomatic diagnosis; only treated regions count; plan of care with goals, active not maintenance; all five regions need findings, high audit risk Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Document the specific spinal regions treated (cervical, thoracic, lumbar, sacral, pelvic) and the segmental diagnosis for each (e.g., M99.0x) plus a supporting symptomatic/neuromusculoskeletal diagnosis. Region count drives code selection; regions that are merely evaluated do not count. Medicare requires a documented subluxation (P.A.R.T. exam: at least 2 of Pain, Asymmetry, Range-of-motion abnormality, Tissue changes, one of which must be A or R), the initial-visit plan of care with goals and expected duration, and evidence the care is active/corrective rather than maintenance. Pre-manipulation assessment, the adjustment, and post-service work are included in the code; do not bill a separate E/M for the routine pre-adjustment check. All five regions must have documented subluxation/dysfunction findings and diagnoses; audit risk is high because 5-region treatment at every visit is rarely supported. Modifiers: AT (Medicare) when treatment is active/corrective; omit AT for maintenance care and use GA with a signed ABN (GA also for other expected denials); 25 goes on the E/M, not the CMT, when a separately identifiable E/M is billed the same day; 59 or XS goes on 97140/97124/97112 etc. (the column-2 code), not on the CMT, when those are performed in a different region Bundling: NCCI: 97140 (manual therapy), 97124 (massage) and 97112 are bundled into CMT when performed in a spinal region that was manipulated; they are separately reportable only for a different, non-contiguous region with 59/XS and documentation of the distinct region. Office E/M codes are bundled into CMT unless a separately identifiable E/M is documented and billed with modifier 25. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: Core in-scope service. Medicare-covered with AT when supported. Workers' comp: Oregon WC: 98940-98942 are paid per Appendix B. Type B attending-physician limits apply (60 days / 18 visits; 30 days of time-loss authorization). Insurers may not deny solely on the OAR 436-010-0230 frequency benchmarks (about 20 visits in the first 60 days, then 4 per month) but treatment beyond them needs clinical justification; after medically stationary status, palliative care requires insurer approval. Legible chart notes identifying who performed the service must accompany every bill.
98943CPT	Manipulation of one or more extraspinal regions (head/TMJ, extremities, ribs, abdomen)	1 unit per visit (covers 1-5 extraspinal regions)	$63.41	Extraspinal region(s) treated named with joint-specific diagnosis and findings; one unit covers 1-5 regions; may be billed with spinal CMT same day when both are documented; 97140 in the same region is bundled Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Document which extraspinal region(s) were treated with the joint-specific diagnosis and findings. One unit covers 1-5 extraspinal regions. May be billed with 98940-98942 on the same date when both spinal and extraspinal regions are treated and documented. Modifiers: 51 or 59 is requested by some payers when billed with spinal CMT (payer-specific); Medicare does not cover it at all; GY on Medicare Bundling: 97140 in the same extraspinal region is bundled; use 59/XS only for a different region. Oregon scope: In scope in Oregon. Medicare: statutorily non-covered (only spinal manipulation is covered) — use GY. Workers' comp: Oregon WC: Priced in Appendix B. Type B attending-physician limits apply (60 days / 18 visits; 30 days of time-loss authorization). Insurers may not deny solely on the OAR 436-010-0230 frequency benchmarks (about 20 visits in the first 60 days, then 4 per month) but treatment beyond them needs clinical justification; after medically stationary status, palliative care requires insurer approval. Legible chart notes identifying who performed the service must accompany every bill.
Physical medicine: modalities (15)
97010CPT	Hot or cold pack applied to one or more areas	1 unit per visit regardless of the number of areas or minutes	$13.39	Supervised modality, billed per visit not timed; document area, parameters, duration and purpose tied to plan goals; bundled (status B) by Medicare-fee-schedule payers and NCCI, rarely paid separately Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Supervised modality: no direct one-on-one contact is required after set-up, so units are per visit (not timed). Document the area(s) treated, parameters (e.g., temperature, traction weight/duration, e-stim type/settings), duration, and the therapeutic purpose tied to the treatment plan/goals. Medical necessity requires that the modality be part of a plan with measurable goals; passive modalities alone for prolonged periods are commonly denied as maintenance. Modifiers: GP on payers that require a therapy-discipline modifier on 97xxx codes (many commercial and Medicare Advantage plans); GY on Medicare (non-covered when furnished by a DC) Bundling: Under Medicare and payers that follow it, 97010 is a bundled (status B) code and is not paid separately. Oregon workers' compensation prices it at $13.39, payable only alongside a constant-attendance service (OAR 436-009-0040(6)(d)). Oregon scope: In scope as physiotherapy/electrotherapy/hydrotherapy (ORS 684.010; OBCE Electrotherapy and Mechanical Traction policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(d): 97010-97028 are NOT payable unless performed in conjunction with a service that requires constant attendance or the provider's knowledge and skill (e.g., CMT, 97110, 97140). Also counts toward the limit of 3 separate CPT-coded modalities/procedures per provider per day (6)(b); when more are billed the insurer pays the 3 that yield the highest payment. Simultaneous treatments from one machine/table must be billed as one charge (6)(e).
97012CPT	Mechanical traction (motorized/intermittent cervical or lumbar)	1 unit per visit regardless of the number of areas or minutes	$28.78	Supervised modality, per visit not timed; document area, weight/duration and purpose tied to plan goals; part of a plan with measurable goals; some payers bundle with same-region CMT, manual traction is 97140 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Supervised modality: no direct one-on-one contact is required after set-up, so units are per visit (not timed). Document the area(s) treated, parameters (e.g., temperature, traction weight/duration, e-stim type/settings), duration, and the therapeutic purpose tied to the treatment plan/goals. Medical necessity requires that the modality be part of a plan with measurable goals; passive modalities alone for prolonged periods are commonly denied as maintenance. Modifiers: GP on payers that require a therapy-discipline modifier on 97xxx codes (many commercial and Medicare Advantage plans); GY on Medicare (non-covered when furnished by a DC) Bundling: Some payers bundle 97012 with CMT in the same region; check payer edits. Manual traction is 97140, not 97012. Oregon scope: In scope as physiotherapy/electrotherapy/hydrotherapy (ORS 684.010; OBCE Electrotherapy and Mechanical Traction policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(d): 97010-97028 are NOT payable unless performed in conjunction with a service that requires constant attendance or the provider's knowledge and skill (e.g., CMT, 97110, 97140). Also counts toward the limit of 3 separate CPT-coded modalities/procedures per provider per day (6)(b); when more are billed the insurer pays the 3 that yield the highest payment. Simultaneous treatments from one machine/table must be billed as one charge (6)(e).
97014CPT	Unattended electrical stimulation (e.g., IFC, TENS-type), one or more areas	1 unit per visit regardless of the number of areas or minutes	$25.44	Supervised modality, per visit not timed; document area, e-stim type/settings, duration and purpose tied to plan goals; Medicare/MA payers require G0283 instead; not with 97032 for the same application Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Supervised modality: no direct one-on-one contact is required after set-up, so units are per visit (not timed). Document the area(s) treated, parameters (e.g., temperature, traction weight/duration, e-stim type/settings), duration, and the therapeutic purpose tied to the treatment plan/goals. Medical necessity requires that the modality be part of a plan with measurable goals; passive modalities alone for prolonged periods are commonly denied as maintenance. Modifiers: GP on payers that require a therapy-discipline modifier on 97xxx codes (many commercial and Medicare Advantage plans); GY on Medicare (non-covered when furnished by a DC) Bundling: Medicare and Medicare Advantage (and some other payers) do not accept 97014; bill G0283 instead. Do not bill 97014 and 97032 for the same application; 97032 requires constant attendance. Oregon scope: In scope as physiotherapy/electrotherapy/hydrotherapy (ORS 684.010; OBCE Electrotherapy and Mechanical Traction policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(d): 97010-97028 are NOT payable unless performed in conjunction with a service that requires constant attendance or the provider's knowledge and skill (e.g., CMT, 97110, 97140). Also counts toward the limit of 3 separate CPT-coded modalities/procedures per provider per day (6)(b); when more are billed the insurer pays the 3 that yield the highest payment. Simultaneous treatments from one machine/table must be billed as one charge (6)(e).
97016CPT	Vasopneumatic compression device, one or more areas	1 unit per visit regardless of the number of areas or minutes	$24.10	Supervised modality, per visit not timed; document area, parameters, duration and purpose tied to plan goals; must be part of a plan with measurable goals; prolonged passive-only care is denied as maintenance Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Supervised modality: no direct one-on-one contact is required after set-up, so units are per visit (not timed). Document the area(s) treated, parameters (e.g., temperature, traction weight/duration, e-stim type/settings), duration, and the therapeutic purpose tied to the treatment plan/goals. Medical necessity requires that the modality be part of a plan with measurable goals; passive modalities alone for prolonged periods are commonly denied as maintenance. Modifiers: GP on payers that require a therapy-discipline modifier on 97xxx codes (many commercial and Medicare Advantage plans); GY on Medicare (non-covered when furnished by a DC) Oregon scope: In scope as physiotherapy/electrotherapy/hydrotherapy (ORS 684.010; OBCE Electrotherapy and Mechanical Traction policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(d): 97010-97028 are NOT payable unless performed in conjunction with a service that requires constant attendance or the provider's knowledge and skill (e.g., CMT, 97110, 97140). Also counts toward the limit of 3 separate CPT-coded modalities/procedures per provider per day (6)(b); when more are billed the insurer pays the 3 that yield the highest payment. Simultaneous treatments from one machine/table must be billed as one charge (6)(e).
97018CPT	Paraffin bath treatment	1 unit per visit regardless of the number of areas or minutes	$12.05	Supervised modality, per visit not timed; document area, parameters, duration and purpose tied to plan goals; must be part of a plan with measurable goals; prolonged passive-only care is denied as maintenance Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Supervised modality: no direct one-on-one contact is required after set-up, so units are per visit (not timed). Document the area(s) treated, parameters (e.g., temperature, traction weight/duration, e-stim type/settings), duration, and the therapeutic purpose tied to the treatment plan/goals. Medical necessity requires that the modality be part of a plan with measurable goals; passive modalities alone for prolonged periods are commonly denied as maintenance. Modifiers: GP on payers that require a therapy-discipline modifier on 97xxx codes (many commercial and Medicare Advantage plans); GY on Medicare (non-covered when furnished by a DC) Oregon scope: In scope as physiotherapy/electrotherapy/hydrotherapy (ORS 684.010; OBCE Electrotherapy and Mechanical Traction policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(d): 97010-97028 are NOT payable unless performed in conjunction with a service that requires constant attendance or the provider's knowledge and skill (e.g., CMT, 97110, 97140). Also counts toward the limit of 3 separate CPT-coded modalities/procedures per provider per day (6)(b); when more are billed the insurer pays the 3 that yield the highest payment. Simultaneous treatments from one machine/table must be billed as one charge (6)(e).
97022CPT	Whirlpool therapy	1 unit per visit regardless of the number of areas or minutes	$31.46	Supervised modality, per visit not timed; document area, parameters, duration and purpose tied to plan goals; must be part of a plan with measurable goals; prolonged passive-only care is denied as maintenance Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Supervised modality: no direct one-on-one contact is required after set-up, so units are per visit (not timed). Document the area(s) treated, parameters (e.g., temperature, traction weight/duration, e-stim type/settings), duration, and the therapeutic purpose tied to the treatment plan/goals. Medical necessity requires that the modality be part of a plan with measurable goals; passive modalities alone for prolonged periods are commonly denied as maintenance. Modifiers: GP on payers that require a therapy-discipline modifier on 97xxx codes (many commercial and Medicare Advantage plans); GY on Medicare (non-covered when furnished by a DC) Oregon scope: In scope as physiotherapy/electrotherapy/hydrotherapy (ORS 684.010; OBCE Electrotherapy and Mechanical Traction policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(d): 97010-97028 are NOT payable unless performed in conjunction with a service that requires constant attendance or the provider's knowledge and skill (e.g., CMT, 97110, 97140). Also counts toward the limit of 3 separate CPT-coded modalities/procedures per provider per day (6)(b); when more are billed the insurer pays the 3 that yield the highest payment. Simultaneous treatments from one machine/table must be billed as one charge (6)(e).
97024CPT	Diathermy (shortwave/microwave heating), one or more areas	1 unit per visit regardless of the number of areas or minutes	$14.73	Supervised modality, per visit not timed; document area, parameters, duration and purpose tied to plan goals; must be part of a plan with measurable goals; prolonged passive-only care is denied as maintenance Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Supervised modality: no direct one-on-one contact is required after set-up, so units are per visit (not timed). Document the area(s) treated, parameters (e.g., temperature, traction weight/duration, e-stim type/settings), duration, and the therapeutic purpose tied to the treatment plan/goals. Medical necessity requires that the modality be part of a plan with measurable goals; passive modalities alone for prolonged periods are commonly denied as maintenance. Modifiers: GP on payers that require a therapy-discipline modifier on 97xxx codes (many commercial and Medicare Advantage plans); GY on Medicare (non-covered when furnished by a DC) Oregon scope: In scope as physiotherapy/electrotherapy/hydrotherapy (ORS 684.010; OBCE Electrotherapy and Mechanical Traction policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(d): 97010-97028 are NOT payable unless performed in conjunction with a service that requires constant attendance or the provider's knowledge and skill (e.g., CMT, 97110, 97140). Also counts toward the limit of 3 separate CPT-coded modalities/procedures per provider per day (6)(b); when more are billed the insurer pays the 3 that yield the highest payment. Simultaneous treatments from one machine/table must be billed as one charge (6)(e).
97026CPT	Infrared light therapy, one or more areas	1 unit per visit regardless of the number of areas or minutes	$13.39	Supervised modality, per visit not timed; document area, parameters, duration and purpose tied to plan goals; must be part of a plan with measurable goals; prolonged passive-only care is denied as maintenance Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Supervised modality: no direct one-on-one contact is required after set-up, so units are per visit (not timed). Document the area(s) treated, parameters (e.g., temperature, traction weight/duration, e-stim type/settings), duration, and the therapeutic purpose tied to the treatment plan/goals. Medical necessity requires that the modality be part of a plan with measurable goals; passive modalities alone for prolonged periods are commonly denied as maintenance. Modifiers: GP on payers that require a therapy-discipline modifier on 97xxx codes (many commercial and Medicare Advantage plans); GY on Medicare (non-covered when furnished by a DC) Oregon scope: In scope as physiotherapy/electrotherapy/hydrotherapy (ORS 684.010; OBCE Electrotherapy and Mechanical Traction policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(d): 97010-97028 are NOT payable unless performed in conjunction with a service that requires constant attendance or the provider's knowledge and skill (e.g., CMT, 97110, 97140). Also counts toward the limit of 3 separate CPT-coded modalities/procedures per provider per day (6)(b); when more are billed the insurer pays the 3 that yield the highest payment. Simultaneous treatments from one machine/table must be billed as one charge (6)(e).
97028CPT	Ultraviolet light therapy, one or more areas	1 unit per visit regardless of the number of areas or minutes	$16.74	Supervised modality, per visit not timed; document area, parameters, duration and purpose tied to plan goals; must be part of a plan with measurable goals; prolonged passive-only care is denied as maintenance Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Supervised modality: no direct one-on-one contact is required after set-up, so units are per visit (not timed). Document the area(s) treated, parameters (e.g., temperature, traction weight/duration, e-stim type/settings), duration, and the therapeutic purpose tied to the treatment plan/goals. Medical necessity requires that the modality be part of a plan with measurable goals; passive modalities alone for prolonged periods are commonly denied as maintenance. Modifiers: GP on payers that require a therapy-discipline modifier on 97xxx codes (many commercial and Medicare Advantage plans); GY on Medicare (non-covered when furnished by a DC) Oregon scope: In scope as physiotherapy/electrotherapy/hydrotherapy (ORS 684.010; OBCE Electrotherapy and Mechanical Traction policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(d): 97010-97028 are NOT payable unless performed in conjunction with a service that requires constant attendance or the provider's knowledge and skill (e.g., CMT, 97110, 97140). Also counts toward the limit of 3 separate CPT-coded modalities/procedures per provider per day (6)(b); when more are billed the insurer pays the 3 that yield the highest payment. Simultaneous treatments from one machine/table must be billed as one charge (6)(e).
97032CPT	Attended electrical stimulation (manual/probe), each 15 min	Per 15 minutes (timed; 8-minute rule)	$29.45	Direct one-on-one contact for all time billed; record start/stop or total minutes, 8-minute rule for units; document area, parameters and how the modality advances plan goals Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Constant-attendance modality: requires direct (one-on-one) contact by the provider or qualified staff for the whole time billed. Timed code: record start/stop times or total minutes for each timed service. Bill by the 8-minute rule (Medicare/most payers: cumulative timed minutes across all timed codes; 1 unit = 8-22 min, 2 = 23-37, 3 = 38-52, 4 = 53-67). Document area treated, parameters, and how the modality advances the plan's goals. Modifiers: GP where a therapy modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS only when a payer edit requires it and the service is distinct in region/time from another service that day Oregon scope: In scope as physiotherapy/electrotherapy. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97033CPT	Iontophoresis: low-voltage current drives topical medication through skin, each 15 min	Per 15 minutes (timed; 8-minute rule)	$38.16	One-on-one contact for all time billed; start/stop or total minutes, 8-minute rule; document area, parameters and goal; document drug, dose and order, bill the drug separately only if payer allows Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Constant-attendance modality: requires direct (one-on-one) contact by the provider or qualified staff for the whole time billed. Timed code: record start/stop times or total minutes for each timed service. Bill by the 8-minute rule (Medicare/most payers: cumulative timed minutes across all timed codes; 1 unit = 8-22 min, 2 = 23-37, 3 = 38-52, 4 = 53-67). Document area treated, parameters, and how the modality advances the plan's goals. Document the medication used, its concentration/dose and the order. Bill the drug separately only if the payer allows a supply code (e.g., J1100 for dexamethasone) — verify; many bundle it. Modifiers: GP where a therapy modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS only when a payer edit requires it and the service is distinct in region/time from another service that day Oregon scope: In scope: OBCE Iontophoresis and Phonophoresis Policy allows OTC lidocaine and salicylates and prepackaged dexamethasone for iontophoresis; chart the drug, dose, and order. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97034CPT	Contrast baths (alternating hot and cold immersion), each 15 min	Per 15 minutes (timed; 8-minute rule)	$28.11	Direct one-on-one contact for all time billed; record start/stop or total minutes, 8-minute rule for units; document area, parameters and how the modality advances plan goals Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Constant-attendance modality: requires direct (one-on-one) contact by the provider or qualified staff for the whole time billed. Timed code: record start/stop times or total minutes for each timed service. Bill by the 8-minute rule (Medicare/most payers: cumulative timed minutes across all timed codes; 1 unit = 8-22 min, 2 = 23-37, 3 = 38-52, 4 = 53-67). Document area treated, parameters, and how the modality advances the plan's goals. Modifiers: GP where a therapy modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS only when a payer edit requires it and the service is distinct in region/time from another service that day Oregon scope: In scope as physiotherapy/electrotherapy. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97035CPT	Therapeutic ultrasound, each 15 min	Per 15 minutes (timed; 8-minute rule)	$28.78	One-on-one contact for all time billed; start/stop or total minutes, 8-minute rule; document area, parameters and goal; phonophoresis is reported as 97035, not with 97010 same area/time under most payers Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Constant-attendance modality: requires direct (one-on-one) contact by the provider or qualified staff for the whole time billed. Timed code: record start/stop times or total minutes for each timed service. Bill by the 8-minute rule (Medicare/most payers: cumulative timed minutes across all timed codes; 1 unit = 8-22 min, 2 = 23-37, 3 = 38-52, 4 = 53-67). Document area treated, parameters, and how the modality advances the plan's goals. Modifiers: GP where a therapy modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS only when a payer edit requires it and the service is distinct in region/time from another service that day Bundling: Phonophoresis is reported as 97035 (no separate drug payment). Not reportable with 97010 for the same area/time under most payer policies. Oregon scope: In scope as physiotherapy/electrotherapy. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97036CPT	Hubbard tank hydrotherapy, each 15 min	Per 15 minutes (timed; 8-minute rule)	$69.62	Direct one-on-one contact for all time billed; record start/stop or total minutes, 8-minute rule for units; document area, parameters and how the modality advances plan goals Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Constant-attendance modality: requires direct (one-on-one) contact by the provider or qualified staff for the whole time billed. Timed code: record start/stop times or total minutes for each timed service. Bill by the 8-minute rule (Medicare/most payers: cumulative timed minutes across all timed codes; 1 unit = 8-22 min, 2 = 23-37, 3 = 38-52, 4 = 53-67). Document area treated, parameters, and how the modality advances the plan's goals. Modifiers: GP where a therapy modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS only when a payer edit requires it and the service is distinct in region/time from another service that day Oregon scope: In scope (hydrotherapy is named in ORS 684.010) but requires a Hubbard tank; almost never applicable to a chiropractic office. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97039CPT	Unlisted modality (e.g., low-level laser, shockwave); specify time if attended	Per 15 minutes (timed; 8-minute rule)	80% of usual feeAppendix B lists no dollar amount; OAR 436-009-0040(1)(a)	One-on-one contact and timed minutes if constant attendance; attach description of modality, device, time and supporting literature; expect manual review and payer pricing; check HCPCS/Category III alternatives Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Constant-attendance modality: requires direct (one-on-one) contact by the provider or qualified staff for the whole time billed. Timed code: record start/stop times or total minutes for each timed service. Bill by the 8-minute rule (Medicare/most payers: cumulative timed minutes across all timed codes; 1 unit = 8-22 min, 2 = 23-37, 3 = 38-52, 4 = 53-67). Document area treated, parameters, and how the modality advances the plan's goals. Unlisted code: attach a description of the modality, the device, the time, and supporting literature; expect manual review and payer-specific pricing. Low-level laser (S8948) and shockwave have HCPCS/Category III alternatives on some payers — check. Modifiers: GP where a therapy modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS only when a payer edit requires it and the service is distinct in region/time from another service that day Oregon scope: In scope for laser (OBCE Laser Therapy Policy: Class I-III and non-surgical Class IV therapeutic laser) and shockwave (OBCE Extracorporeal Shockwave Therapy Policy, trained providers). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
Physical medicine: procedures (14)
97110CPT	Exercise session to restore strength, stamina, motion or flexibility, per 15 min	Per 15 minutes (timed; 8-minute rule)	$58.24	One-on-one, timed minutes with 8-minute rule; document each exercise, sets/reps or resistance, body region and measurable goal; plan of care with functional goals, home program alone is not billable time Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Document each exercise, sets/reps or resistance, the body region, and the measurable goal (e.g., ROM, strength). A written home program alone is not billable time. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97112CPT	Retraining of movement control: balance, coordination, posture, body awareness, per 15 min	Per 15 minutes (timed; 8-minute rule)	$65.60	One-on-one, timed minutes with 8-minute rule; document the specific deficit and re-education activity, distinct from 97110; bundled in a spinal region receiving CMT (59/XS for a separate region) Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Document the specific deficit (balance, proprioception, coordination) and the re-education activity; distinct from plain strengthening (97110). Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Bundling: NCCI (2026 policy manual): not separately reportable when performed in a spinal region receiving CMT; 59/XS for a separate non-contiguous region. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97113CPT	Aquatic therapy with therapeutic exercise in water, each 15 min	Per 15 minutes (timed; 8-minute rule)	$74.30	One-on-one in a pool; timed minutes, 8-minute rule; document exercises, region and goal; document why the water environment is medically necessary Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Requires a pool and one-on-one attendance; document why the water environment is medically necessary (e.g., weight-bearing restriction). Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97116CPT	Gait training including stair climbing, each 15 min	Per 15 minutes (timed; 8-minute rule)	$58.24	One-on-one, timed minutes with 8-minute rule; document gait deficit, training performed, assistive devices and functional goals; plan of care with measurable goals Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Document the gait deficit, the training performed, assistive devices, and functional goals. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97124CPT	Massage using stroking, kneading or percussion techniques, per 15 min	Per 15 minutes (timed; 8-minute rule)	$59.58	One-on-one, timed minutes with 8-minute rule; document area, technique, minutes and purpose; not with 97140 same region/session, bundled into CMT in the manipulated region (59/XS for a distinct region) Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Document area, technique, minutes and purpose. Do not report both 97124 and 97140 for the same region in the same session; use 97140 for myofascial release/mobilization and 97124 for classic massage strokes. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Bundling: NCCI: mutually exclusive with 97140 for the same region/session; bundled into CMT in the manipulated region (59/XS for a distinct region). Some payers exclude massage entirely or require it to be performed by the DC. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97139CPT	Unlisted therapeutic procedure	Per 15 minutes (timed; 8-minute rule)	80% of usual feeAppendix B lists no dollar amount; OAR 436-009-0040(1)(a)	One-on-one timed service with minutes documented; attach description, time and rationale, expect manual pricing; use only when no specific code fits; plan of care with functional goals Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Attach a description, time, and rationale; expect manual pricing. Use only when no specific code fits (e.g., certain instrument-assisted techniques a payer refuses to accept under 97140). Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97140CPT	Hands-on soft-tissue and joint work other than an adjustment, per 15 min	Per 15 minutes (timed; 8-minute rule)	$55.56	One-on-one, timed minutes with 8-minute rule; document technique, region(s), minutes and goals; with same-day CMT must be a different non-contiguous region with 59/XS, named in the note; not with 97124 same region Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Document the technique, the specific body region(s), minutes, and goals. When billed with CMT on the same date it must be performed in a different, non-contiguous region than any region adjusted and be billed with 59/XS; the note must make the separate region explicit. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Bundling: NCCI: bundled into 98940-98943 when performed in a region that was manipulated; payable separately only with 59/XS for a different, non-contiguous region. Not reportable with 97124 for the same region. Manual traction is 97140, not 97012. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97150CPT	Therapeutic procedure(s) delivered to a group of 2 or more patients at once	Per session per patient (untimed)	$36.15	Untimed; constant attendance to the group but not one-on-one; each patient's note documents the activities and their individual plan; cannot bill one-on-one timed codes for the same minutes Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Untimed; constant attendance to the group but not one-on-one. Each patient's note must document the activities and their individual plan. Cannot bill one-on-one timed codes for the same minutes. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97530CPT	Therapeutic activities: dynamic functional tasks to improve function, each 15 min	Per 15 minutes (timed; 8-minute rule)	$70.29	One-on-one, timed minutes with 8-minute rule; document the functional activity, the deficit addressed and progress toward functional goals; distinct from 97110 in the note, separate time blocks from 97140/97110 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Document the functional activity, the functional deficit it addresses, and progress toward measurable functional goals; must be distinct from 97110 exercise in the note. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Bundling: Some payers edit 97530 against 97140/97110 on the same date; separate time blocks and distinct documentation required. Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97535CPT	Self-care/home-management training (ADLs, body mechanics, home program), each 15 min	Per 15 minutes (timed; 8-minute rule)	$64.93	One-on-one, timed minutes with 8-minute rule; document the specific instruction (e.g., lifting mechanics, home exercise with return demonstration) and time; plan of care with functional goals Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Document the specific instruction (e.g., lifting mechanics, ergonomic changes, home exercise instruction with return demonstration) and time; must be one-on-one. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97750CPT	Measured test of physical function with a written report, per 15 min	Per 15 minutes (timed; 8-minute rule)	$67.61	One-on-one timed service with minutes documented; separate written report of results and their use in the plan; not for routine exam-room ROM/strength checks (part of E/M); 95851/95852 bundled into it Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Requires a separate written report of the results and their use in the plan; document time. Not for routine exam-room ROM/strength checks (those are part of the E/M). Used for functional capacity evaluations and device-assisted testing. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Bundling: Bundled with same-day E/M by many payers unless clearly separate; 95851/95852 (ROM) are bundled into 97750. Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97760CPT	Fitting and training with a brace or splint, first visit, per 15 min	Per 15 minutes (timed; 8-minute rule)	$92.38	One-on-one, timed minutes; document assessment of fit/function, training provided and time; not for handing over an off-the-shelf brace, not with 97763 same device; often bundled into the L-code for simple fitting Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Document assessment of fit/function, training provided, and time; typically for custom or complex devices. Do not report for simply handing over an off-the-shelf brace. Do not report with 97763 for the same device. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Bundling: Bundled into the L-code supply by many payers when the fitting is simple; separately reportable only when skilled assessment/training time is documented. Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97761CPT	Prosthetic training, initial encounter, each 15 min	Per 15 minutes (timed; 8-minute rule)	$81.00	One-on-one, timed minutes; requires a prosthesis; document training and time; essentially never applicable to chiropractic practice Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. Requires a prosthesis; document training and time. Essentially never applicable to chiropractic practice. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
97763CPT	Follow-up brace or splint check and training, per 15 min	Per 15 minutes (timed; 8-minute rule)	$100.41	One-on-one, timed minutes; follow-up after the initial 97760/97761 encounter; document time and what was modified; bundled into the L-code by many payers when fitting is simple Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Therapeutic procedure requiring direct one-on-one contact by the provider or qualified staff for the time billed. Timed code: document start/stop times or total minutes for each service, the specific activity/exercise performed, body area, and the functional goal it addresses. Apply the 8-minute rule. Medicare-style payers count cumulative timed minutes across codes; Oregon workers' compensation applies the 8-minute table to each code separately (OAR 436-009-0040(6)(a)). Medical necessity requires a plan of care with measurable, functional goals and periodic re-assessment. For follow-up assessment/adjustment/training after the initial 97760/97761 encounter; document time and what was modified. Modifiers: GP where a therapy-discipline modifier is required; GY on Medicare (non-covered when furnished by a DC); 59/XS when an NCCI/payer edit pairs it with another same-day service and the two are performed in distinct regions or separate time blocks Bundling: Bundled into the L-code supply by many payers when the fitting is simple; separately reportable only when skilled assessment/training time is documented. Oregon scope: In scope as physiotherapy (OBCE Myofascial Therapy and Massage, IASTM, and related policies). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: OAR 436-009-0040(6)(a) time table is applied per code (0-7 min = 0 units, 8-22 = 1, 23-37 = 2, 38-52 = 3, 53-67 = 4, 68-82 = 5); chart notes must show begin/end times or minutes for each constant-attendance service (6)(c); limit of 3 separate CPT-coded modality/procedure codes per provider per day (6)(b).
Radiology (66)
70250CPT	Skull, fewer than 4 views	Per study (1 unit); the code encodes the number of views taken	$81.87PC $19.89 · TC $61.97	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
70260CPT	Skull, complete study, 4 or more views	Per study (1 unit); the code encodes the number of views taken	$100.23PC $29.84 · TC $70.39	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
70328CPT	Temporomandibular joint, open and closed mouth views, one side	Per study (1 unit); the code encodes the number of views taken	$78.04PC $19.89 · TC $58.15	Clinical indication documented before imaging; diagnostic-quality images with a written, signed interpretation report; views billed match views taken; bilateral study is 70330, not 70328 x2 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Bilateral TMJ is 70330, not 70328 x2. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
70330CPT	Temporomandibular joints, open and closed mouth views, both sides	Per study (1 unit); the code encodes the number of views taken	$122.42PC $26.01 · TC $96.40	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
71045CPT	Chest, single view	Per study (1 unit); the code encodes the number of views taken	$58.15PC $19.13 · TC $39.02	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
71046CPT	Chest, 2 views	Per study (1 unit); the code encodes the number of views taken	$75.74PC $22.95 · TC $52.79	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
71100CPT	Ribs, one side, 2 views	Per study (1 unit); the code encodes the number of views taken	$82.63PC $23.72 · TC $58.91	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
71101CPT	Ribs, one side, including a chest view, 3 or more views	Per study (1 unit); the code encodes the number of views taken	$96.40PC $29.07 · TC $67.33	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
71110CPT	Ribs, both sides, 3 views	Per study (1 unit); the code encodes the number of views taken	$98.70PC $30.60 · TC $68.09	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
71111CPT	Ribs, both sides, including a chest view, 4 or more views	Per study (1 unit); the code encodes the number of views taken	$117.83PC $34.43 · TC $83.40	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72020CPT	Single view of the spine, any one region (e.g., lateral cervical follow-up)	Per study (1 unit); the code encodes the number of views taken	$54.32PC $17.60 · TC $36.72	Clinical indication documented before imaging; diagnostic-quality images with a written, signed interpretation report; views billed match views taken; not billable in addition to a regional series that includes the view Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Not billable in addition to a regional series that includes that view. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72040CPT	Cervical spine, 2 or 3 views	Per study (1 unit); the code encodes the number of views taken	$91.05PC $23.72 · TC $67.33	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72050CPT	Cervical spine, 4 or 5 views (e.g., AP, lateral, obliques, open-mouth)	Per study (1 unit); the code encodes the number of views taken	$126.24PC $29.84 · TC $96.40	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72052CPT	Cervical spine, 6 or more views (adds flexion/extension)	Per study (1 unit); the code encodes the number of views taken	$143.84PC $32.90 · TC $110.94	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72070CPT	Thoracic spine, 2 views	Per study (1 unit); the code encodes the number of views taken	$75.74PC $22.19 · TC $53.56	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72072CPT	Thoracic spine, 3 views	Per study (1 unit); the code encodes the number of views taken	$88.75PC $23.72 · TC $65.03	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72074CPT	Thoracic spine, 4 or more views	Per study (1 unit); the code encodes the number of views taken	$100.99PC $26.01 · TC $74.98	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72080CPT	Thoracolumbar junction, 2 views	Per study (1 unit); the code encodes the number of views taken	$80.34PC $22.95 · TC $57.38	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72081CPT	Full-spine (scoliosis) study, 1 view	Per study (1 unit); the code encodes the number of views taken	$101.76PC $29.07 · TC $72.68	Clinical indication and a documented reason (scoliosis/postural survey) before imaging; diagnostic-quality images with a signed interpretation report; routine use often denied; no regional spine codes for included views Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Do not also bill regional spine codes (72040-72110) for views that are part of the full-spine study; full-spine films need a documented reason (scoliosis/postural survey) and are frequently denied for routine use. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72082CPT	Full-spine (scoliosis) study, 2 or 3 views	Per study (1 unit); the code encodes the number of views taken	$164.50PC $34.43 · TC $130.07	Clinical indication and a documented reason (scoliosis/postural survey) before imaging; diagnostic-quality images with a signed interpretation report; routine use often denied; no regional spine codes for included views Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Do not also bill regional spine codes (72040-72110) for views that are part of the full-spine study; full-spine films need a documented reason (scoliosis/postural survey) and are frequently denied for routine use. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72083CPT	Full-spine (scoliosis) study, 4 or 5 views	Per study (1 unit); the code encodes the number of views taken	$182.86PC $39.02 · TC $143.84	Clinical indication and a documented reason (scoliosis/postural survey) before imaging; diagnostic-quality images with a signed interpretation report; routine use often denied; no regional spine codes for included views Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Do not also bill regional spine codes (72040-72110) for views that are part of the full-spine study; full-spine films need a documented reason (scoliosis/postural survey) and are frequently denied for routine use. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72084CPT	Full-spine (scoliosis) study, 6 or more views	Per study (1 unit); the code encodes the number of views taken	$226.47PC $45.14 · TC $181.33	Clinical indication and a documented reason (scoliosis/postural survey) before imaging; diagnostic-quality images with a signed interpretation report; routine use often denied; no regional spine codes for included views Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Do not also bill regional spine codes (72040-72110) for views that are part of the full-spine study; full-spine films need a documented reason (scoliosis/postural survey) and are frequently denied for routine use. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72100CPT	Lumbosacral spine, 2 or 3 views	Per study (1 unit); the code encodes the number of views taken	$91.81PC $23.72 · TC $68.09	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72110CPT	Lumbosacral spine, 4 or more views (adds obliques/spot)	Per study (1 unit); the code encodes the number of views taken	$122.42PC $29.07 · TC $93.34	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72114CPT	Lumbosacral spine complete study with bending views, 6 or more views	Per study (1 unit); the code encodes the number of views taken	$141.54PC $32.90 · TC $108.64	Clinical indication documented before imaging; diagnostic-quality images with a written, signed interpretation report; views billed match views taken; includes the bending views, do not add 72120 or 72110 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Includes the bending views; do not add 72120 or 72110. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72120CPT	Lumbosacral spine bending views only, 2 or 3 views	Per study (1 unit); the code encodes the number of views taken	$96.40PC $24.48 · TC $71.92	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72170CPT	Pelvis, 1 or 2 views	Per study (1 unit); the code encodes the number of views taken	$64.27PC $19.13 · TC $45.14	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72190CPT	Pelvis, 3 or more views	Per study (1 unit); the code encodes the number of views taken	$99.46PC $28.31 · TC $71.15	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72200CPT	Sacroiliac joints, fewer than 3 views	Per study (1 unit); the code encodes the number of views taken	$77.28PC $19.13 · TC $58.15	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72202CPT	Sacroiliac joints, 3 or more views	Per study (1 unit); the code encodes the number of views taken	$88.75PC $23.72 · TC $65.03	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
72220CPT	Sacrum and coccyx, 2 or more views	Per study (1 unit); the code encodes the number of views taken	$73.45PC $19.13 · TC $54.32	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73000CPT	Clavicle, complete study	Per study (1 unit); the code encodes the number of views taken	$76.51PC $18.36 · TC $58.15	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73010CPT	Scapula, complete study	Per study (1 unit); the code encodes the number of views taken	$57.38PC $20.66 · TC $36.72	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73020CPT	Shoulder, 1 view	Per study (1 unit); the code encodes the number of views taken	$49.73PC $16.83 · TC $32.90	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73030CPT	Shoulder, 2 or more views	Per study (1 unit); the code encodes the number of views taken	$81.87PC $20.66 · TC $61.21	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73050CPT	X-ray of both acromioclavicular joints, with or without weights	Per study (1 unit); the code encodes the number of views taken	$69.62PC $21.42 · TC $48.20	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73060CPT	Humerus, 2 or more views	Per study (1 unit); the code encodes the number of views taken	$73.45PC $18.36 · TC $55.09	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73070CPT	Elbow, 2 views	Per study (1 unit); the code encodes the number of views taken	$67.33PC $18.36 · TC $48.97	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73080CPT	Elbow, 3 or more views	Per study (1 unit); the code encodes the number of views taken	$75.74PC $19.13 · TC $56.62	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73090CPT	Forearm, 2 views	Per study (1 unit); the code encodes the number of views taken	$66.56PC $17.60 · TC $48.97	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73100CPT	Wrist, 2 views	Per study (1 unit); the code encodes the number of views taken	$78.81PC $19.13 · TC $59.68	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73110CPT	Wrist, 3 or more views	Per study (1 unit); the code encodes the number of views taken	$97.93PC $19.89 · TC $78.04	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73120CPT	Hand, 2 views	Per study (1 unit); the code encodes the number of views taken	$71.92PC $18.36 · TC $53.56	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73130CPT	Hand, 3 or more views	Per study (1 unit); the code encodes the number of views taken	$87.99PC $19.89 · TC $68.09	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73140CPT	Finger(s), 2 or more views	Per study (1 unit); the code encodes the number of views taken	$90.28PC $15.30 · TC $74.98	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73501CPT	X-ray of one hip, 1 view, pelvis included if taken	Per study (1 unit); the code encodes the number of views taken	$77.28PC $20.66 · TC $56.62	Clinical indication documented before imaging; diagnostic-quality images with a written, signed interpretation report; views billed match views taken; pelvis view included, do not add 72170/72190 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Includes the pelvis view when taken; do not add 72170/72190. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73502CPT	X-ray of one hip, 2 or 3 views, pelvis included if taken	Per study (1 unit); the code encodes the number of views taken	$111.70PC $24.48 · TC $87.22	Clinical indication documented before imaging; diagnostic-quality images with a written, signed interpretation report; views billed match views taken; pelvis view included, do not add 72170/72190 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Includes the pelvis view when taken; do not add 72170/72190. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73503CPT	X-ray of one hip, 4 or more views, pelvis included if taken	Per study (1 unit); the code encodes the number of views taken	$143.84PC $30.60 · TC $113.23	Clinical indication documented before imaging; diagnostic-quality images with a written, signed interpretation report; views billed match views taken; pelvis view included, do not add 72170/72190 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Includes the pelvis view when taken; do not add 72170/72190. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73521CPT	X-ray of both hips, 2 views, pelvis included if taken	Per study (1 unit); the code encodes the number of views taken	$96.40PC $24.48 · TC $71.92	Clinical indication documented before imaging; diagnostic-quality images with a written, signed interpretation report; views billed match views taken; pelvis view included, do not add 72170/72190 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Includes the pelvis view when taken; do not add 72170/72190. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73522CPT	X-ray of both hips, 3 or 4 views, pelvis included if taken	Per study (1 unit); the code encodes the number of views taken	$124.71PC $32.13 · TC $92.58	Clinical indication documented before imaging; diagnostic-quality images with a written, signed interpretation report; views billed match views taken; pelvis view included, do not add 72170/72190 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Includes the pelvis view when taken; do not add 72170/72190. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73523CPT	X-ray of both hips, 5 or more views, pelvis included if taken	Per study (1 unit); the code encodes the number of views taken	$140.78PC $33.66 · TC $107.11	Clinical indication documented before imaging; diagnostic-quality images with a written, signed interpretation report; views billed match views taken; pelvis view included, do not add 72170/72190 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Bundling: Includes the pelvis view when taken; do not add 72170/72190. Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73552CPT	Femur, 2 or more views	Per study (1 unit); the code encodes the number of views taken	$81.87PC $19.89 · TC $61.97	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73560CPT	Knee, 1 or 2 views	Per study (1 unit); the code encodes the number of views taken	$78.81PC $18.36 · TC $60.44	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73562CPT	Knee, 3 views	Per study (1 unit); the code encodes the number of views taken	$97.17PC $21.42 · TC $75.74	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73564CPT	Knee, complete study, 4 or more views	Per study (1 unit); the code encodes the number of views taken	$113.23PC $25.25 · TC $87.99	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73565CPT	Both knees, standing AP view	Per study (1 unit); the code encodes the number of views taken	$96.40PC $19.13 · TC $77.28	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken and documented; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73590CPT	Tibia and fibula, 2 views	Per study (1 unit); the code encodes the number of views taken	$71.92PC $17.60 · TC $54.32	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73600CPT	Ankle, 2 views	Per study (1 unit); the code encodes the number of views taken	$74.21PC $18.36 · TC $55.85	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73610CPT	Ankle, 3 or more views	Per study (1 unit); the code encodes the number of views taken	$84.93PC $19.13 · TC $65.80	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73620CPT	Foot, 2 views	Per study (1 unit); the code encodes the number of views taken	$65.80PC $17.60 · TC $48.20	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73630CPT	Foot, complete study, 3 or more views	Per study (1 unit); the code encodes the number of views taken	$78.04PC $18.36 · TC $59.68	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73650CPT	Heel bone (calcaneus), 2 or more views	Per study (1 unit); the code encodes the number of views taken	$65.03PC $17.60 · TC $47.44	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
73660CPT	Toe(s), 2 or more views	Per study (1 unit); the code encodes the number of views taken	$65.80PC $14.54 · TC $51.26	Clinical indication documented before imaging; diagnostic-quality images retained with a written, signed interpretation report; views billed match views taken; RT/LT for side-specific studies, TC/26 if split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Modifiers: TC / 26 when only the technical or professional component is billed; GY on Medicare (x-rays performed or ordered by a DC are non-covered); RT/LT for paired extremity studies; 50 for bilateral procedures where the code is unilateral (payer-dependent) Oregon scope: In scope: an Oregon DC may perform, order and interpret any diagnostic imaging modality for which they are trained (OBCE Diagnostic Imaging Policy, ratified 10/22/2025). X-ray equipment/operators must meet Oregon Health Authority Radiation Protection Services requirements. Workers' comp: Oregon WC: OAR 436-009-0040(4)(a): insurers pay only for x-ray films of diagnostic quality that include a report of findings; 14x36-inch lateral views are not paid. Plain films need no pre-authorization. For MRI, CT and other advanced imaging, pre-authorization is optional unless an MCO requires it; if the provider asks the insurer in writing, the insurer must answer within 14 days, and approval is not a guarantee of payment (OAR 436-010-0230(12)).
76881CPT	Complete diagnostic ultrasound of a joint, real-time with image documentation	Per joint/study	$123.18PC $97.93 · TC $25.25	Clinical indication documented; diagnostic study with permanently recorded images; written report covering all required joint structures; not for ultrasound used only to guide treatment (76882 is the limited study) Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Must be a diagnostic study with permanently recorded images and a written report covering all required joint structures; 76882 is the limited study. Not for ultrasound used only to guide a treatment. Modifiers: 26 / TC if split; RT/LT; GY on Medicare Bundling: Not billable with 97035 therapeutic ultrasound as a diagnostic study. Oregon scope: In scope under the OBCE Diagnostic Imaging Policy for trained DCs; many payers require credentialing (e.g., RMSK) — verify. Included as an optional add; not on the original list. Workers' comp: Oregon WC: imaging other than plain films requires a written preauthorization request.
76882CPT	Limited diagnostic ultrasound of a joint or extremity structure (e.g., single tendon)	Per study	$146.90PC $73.45 · TC $73.45	Clinical indication documented; recorded images retained; written report of the specific structure examined; TC/26 if components split Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Recorded images and a written report of the specific structure examined are required. Modifiers: 26 / TC if split; RT/LT; GY on Medicare Oregon scope: In scope for trained DCs (OBCE Diagnostic Imaging Policy); payer credentialing often required — verify. Workers' comp: Oregon WC: written preauthorization request required for non-plain-film imaging.
77080CPT	DXA bone density scan of the axial skeleton (hip, pelvis, spine)	Per study	$90.28PC $21.42 · TC $68.86	Clinical indication documented; DXA equipment and training; written interpretation with T-/Z-scores; payer frequency limits (typically every 2 years) and osteoporosis-risk diagnosis requirements Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Clinical indication (history/exam findings) documented before imaging; images must be of diagnostic quality and retained; a written, signed interpretation report is required for every study (OBCE Diagnostic Imaging Policy: 'every diagnostic imaging procedure must be accompanied by a formal interpretation report'). Bill the global code when you own the equipment and read the film; use TC (technical only) or 26 (professional only) if the components are split. Views billed must match views taken and documented. Repeat imaging needs its own documented rationale. Requires DXA equipment and training; a written interpretation with T-/Z-scores is required. Payers apply frequency limits (typically every 2 years) and diagnosis requirements (osteoporosis risk). Modifiers: TC / 26 if split; GY on Medicare Oregon scope: In scope under the OBCE Diagnostic Imaging Policy (any modality for which the DC is trained), but few chiropractic offices own DXA; ordering it from an imaging center is the usual path. Verify payer credentialing. Workers' comp: Oregon WC: rarely related to a compensable injury; pre-authorization is optional but advisable for non-plain-film imaging (OAR 436-010-0230(12)).
Minor procedures (11)
10060CPT	Incision and drainage of a simple abscess (boil, cyst, paronychia)	Per lesion/procedure (10061 is complicated/multiple)	$348.54	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: The Board does not publish a list of approved minor surgery procedures; confirm scope, certification (OAR 811-015-0030) and payer policy before billing any minor surgery code.
10120CPT	Removal of a subcutaneous foreign body through a simple incision	Per procedure	$426.40	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
11055CPT	Paring or cutting of a single corn or callus	Per session (1 lesion)	$190.11	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Routine foot care codes; payers (including Medicare, where a DC is excluded anyway) usually cover them only with a systemic condition and class findings, and many treat nail trimming as non-covered routine care. Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
11056CPT	Paring or cutting of 2 to 4 corns or calluses	Per session	$219.99	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Routine foot care codes; payers (including Medicare, where a DC is excluded anyway) usually cover them only with a systemic condition and class findings, and many treat nail trimming as non-covered routine care. Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
11057CPT	Paring or cutting of more than 4 corns or calluses	Per session	$240.81	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Routine foot care codes; payers (including Medicare, where a DC is excluded anyway) usually cover them only with a systemic condition and class findings, and many treat nail trimming as non-covered routine care. Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
11719CPT	Trimming of non-dystrophic nails, any number	Per session	$38.93	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Routine foot care codes; payers (including Medicare, where a DC is excluded anyway) usually cover them only with a systemic condition and class findings, and many treat nail trimming as non-covered routine care. Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
11720CPT	Debridement of 1 to 5 thickened/dystrophic nails	Per session	$88.72	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Routine foot care codes; payers (including Medicare, where a DC is excluded anyway) usually cover them only with a systemic condition and class findings, and many treat nail trimming as non-covered routine care. Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
11721CPT	Debridement of 6 or more nails	Per session	$122.22	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Routine foot care codes; payers (including Medicare, where a DC is excluded anyway) usually cover them only with a systemic condition and class findings, and many treat nail trimming as non-covered routine care. Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
11730CPT	Simple removal (avulsion) of a nail plate, partial or complete, one nail	Per nail (11732 each additional)	$302.37	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
12001CPT	Simple repair of superficial wounds (scalp, neck, trunk, limbs), 2.5 cm or less	Per repair (sum lengths of same-classification wounds)	$309.61	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
17110CPT	Destruction of benign skin lesions such as warts (not skin tags), up to 14	Per session (up to 14 lesions; 17111 for 15+)	$300.56	OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia (lidocaine only), technique, wound care and follow-up; 0-/10-day global period, same-problem E/M usually bundled Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: OBCE minor-surgery certification on file; informed consent; procedure note with indication, anesthesia used (lidocaine only), technique, specimens/wound care, and follow-up. Surgical codes carry a 0- or 10-day global period: routine follow-up is included (report 99024 for tracking). Supplies are usually included; some payers allow 99070/A4550 for surgical trays. Modifiers: GY on Medicare; RT/LT, FA-F9/TA-T9 finger/toe modifiers where the code is digit-specific; 25 on a same-day E/M only if the E/M is significant and separate from the decision to perform a minor procedure Bundling: Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled. Oregon scope: Minor surgery is named in ORS 684.010(2), but an Oregon DC may practice it only after obtaining the OBCE certification of special competency in minor surgery (OAR 811-015-0030: 36 hours of coursework plus a supervised 25-case rotation). Anesthesia is limited to topical lidocaine and injectable lidocaine 1%-2% (with or without 1:100,000 epinephrine) used in connection with minor surgery (OBCE Local Anesthetics Policy); injections of antibiotics, steroids or Botox are not allowed (OBCE Minor Surgery Procedures and Devices Policy). RARE in practice: confirm certification, malpractice coverage, and that the payer credentials DCs for the code. Medicare will not pay a DC for any surgical service (GY). Workers' comp: Oregon WC: paid per Appendix B surgical rules (OAR 436-009-0040(3)); elective procedures require 7 days' notice to the insurer. Extremely uncommon for a DC in the WC system. Verify: See 10060.
Tests & measurements (5)
36415CPT	Routine venipuncture to collect a blood specimen	1 per encounter	80% of usual feeAppendix B lists no dollar amount; OAR 436-009-0040(1)(a)	Lab order and clinical indication in the chart; specimen to a CLIA-certified lab or run in-office under a CLIA certificate/waiver; once per encounter regardless of tubes; not with 36416 same draw Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Order and clinical indication for the lab test in the chart; specimen sent to a CLIA-certified lab (or run in-office under a CLIA certificate/waiver). Bill once per encounter regardless of tubes. Modifiers: GY on Medicare Bundling: Not billable with 36416 (capillary) for the same draw. Oregon scope: In scope: OBCE Laboratory Studies and Allergy Testing policies confirm venipuncture and ordering/interpreting any lab test are within scope; in-office testing needs a CLIA certificate or waiver. Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: lab fees follow ORS 676.310 — if an outside lab performs the test, the bill must show the lab's charge and any separate service fee (OAR 436-009-0040(5)).
95851CPT	Range-of-motion measurement with written report, per extremity or trunk section	Per extremity or per trunk section measured	$43.45	Goniometric/inclinometric or device measurement in a separate written report (values, side comparison, interpretation), not routine exam ROM; for baseline, progress or impairment rating; bundled into E/M and 97750 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Requires device-assisted or formal goniometric/inclinometric measurement recorded in a separate report (numbers, side-to-side comparison, interpretation), not the routine ROM observed during an exam. Medical necessity: baseline or progress measurement used for the treatment plan or an impairment rating. Modifiers: 59/XS when a payer edit pairs it with same-day E/M and the measurement is a separate service; GY on Medicare Bundling: NCCI bundles 95851/95852 into E/M services and into 97750; most payers consider ROM part of the exam. Commonly denied unless clearly separate. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: In scope: OBCE Device-Assisted Range of Motion Measurement and Muscle Testing Policy (DCs may perform; CAs may measure but not interpret). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: appropriate for impairment findings at claim closure (a DC attending physician at closure may make impairment findings; see closing exam OSC CE001/CR001); paid per Appendix B.
95852CPT	Range-of-motion measurement of the hand with written report	Per hand study	$35.65	Separate written report with measurements as for 95851; bundled into E/M and 97750 by NCCI Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Same documentation as 95851 — separate written report with measurements. Modifiers: GY on Medicare Bundling: Bundled into E/M and 97750 by NCCI. (NCCI edits bind Medicare and payers that adopt them; Oregon workers' compensation does not adopt NCCI, OAR 436-009-0004(5)(a), though insurers may still return or down-code a bill.) Oregon scope: In scope (OBCE Device-Assisted ROM policy). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: paid per Appendix B when separately documented.
96160CPT	Patient-completed health risk questionnaire, scored and documented	Per standardized instrument	$5.01	Standardized scored instrument (e.g., Oswestry, NDI, while PHQ-type screens are 96127); record instrument, score and how it changed management; per instrument, frequency limits common; not with 96161/96127 same date Oregon scope noteWorkers' comp noteBundlingVerify before use Full notes, modifiers and bundling Full notes: Use a standardized, scored instrument (e.g., Oswestry, NDI, PHQ-type screens are 96127 not 96160); record the instrument, score, and how it changed management. Report per instrument; many payers limit frequency and bundle it into E/M. Cannot be reported with 96161 or 96127 on the same date. Modifiers: 25 on the E/M when billed together (payer-dependent); GY on Medicare Bundling: Bundled with E/M by many payers; not with 96127/96161 same day. Oregon scope: In scope as part of evaluation, but payer acceptance from a DC is inconsistent — verify; many chiropractic payer policies treat outcome questionnaires as part of the E/M. Workers' comp: Oregon WC: no specific rule; outcome measures are expected within chart notes and are not usually paid separately. Verify: Payer acceptance of health risk assessment codes from a chiropractic physician varies; confirm with the payer.
96161CPT	Caregiver-completed risk questionnaire about the patient, scored and documented	Per standardized instrument	$5.57	Caregiver completes the instrument (e.g., parent for a pediatric patient); document instrument, score and use; not with 96160/96127 same date; often bundled with E/M Oregon scope noteBundlingVerify before use Full notes, modifiers and bundling Full notes: Caregiver completes the instrument (e.g., a parent for a pediatric patient); document instrument, score, and use. Not with 96160 on the same date. Modifiers: GY on Medicare Bundling: Not with 96160/96127 same day; often bundled with E/M. Oregon scope: In scope in principle; rarely applicable to chiropractic care and rarely paid to a DC — verify. Verify: See 96160.
Supplies, DME & orthotics (56)
99070CPT	Supplies used during a visit beyond what the visit normally includes	Per item (list quantity and description)	80% of usual feeAppendix B lists no dollar amount; OAR 436-009-0040(1)(a)	List each item and cost, invoice on request; document the medical reason; use a specific HCPCS code (A/E/L) whenever one exists; ordinary in-office supplies used during a procedure are not separately billable Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: List each item and its cost; attach an invoice on request. Use a specific HCPCS code instead whenever one exists (A/E/L codes) because many payers deny 99070 as unspecified. Document the medical reason for the item. Modifiers: GY on Medicare Bundling: Ordinary in-office supplies (electrodes used during 97014, lotion for massage) are included in the procedure and not separately billable. Oregon scope: In scope (OBCE DME Policy). Medicare: statutorily excluded when performed or ordered by a DC (only 98940-98942 for spinal subluxation are covered). Append GY if a denial is needed for secondary insurance; the patient is financially responsible. Workers' comp: Oregon WC: supplies not in Appendix E are paid at 80% of usual fee (OAR 436-009-0080); use a HCPCS code where one exists.
A4556HCPCS	Electrodes, per pair (e.g., for a home TENS unit)	Per item (each); rentals per month with RR	$20.05Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
A4557HCPCS	Lead wires, per pair (TENS/NMES units)	Per item (each); rentals per month with RR	$26.19Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
A4570HCPCS	Splint (non-specific supply code)	Per item (each); rentals per month with RR	80% of usual feeNot in Appendix E; OAR 436-009-0080(6)	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
A4595HCPCS	Monthly supplies for a 2-lead TENS/NMES unit (electrodes, gel, tape, batteries)	Per item (each); rentals per month with RR	$32.31Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; signed proof of delivery and supplier invoice; NU/UE/RR modifier; includes A4556/A4557, do not bill those separately in the same month Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Do not bill A4556/A4557 separately in a month billed with A4595 (A4595 includes them). Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
E0190HCPCS	Positioning cushion, pillow or wedge (e.g., cervical pillow, lumbar roll)	Per item (each); rentals per month with RR	80% of usual feeNot in Appendix E; OAR 436-009-0080(6)	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Pillows/cushions are often excluded as comfort/convenience items; get a signed waiver or bill as patient-pay. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
E0191HCPCS	Heel or elbow protector, each	Per item (each); rentals per month with RR	$14.42Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
E0199HCPCS	Dry pressure pad for a mattress, standard size	Per item	$46.30Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Order and necessity documented; HCPCS with NU Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $46.30 new.
E0210HCPCS	Electric heating pad, standard	Per item	$52.01Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Order and necessity documented; HCPCS with NU; heating pads are DME under OAR 436-009-0080(1) Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $52.01 new.
E0215HCPCS	Electric heating pad, moist	Per item	$102.30Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	As E0210 Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $102.30 new.
E0217HCPCS	Water-circulating heat pad with pump	Per item	$843.38Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	As E0210 Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $843.38 new.
E0720HCPCS	TENS unit, 2 leads, localized stimulation (home use)	Per item (each); rentals per month with RR	$319.85Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis; document trial/response, ability to use it, and purchase vs rental (NU/RR); proof of delivery and invoice; many payers require a 30-60 day rental trial, exclude chronic low back pain Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. TENS: document the diagnosis, a trial period/response, the patient's ability to use the unit, and whether purchased or rented; many payers require a 30-60 day rental trial before purchase and exclude TENS for chronic low back pain. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: In-office e-stim (97014/G0283/97032) is a separate service; the home unit is the DME item. A4595 is not billable in the same month the unit's initial supplies were included. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
E0730HCPCS	TENS unit, 4 or more leads, multiple nerve areas (home use)	Per item (each); rentals per month with RR	$344.94Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis; document trial/response, ability to use it, and purchase vs rental (NU/RR); proof of delivery and invoice; many payers require a 30-60 day rental trial, exclude chronic low back pain Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. TENS: document the diagnosis, a trial period/response, the patient's ability to use the unit, and whether purchased or rented; many payers require a 30-60 day rental trial before purchase and exclude TENS for chronic low back pain. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: In-office e-stim (97014/G0283/97032) is a separate service; the home unit is the DME item. A4595 is not billable in the same month the unit's initial supplies were included. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
E0731HCPCS	Form-fitting conductive garment for TENS or NMES delivery	Per item (each); rentals per month with RR	$371.19Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
E0849HCPCS	Home cervical traction unit with a pneumatic or hydraulic force system	Per item or per month	$875.52Appendix E (DMEPOS), new purchase; used 75%; rental fixed at $98.40 per month (OAR 436-009-0080(7))	Report by the attending physician justifying the need for home traction (OAR 436-010-0230(13)); instructions given; HCPCS with NU or RR Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Modifiers: NU (new); RR (rental) Oregon scope: Home traction is DME under OAR 436-009-0080(1). Workers' comp: Appendix E purchase maximum $875.52. Rental is fixed at $98.40 a month by OAR 436-009-0080(7), not 10%; after 13 months the insurer may treat it as purchased.
E0855HCPCS	Cervical traction device with a stand or frame	Per item	$839.64Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	As E0849 Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $839.64 new; rental 10% per month.
E1399HCPCS	Miscellaneous DME not otherwise classified (e.g., home traction, foam roller)	Per item (each); rentals per month with RR	80% of usual feeNot in Appendix E; OAR 436-009-0080(6)	Written order tied to diagnosis and functional need; proof of delivery and supplier invoice; narrative description with manufacturer/model, NU/UE/RR modifier; expect manual pricing or denial Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Unlisted DME: include a narrative description, manufacturer/model, and invoice; expect manual pricing or denial. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Oregon WC explicitly names E1399 as the HCPCS unlisted code to use when no specific code exists (OAR 436-009-0010). Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L0120HCPCS	Soft foam cervical collar, prefabricated	Per item	$46.52Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Order and medical necessity in the note; item dispensed and fitted; HCPCS with NU modifier; usual fee billed Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Oregon scope: Within scope under the Board's DME policy. Workers' comp: Appendix E maximum $46.52 new; used 75%; rental 10% per month.
L0140HCPCS	Semi-rigid cervical collar (Philadelphia type), prefabricated	Per item	$112.20Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	As L0120 Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $112.20 new.
L0172HCPCS	Cervical collar with a moulded rigid thermoplastic frame, prefabricated	Per item	$180.25Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	As L0120 Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $180.25 new.
L0174HCPCS	Cervical collar with thoracic extension, semi-rigid, prefabricated	Per item	$379.50Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	As L0120 Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $379.50 new.
L0450HCPCS	Flexible TLSO, upper thoracic trunk support, prefabricated off-the-shelf	Per item (each); bilateral foot inserts = 2 units or RT/LT	$233.87Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to a diagnosis supporting mobility restriction, muscle support or post-injury stabilization; fitting and signed proof of delivery documented; PDAC-verified product for the L-code; NU/UE/RR modifier Oregon scope noteWorkers' comp noteVerify before use Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month. Verify: Descriptor paraphrased from partial sources; confirm against the 2026 HCPCS file.
L0454HCPCS	Flexible TLSO from sacrococcygeal junction to above T-9, prefabricated off-the-shelf	Per item (each); bilateral foot inserts = 2 units or RT/LT	$475.92Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to a diagnosis supporting mobility restriction, muscle support or post-injury stabilization; fitting and signed proof of delivery documented; PDAC-verified product for the L-code; NU/UE/RR modifier Oregon scope noteWorkers' comp noteVerify before use Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month. Verify: Descriptor paraphrased from partial sources; confirm against the 2026 HCPCS file.
L0456HCPCS	Flexible TLSO with rigid posterior panel, prefabricated off-the-shelf	Per item (each); bilateral foot inserts = 2 units or RT/LT	$1,364.78Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to a diagnosis supporting mobility restriction, muscle support or post-injury stabilization; fitting and signed proof of delivery documented; PDAC-verified product for the L-code; NU/UE/RR modifier Oregon scope noteWorkers' comp noteVerify before use Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month. Verify: Descriptor paraphrased from partial sources; confirm against the 2026 HCPCS file.
L0625HCPCS	Flexible lumbar orthosis (soft binder type), L-1 to below L-5, prefabricated OTS	Per item (each); bilateral foot inserts = 2 units or RT/LT	$62.27Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to a diagnosis supporting mobility restriction, muscle support or post-injury stabilization; fitting and signed proof of delivery documented; PDAC-verified product for the L-code; NU/UE/RR modifier Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L0626HCPCS	Lumbar orthosis, rigid posterior panel(s), sagittal control, custom-fitted	Per item (each); bilateral foot inserts = 2 units or RT/LT	$106.94Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order with a diagnosis needing mobility restriction, muscle support or stabilization; note that a trained person trimmed/molded/modified the item (else bill OTS code); proof of delivery, PDAC product, NU/UE/RR Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Spinal orthoses: most payers require a diagnosis supporting the need to reduce pain by restricting mobility, support weak spinal muscles, or stabilize after injury, and PDAC verification of the specific product for the L-code. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Only one spinal orthosis per episode is typical; a flexible binder (L0625) is not billable in addition to a rigid-panel orthosis for the same region. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L0627HCPCS	Lumbar orthosis, rigid anterior and posterior panels, sagittal control, custom-fitted	Per item (each); bilateral foot inserts = 2 units or RT/LT	$564.08Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order with a diagnosis needing mobility restriction, muscle support or stabilization; note that a trained person trimmed/molded/modified the item (else bill OTS code); proof of delivery, PDAC product, NU/UE/RR Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Spinal orthoses: most payers require a diagnosis supporting the need to reduce pain by restricting mobility, support weak spinal muscles, or stabilize after injury, and PDAC verification of the specific product for the L-code. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Only one spinal orthosis per episode is typical; a flexible binder (L0625) is not billable in addition to a rigid-panel orthosis for the same region. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L0631HCPCS	LSO, rigid anterior and posterior panels, sagittal control, custom-fitted	Per item (each); bilateral foot inserts = 2 units or RT/LT	$1,408.70Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order with a diagnosis needing mobility restriction, muscle support or stabilization; note that a trained person trimmed/molded/modified the item (else bill OTS code); proof of delivery, PDAC product, NU/UE/RR Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Spinal orthoses: most payers require a diagnosis supporting the need to reduce pain by restricting mobility, support weak spinal muscles, or stabilize after injury, and PDAC verification of the specific product for the L-code. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Only one spinal orthosis per episode is typical; a flexible binder (L0625) is not billable in addition to a rigid-panel orthosis for the same region. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L0637HCPCS	LSO, rigid front/back and lateral panels, sagittal-coronal control, custom-fitted	Per item (each); bilateral foot inserts = 2 units or RT/LT	$1,542.34Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order with a diagnosis needing mobility restriction, muscle support or stabilization; note that a trained person trimmed/molded/modified the item (else bill OTS code); proof of delivery, PDAC product, NU/UE/RR Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Spinal orthoses: most payers require a diagnosis supporting the need to reduce pain by restricting mobility, support weak spinal muscles, or stabilize after injury, and PDAC verification of the specific product for the L-code. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Only one spinal orthosis per episode is typical; a flexible binder (L0625) is not billable in addition to a rigid-panel orthosis for the same region. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L0642HCPCS	Lumbar orthosis, rigid anterior and posterior panels, prefabricated OTS (OTS of L0627)	Per item (each); bilateral foot inserts = 2 units or RT/LT	$464.70Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to a diagnosis supporting mobility restriction, muscle support or post-injury stabilization; fitting and signed proof of delivery documented; PDAC-verified product for the L-code; NU/UE/RR modifier Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Spinal orthoses: most payers require a diagnosis supporting the need to reduce pain by restricting mobility, support weak spinal muscles, or stabilize after injury, and PDAC verification of the specific product for the L-code. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Only one spinal orthosis per episode is typical; a flexible binder (L0625) is not billable in addition to a rigid-panel orthosis for the same region. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L0648HCPCS	LSO, rigid anterior and posterior panels, prefabricated OTS (OTS of L0631)	Per item (each); bilateral foot inserts = 2 units or RT/LT	$1,160.51Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to a diagnosis supporting mobility restriction, muscle support or post-injury stabilization; fitting and signed proof of delivery documented; PDAC-verified product for the L-code; NU/UE/RR modifier Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Spinal orthoses: most payers require a diagnosis supporting the need to reduce pain by restricting mobility, support weak spinal muscles, or stabilize after injury, and PDAC verification of the specific product for the L-code. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Only one spinal orthosis per episode is typical; a flexible binder (L0625) is not billable in addition to a rigid-panel orthosis for the same region. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L0650HCPCS	LSO, rigid front/back and lateral panels, prefabricated OTS (OTS of L0637)	Per item (each); bilateral foot inserts = 2 units or RT/LT	$1,298.97Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to a diagnosis supporting mobility restriction, muscle support or post-injury stabilization; fitting and signed proof of delivery documented; PDAC-verified product for the L-code; NU/UE/RR modifier Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Spinal orthoses: most payers require a diagnosis supporting the need to reduce pain by restricting mobility, support weak spinal muscles, or stabilize after injury, and PDAC verification of the specific product for the L-code. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Only one spinal orthosis per episode is typical; a flexible binder (L0625) is not billable in addition to a rigid-panel orthosis for the same region. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L1832HCPCS	Knee brace with adjustable hinges and rigid support, prefabricated, custom-fitted	Per item	$799.23Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Order and necessity documented; fitting and adjustment by the office recorded; HCPCS with NU Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $799.23 new.
L1833HCPCS	Knee brace with adjustable hinges and rigid support, prefabricated, off the shelf	Per item	$717.83Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	As L1832 without custom fitting Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $717.83 new.
L1851HCPCS	Single-upright knee brace with adjustable hinges and condylar pads, off the shelf	Per item	$1,035.64Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	As L1833 Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $1,035.64 new.
L1902HCPCS	Ankle-foot orthosis, ankle gauntlet (lace-up/strap support), prefabricated OTS	Per item (each); bilateral foot inserts = 2 units or RT/LT	$128.68Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L1906HCPCS	Ankle-foot orthosis, multi-ligament ankle support (stirrup), prefabricated OTS	Per item (each); bilateral foot inserts = 2 units or RT/LT	$158.10Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L1932HCPCS	AFO with rigid anterior tibial shell, carbon fiber, prefabricated, fitted/adjusted	Per item (each); bilateral foot inserts = 2 units or RT/LT	$1,224.53Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; note that a trained person trimmed/molded/modified the item for this patient (else bill the OTS code); signed proof of delivery and invoice; NU/UE/RR, RT/LT Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Carbon AFO for foot drop; requires orthotic expertise — rarely dispensed by a DC. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L3000HCPCS	Custom foot insert molded to patient model, UCB/Berkeley shell type, each	Per item (each); bilateral foot inserts = 2 units or RT/LT	$431.06Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order with diagnosis and biomechanical exam; document casting/scanning method; bill per foot (2 units or RT/LT), casting and fitting included; many plans exclude or limit foot orthotics Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom foot orthotics: document the casting/scanning method, biomechanical exam, and diagnosis; bill per foot (2 units or RT/LT lines). Many plans exclude foot orthotics or limit them to diabetic/specific diagnoses; prefabricated inserts are L3040-series or non-covered. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Casting is included; do not bill 29799 or 97760 for the cast/scan. Dispensing/fitting time is included. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L3010HCPCS	Custom foot insert molded to patient model with longitudinal arch support, each	Per item (each); bilateral foot inserts = 2 units or RT/LT	$239.14Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order with diagnosis and biomechanical exam; document casting/scanning method; bill per foot (2 units or RT/LT), casting and fitting included; many plans exclude or limit foot orthotics Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom foot orthotics: document the casting/scanning method, biomechanical exam, and diagnosis; bill per foot (2 units or RT/LT lines). Many plans exclude foot orthotics or limit them to diabetic/specific diagnoses; prefabricated inserts are L3040-series or non-covered. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Casting is included; do not bill 29799 or 97760 for the cast/scan. Dispensing/fitting time is included. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L3020HCPCS	Custom foot insert molded to patient model, longitudinal and metatarsal support, each	Per item (each); bilateral foot inserts = 2 units or RT/LT	$272.24Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order with diagnosis and biomechanical exam; document casting/scanning method; bill per foot (2 units or RT/LT), casting and fitting included; many plans exclude or limit foot orthotics Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom foot orthotics: document the casting/scanning method, biomechanical exam, and diagnosis; bill per foot (2 units or RT/LT lines). Many plans exclude foot orthotics or limit them to diabetic/specific diagnoses; prefabricated inserts are L3040-series or non-covered. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Casting is included; do not bill 29799 or 97760 for the cast/scan. Dispensing/fitting time is included. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L3030HCPCS	Foot insert formed directly to the patient's foot, each	Per item (each); bilateral foot inserts = 2 units or RT/LT	$104.73Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order with diagnosis and biomechanical exam; document casting/scanning method; bill per foot (2 units or RT/LT), casting and fitting included; many plans exclude or limit foot orthotics Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom foot orthotics: document the casting/scanning method, biomechanical exam, and diagnosis; bill per foot (2 units or RT/LT lines). Many plans exclude foot orthotics or limit them to diabetic/specific diagnoses; prefabricated inserts are L3040-series or non-covered. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Bundling: Casting is included; do not bill 29799 or 97760 for the cast/scan. Dispensing/fitting time is included. Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L3660HCPCS	Shoulder orthosis, figure-of-eight clavicle strap, canvas/webbing, prefabricated OTS	Per item (each); bilateral foot inserts = 2 units or RT/LT	$132.21Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L3670HCPCS	Shoulder orthosis, acromioclavicular support, canvas/webbing, prefabricated OTS	Per item (each); bilateral foot inserts = 2 units or RT/LT	$151.21Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L3807HCPCS	Wrist-hand-finger splint without joints, prefabricated, custom-fitted	Per item	$312.28Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Order and necessity documented; fitting recorded; HCPCS with NU Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $312.28 new.
L3809HCPCS	Wrist-hand-finger splint without joints, prefabricated, off the shelf	Per item	$312.28Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	As L3807 without custom fitting Workers' comp note Full notes, modifiers and bundling Modifiers: NU (new) Workers' comp: Appendix E maximum $312.28 new.
L3908HCPCS	Wrist-hand orthosis, wrist extension cock-up splint, non-molded, prefabricated OTS	Per item (each); bilateral foot inserts = 2 units or RT/LT	$102.75Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L3914HCPCS	Wrist-hand orthosis, cock-up type, prefabricated custom-fitted (verify descriptor)	Per item (each); bilateral foot inserts = 2 units or RT/LT	80% of usual feeNot in Appendix E; OAR 436-009-0080(6)	Written order tied to diagnosis and functional need; note that a trained person trimmed/molded/modified the item for this patient (else bill the OTS code); signed proof of delivery and invoice; NU/UE/RR, RT/LT Oregon scope noteWorkers' comp noteVerify before use Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month. Verify: The HCPCS descriptor for this code has been revised and sources disagree on the current wording; check the 2026 HCPCS file.
L3923HCPCS	Hand-finger orthosis without joints, prefabricated, custom-fitted	Per item (each); bilateral foot inserts = 2 units or RT/LT	$122.99Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; note that a trained person trimmed/molded/modified the item for this patient (else bill the OTS code); signed proof of delivery and invoice; NU/UE/RR, RT/LT Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L3960HCPCS	Shoulder-elbow-wrist-hand abduction ('airplane') orthosis, prefabricated, fitted	Per item (each); bilateral foot inserts = 2 units or RT/LT	$1,063.06Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; note that a trained person trimmed/molded/modified the item for this patient (else bill the OTS code); signed proof of delivery and invoice; NU/UE/RR, RT/LT Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Post-surgical/positioning device; rarely dispensed by a DC — verify. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L4360HCPCS	Pneumatic/vacuum walking boot, prefabricated, custom-fitted	Per item (each); bilateral foot inserts = 2 units or RT/LT	$485.33Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; note that a trained person trimmed/molded/modified the item for this patient (else bill the OTS code); signed proof of delivery and invoice; NU/UE/RR, RT/LT Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L4361HCPCS	Pneumatic/vacuum walking boot, prefabricated off-the-shelf	Per item (each); bilateral foot inserts = 2 units or RT/LT	$485.33Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L4386HCPCS	Non-pneumatic walking boot, prefabricated, custom-fitted	Per item (each); bilateral foot inserts = 2 units or RT/LT	$217.54Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; note that a trained person trimmed/molded/modified the item for this patient (else bill the OTS code); signed proof of delivery and invoice; NU/UE/RR, RT/LT Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Custom-fitted codes require documentation that a trained individual actually trimmed, bent, molded or otherwise modified the item for this patient; if it was simply sized and handed over, bill the off-the-shelf counterpart. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
L4387HCPCS	Non-pneumatic walking boot, prefabricated off-the-shelf	Per item (each); bilateral foot inserts = 2 units or RT/LT	$217.54Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
S8450HCPCS	Prefabricated finger splint (specify digit with F-modifier)	Per item (each); rentals per month with RR	80% of usual feeNot in Appendix E; OAR 436-009-0080(6)	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. S-codes are not recognized by Medicare (use A4570 or an L-code); commercial and WC payers may accept them. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
S8451HCPCS	Prefabricated wrist or ankle splint	Per item (each); rentals per month with RR	80% of usual feeNot in Appendix E; OAR 436-009-0080(6)	Written order tied to diagnosis and functional need; fitting/instruction and signed proof of delivery documented; keep supplier invoice; NU/UE/RR modifier (required by Oregon WC and most payers) Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Written order/prescription in the chart tied to a documented diagnosis and functional need; fitting/instruction documented; proof of delivery signed by the patient; keep the supplier invoice (many payers and Oregon WC price unlisted items from cost). Use the HCPCS code that matches the product exactly (many Medicare/commercial payers require the product to appear on the PDAC product classification list for the billed L-code). Do not also bill 97760/97763 for simple fitting of an off-the-shelf item unless a payer allows it and the time/skill is documented. Modifiers: NU (new purchase), UE (used), RR (rental) — required by Oregon WC (OAR 436-009-0080(5)) and most payers; RT/LT for side-specific orthoses; KX/GA/GY per Medicare DMEPOS policy when applicable; GY on Medicare Part B claims from a DC (DC-furnished DME is not payable by Medicare) Oregon scope: In scope: an Oregon DC may recommend, order, or provide DME (OBCE Durable Medical Equipment Policy). Medicare will not pay a DC for DME/orthotics; a separate DMEPOS supplier enrollment is required for Medicare and some commercial plans. S-codes are not recognized by Medicare (use A4570 or an L-code); commercial and WC payers may accept them. Workers' comp: Oregon WC: OAR 436-009-0080: new items listed in Appendix E are paid at the lesser of the Appendix E amount or your usual fee; items not in Appendix E at 80% of usual fee; used items at 75% of Appendix E. Use NU/UE/RR modifiers. TENS, home traction, heating pads and reusable hot/cold packs are treated as DME. Fifteen rental items have a fixed monthly rate under OAR 436-009-0080(7) instead of 10%; the one a chiropractic office meets is E0849 cervical traction at $98.40 a month.
Reports & administrative (5)
99071CPT	Educational supplies (books, pamphlets, videos) given to the patient at cost	Per item	80% of usual feeAppendix B lists no dollar amount; OAR 436-009-0040(1)(a)	Document the item and its cost; rarely covered, usually patient-pay Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Full notes: Document the item and its cost; rarely covered — usually patient-pay. Modifiers: None Oregon scope: In scope; almost never reimbursed by insurers. Workers' comp: Oregon WC: not a listed service; unlikely to be paid.
99072CPT	Extra supplies and staff time during a declared respiratory public-health emergency	1 per visit during an applicable PHE	80% of usual feeAppendix B lists no dollar amount; OAR 436-009-0040(1)(a)	Only during a declared PHE; COVID-19 PHE ended May 11, 2023, so not billable now; verify current status before use Oregon scope noteBundling Full notes, modifiers and bundling Full notes: Applicable only during a declared PHE; the COVID-19 PHE ended May 11, 2023, so this code should not be billed now. Still listed in CPT — verify current status before use. Modifiers: None Bundling: Was not payable by Medicare even during the PHE. Oregon scope: Not currently applicable; retained for reference only.
99080CPT	Special report or form beyond the usual record (narrative, disability/RTW paperwork)	Per report (some payers accept units of time; document minutes)	80% of usual feeAppendix B lists no dollar amount; OAR 436-009-0040(1)(a)	Document what was prepared, who requested it and time spent; not for routine chart notes, claim forms or record copies; mainly a WC/auto/attorney-request code, most health payers do not pay it Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Document what was prepared, who requested it, and the time spent. Not for routine chart notes, claim forms, or copying records. Most commercial and Medicare payers do not pay 99080; it is primarily a workers' comp / auto / attorney-request code. Modifiers: None Bundling: Not payable for the standard chart note that Oregon WC requires to accompany every bill. Oregon scope: In scope; payment is payer-specific. Medicare does not pay it. Workers' comp: Oregon WC: OAR 436-009-0040(7)(a) directs providers to bill 99080 (with documented time) when the insurer or another provider requests a report or record review; paid per Appendix B. Use OSC D0019 instead for an insurer-requested review of and response to an IME report, and R0001/R0002 for copies of records.
99358CPT	Prolonged non-face-to-face service on a non-visit day (e.g., record review), first hour	1 unit per date (30-74 minutes)	$197.73	Document date, total time (at least 30 min), what was reviewed and why it was necessary for care; not on the same date as 99417; Medicare stopped paying in 2023, some commercial/WC pay Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Document the date, the total time (at least 30 minutes), what was reviewed and why it was necessary for the patient's care. Medicare assigned status 'I' (invalid) and stopped paying 99358/99359 in 2023; some commercial payers and WC pay them. Cannot be reported on the same date as 99417. Modifiers: None Bundling: Not on the same day as an E/M with 99417; if the work is a report for an insurer, 99080 is the better code. Oregon scope: In scope; check payer — Medicare/Medicare Advantage: not payable. Workers' comp: Oregon WC: may be paid per Appendix B when documented; for insurer-requested record review use 99080 or D0019 as directed by OAR 436-009-0040(7).
99359CPT	Prolonged non-face-to-face service, each additional 30 min beyond the first hour	Each additional 30 minutes (add-on)	$84.12	Add-on to 99358 on the same date; document total time Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Add-on to 99358 on the same date; document total time. Modifiers: None Bundling: Cannot be reported without 99358. Oregon scope: Same as 99358 (Medicare invalid). Workers' comp: Same as 99358.
Telehealth (26)
98000CPT	New patient audio-video telehealth visit, straightforward decision making or 15 min	Per visit (1 per date)	$164.05	Real-time audio and video, level by MDM or total time; document consent, patient location (POS 02/10), technology, start/end times and OBCE telehealth content; no modifier 95; Medicare/MA use 99202-99215 with 95 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous real-time audio AND video visit. Level is selected by MDM or total time like office E/M (98000 straightforward/15 min, 98001 low/30, 98002 moderate/45, 98003 high/60 for new patients; 98004 straightforward/10, 98005 low/20, 98006 moderate/30, 98007 high/40 for established). Document patient consent to telehealth, the patient's location (POS 10 home / 02 other), the technology used, start/end times, and the same clinical content required by the OBCE Telehealth Policy (reason for visit, history, visual evaluation, provisional diagnosis, report of findings, PARQ/consent, recommendations). Medicare and Medicare Advantage do NOT pay 98000-98015 (status 'I'); for those payers bill 99202-99215 with modifier 95 and POS 02/10. Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98001CPT	New patient audio-video telehealth visit, low complexity or 30 min	Per visit (1 per date)	$256.64	Real-time audio and video, level by MDM or total time; document consent, patient location (POS 02/10), technology, start/end times and OBCE telehealth content; no modifier 95; Medicare/MA use 99202-99215 with 95 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous real-time audio AND video visit. Level is selected by MDM or total time like office E/M (98000 straightforward/15 min, 98001 low/30, 98002 moderate/45, 98003 high/60 for new patients; 98004 straightforward/10, 98005 low/20, 98006 moderate/30, 98007 high/40 for established). Document patient consent to telehealth, the patient's location (POS 10 home / 02 other), the technology used, start/end times, and the same clinical content required by the OBCE Telehealth Policy (reason for visit, history, visual evaluation, provisional diagnosis, report of findings, PARQ/consent, recommendations). Medicare and Medicare Advantage do NOT pay 98000-98015 (status 'I'); for those payers bill 99202-99215 with modifier 95 and POS 02/10. Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98002CPT	New patient audio-video telehealth visit, moderate complexity or 45 min	Per visit (1 per date)	$387.15	Real-time audio and video, level by MDM or total time; document consent, patient location (POS 02/10), technology, start/end times and OBCE telehealth content; no modifier 95; Medicare/MA use 99202-99215 with 95 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous real-time audio AND video visit. Level is selected by MDM or total time like office E/M (98000 straightforward/15 min, 98001 low/30, 98002 moderate/45, 98003 high/60 for new patients; 98004 straightforward/10, 98005 low/20, 98006 moderate/30, 98007 high/40 for established). Document patient consent to telehealth, the patient's location (POS 10 home / 02 other), the technology used, start/end times, and the same clinical content required by the OBCE Telehealth Policy (reason for visit, history, visual evaluation, provisional diagnosis, report of findings, PARQ/consent, recommendations). Medicare and Medicare Advantage do NOT pay 98000-98015 (status 'I'); for those payers bill 99202-99215 with modifier 95 and POS 02/10. Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98003CPT	New patient audio-video telehealth visit, high complexity or 60 min	Per visit (1 per date)	$516.93	Real-time audio and video, level by MDM or total time; document consent, patient location (POS 02/10), technology, start/end times and OBCE telehealth content; no modifier 95; Medicare/MA use 99202-99215 with 95 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous real-time audio AND video visit. Level is selected by MDM or total time like office E/M (98000 straightforward/15 min, 98001 low/30, 98002 moderate/45, 98003 high/60 for new patients; 98004 straightforward/10, 98005 low/20, 98006 moderate/30, 98007 high/40 for established). Document patient consent to telehealth, the patient's location (POS 10 home / 02 other), the technology used, start/end times, and the same clinical content required by the OBCE Telehealth Policy (reason for visit, history, visual evaluation, provisional diagnosis, report of findings, PARQ/consent, recommendations). Medicare and Medicare Advantage do NOT pay 98000-98015 (status 'I'); for those payers bill 99202-99215 with modifier 95 and POS 02/10. Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98004CPT	Established patient audio-video telehealth visit, straightforward or 10 min	Per visit (1 per date)	$129.78	Real-time audio and video, level by MDM or total time; document consent, patient location (POS 02/10), technology, start/end times and OBCE telehealth content; no modifier 95; Medicare/MA use 99202-99215 with 95 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous real-time audio AND video visit. Level is selected by MDM or total time like office E/M (98000 straightforward/15 min, 98001 low/30, 98002 moderate/45, 98003 high/60 for new patients; 98004 straightforward/10, 98005 low/20, 98006 moderate/30, 98007 high/40 for established). Document patient consent to telehealth, the patient's location (POS 10 home / 02 other), the technology used, start/end times, and the same clinical content required by the OBCE Telehealth Policy (reason for visit, history, visual evaluation, provisional diagnosis, report of findings, PARQ/consent, recommendations). Medicare and Medicare Advantage do NOT pay 98000-98015 (status 'I'); for those payers bill 99202-99215 with modifier 95 and POS 02/10. Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98005CPT	Established patient audio-video telehealth visit, low complexity or 20 min	Per visit (1 per date)	$207.79	Real-time audio and video, level by MDM or total time; document consent, patient location (POS 02/10), technology, start/end times and OBCE telehealth content; no modifier 95; Medicare/MA use 99202-99215 with 95 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous real-time audio AND video visit. Level is selected by MDM or total time like office E/M (98000 straightforward/15 min, 98001 low/30, 98002 moderate/45, 98003 high/60 for new patients; 98004 straightforward/10, 98005 low/20, 98006 moderate/30, 98007 high/40 for established). Document patient consent to telehealth, the patient's location (POS 10 home / 02 other), the technology used, start/end times, and the same clinical content required by the OBCE Telehealth Policy (reason for visit, history, visual evaluation, provisional diagnosis, report of findings, PARQ/consent, recommendations). Medicare and Medicare Advantage do NOT pay 98000-98015 (status 'I'); for those payers bill 99202-99215 with modifier 95 and POS 02/10. Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98006CPT	Established patient audio-video telehealth visit, moderate complexity or 30 min	Per visit (1 per date)	$296.01	Real-time audio and video, level by MDM or total time; document consent, patient location (POS 02/10), technology, start/end times and OBCE telehealth content; no modifier 95; Medicare/MA use 99202-99215 with 95 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous real-time audio AND video visit. Level is selected by MDM or total time like office E/M (98000 straightforward/15 min, 98001 low/30, 98002 moderate/45, 98003 high/60 for new patients; 98004 straightforward/10, 98005 low/20, 98006 moderate/30, 98007 high/40 for established). Document patient consent to telehealth, the patient's location (POS 10 home / 02 other), the technology used, start/end times, and the same clinical content required by the OBCE Telehealth Policy (reason for visit, history, visual evaluation, provisional diagnosis, report of findings, PARQ/consent, recommendations). Medicare and Medicare Advantage do NOT pay 98000-98015 (status 'I'); for those payers bill 99202-99215 with modifier 95 and POS 02/10. Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98007CPT	Established patient audio-video telehealth visit, high complexity or 40 min	Per visit (1 per date)	$419.96	Real-time audio and video, level by MDM or total time; document consent, patient location (POS 02/10), technology, start/end times and OBCE telehealth content; no modifier 95; Medicare/MA use 99202-99215 with 95 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous real-time audio AND video visit. Level is selected by MDM or total time like office E/M (98000 straightforward/15 min, 98001 low/30, 98002 moderate/45, 98003 high/60 for new patients; 98004 straightforward/10, 98005 low/20, 98006 moderate/30, 98007 high/40 for established). Document patient consent to telehealth, the patient's location (POS 10 home / 02 other), the technology used, start/end times, and the same clinical content required by the OBCE Telehealth Policy (reason for visit, history, visual evaluation, provisional diagnosis, report of findings, PARQ/consent, recommendations). Medicare and Medicare Advantage do NOT pay 98000-98015 (status 'I'); for those payers bill 99202-99215 with modifier 95 and POS 02/10. Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98008CPT	New patient audio-only telehealth visit, straightforward (over 10 min discussion)	Per visit (1 per date)	$164.05	Real-time audio-only with over 10 min of medical discussion; level by MDM/time as for 98000-98007;document why video was not used, consent, location (POS 02/10) and start/end times; Medicare uses 99202-99215 with 93 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous audio-only visit (telephone) with more than 10 minutes of medical discussion; new-patient codes 98008-98011 and established 98012-98015 mirror the MDM/time levels of 98000-98007. Document why video was not used/available, consent, location, and start/end times. Medicare does not pay these (bill 99202-99215 with modifier 93 where Medicare allows audio-only). Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98009CPT	New patient audio-only telehealth visit, low complexity	Per visit (1 per date)	$256.64	Real-time audio-only with over 10 min of medical discussion; level by MDM/time as for 98000-98007;document why video was not used, consent, location (POS 02/10) and start/end times; Medicare uses 99202-99215 with 93 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous audio-only visit (telephone) with more than 10 minutes of medical discussion; new-patient codes 98008-98011 and established 98012-98015 mirror the MDM/time levels of 98000-98007. Document why video was not used/available, consent, location, and start/end times. Medicare does not pay these (bill 99202-99215 with modifier 93 where Medicare allows audio-only). Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98010CPT	New patient audio-only telehealth visit, moderate complexity	Per visit (1 per date)	$387.15	Real-time audio-only with over 10 min of medical discussion; level by MDM/time as for 98000-98007;document why video was not used, consent, location (POS 02/10) and start/end times; Medicare uses 99202-99215 with 93 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous audio-only visit (telephone) with more than 10 minutes of medical discussion; new-patient codes 98008-98011 and established 98012-98015 mirror the MDM/time levels of 98000-98007. Document why video was not used/available, consent, location, and start/end times. Medicare does not pay these (bill 99202-99215 with modifier 93 where Medicare allows audio-only). Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98011CPT	New patient audio-only telehealth visit, high complexity	Per visit (1 per date)	$516.93	Real-time audio-only with over 10 min of medical discussion; level by MDM/time as for 98000-98007;document why video was not used, consent, location (POS 02/10) and start/end times; Medicare uses 99202-99215 with 93 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous audio-only visit (telephone) with more than 10 minutes of medical discussion; new-patient codes 98008-98011 and established 98012-98015 mirror the MDM/time levels of 98000-98007. Document why video was not used/available, consent, location, and start/end times. Medicare does not pay these (bill 99202-99215 with modifier 93 where Medicare allows audio-only). Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98012CPT	Established patient audio-only telehealth visit, straightforward (over 10 min)	Per visit (1 per date)	$129.78	Real-time audio-only with over 10 min of medical discussion; level by MDM/time as for 98000-98007;document why video was not used, consent, location (POS 02/10) and start/end times; Medicare uses 99202-99215 with 93 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous audio-only visit (telephone) with more than 10 minutes of medical discussion; new-patient codes 98008-98011 and established 98012-98015 mirror the MDM/time levels of 98000-98007. Document why video was not used/available, consent, location, and start/end times. Medicare does not pay these (bill 99202-99215 with modifier 93 where Medicare allows audio-only). Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98013CPT	Established patient audio-only telehealth visit, low complexity	Per visit (1 per date)	$207.79	Real-time audio-only with over 10 min of medical discussion; level by MDM/time as for 98000-98007;document why video was not used, consent, location (POS 02/10) and start/end times; Medicare uses 99202-99215 with 93 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous audio-only visit (telephone) with more than 10 minutes of medical discussion; new-patient codes 98008-98011 and established 98012-98015 mirror the MDM/time levels of 98000-98007. Document why video was not used/available, consent, location, and start/end times. Medicare does not pay these (bill 99202-99215 with modifier 93 where Medicare allows audio-only). Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98014CPT	Established patient audio-only telehealth visit, moderate complexity	Per visit (1 per date)	$296.01	Real-time audio-only with over 10 min of medical discussion; level by MDM/time as for 98000-98007;document why video was not used, consent, location (POS 02/10) and start/end times; Medicare uses 99202-99215 with 93 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous audio-only visit (telephone) with more than 10 minutes of medical discussion; new-patient codes 98008-98011 and established 98012-98015 mirror the MDM/time levels of 98000-98007. Document why video was not used/available, consent, location, and start/end times. Medicare does not pay these (bill 99202-99215 with modifier 93 where Medicare allows audio-only). Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98015CPT	Established patient audio-only telehealth visit, high complexity	Per visit (1 per date)	$419.96	Real-time audio-only with over 10 min of medical discussion; level by MDM/time as for 98000-98007;document why video was not used, consent, location (POS 02/10) and start/end times; Medicare uses 99202-99215 with 93 Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Synchronous audio-only visit (telephone) with more than 10 minutes of medical discussion; new-patient codes 98008-98011 and established 98012-98015 mirror the MDM/time levels of 98000-98007. Document why video was not used/available, consent, location, and start/end times. Medicare does not pay these (bill 99202-99215 with modifier 93 where Medicare allows audio-only). Modifiers: POS 02 (patient not at home) or POS 10 (patient at home) is required; Modifier 95 is generally NOT added to 98000-98015 (the code itself denotes telehealth); Oregon WC explicitly exempts 98000-98007 from modifier 95; For Medicare and other payers that reject 98000-98015: bill 99202-99215 with 95 (video) or 93 (audio-only) Bundling: Not reportable with 98016 or with an in-person E/M on the same date for the same problem. Oregon scope: In scope: OAR 811-015-0066 and the OBCE Telehealth Policy allow telehealth for new and established patients if the listed procedures are documented. A hands-on service (CMT, therapy) cannot be billed via telehealth. Commercial coverage of 98000-98015 for DCs varies — verify each payer (Oregon's telehealth parity law, ORS 743A.058, applies to fully insured plans). Workers' comp: Oregon WC: OAR 436-009-0012 — use POS 02 or 10; modifier 95 on telemedicine except for 98000-98007; paid at the non-facility rate or usual fee, whichever is less; services are not limited to CPT Appendix P.
98016CPT	Brief 5-10 min patient-initiated virtual check-in to decide if a visit is needed	Per check-in (1 per 7 days)	$37.91	Established patient, patient-initiated; 5-10 min of medical discussion; not within 7 days after or 24 hours before a related E/M (bundled); document consent, time and outcome Oregon scope noteWorkers' comp noteBundling Full notes, modifiers and bundling Full notes: Patient-initiated; 5-10 minutes of medical discussion; not originating from an E/M in the prior 7 days and not leading to an E/M within 24 hours (otherwise bundled). Document consent, time and outcome. Replaces HCPCS G2012; Medicare pays 98016 (though not to a DC). Modifiers: POS 02/10; GY on Medicare (DC-furnished) Bundling: Bundled if related to an E/M within 7 days before or 24 hours after. Oregon scope: In scope under the OBCE telehealth policy for established patients. Workers' comp: Oregon WC: telehealth (non-telemedicine) services use POS 02/10 without modifier 95 (OAR 436-009-0012(3)(b)).
98966CPT	Telephone assessment by a qualified non-physician professional, 5 to 10 minutes	Per call	$81.18	Patient-initiated call; not within 7 days of a related visit or leading to one within 24 hours; time documented; written for non-physician professionals, so a chiropractic physician normally uses the audio-only E/M codes 98008 to 98015 Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Modifiers: No modifier 95; POS 02 or 10 Oregon scope: Physician telephone codes 99441 to 99443 were deleted in 2025; the audio-only E/M codes 98008 to 98015 are the physician equivalents. Workers' comp: Priced in Appendix B ($81.18). Oregon workers' compensation: POS 02 or 10, no modifier 95 (OAR 436-009-0012(3)(b)).
98967CPT	Telephone assessment by a qualified non-physician professional, 11 to 20 minutes	Per call	$133.82	As 98966 with 11 to 20 minutes Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Modifiers: No modifier 95; POS 02 or 10 Oregon scope: See 98966. Workers' comp: Priced in Appendix B ($133.82).
98968CPT	Telephone assessment by a qualified non-physician professional, 21 to 30 minutes	Per call	$194.07	As 98966 with 21 to 30 minutes Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Modifiers: No modifier 95; POS 02 or 10 Oregon scope: See 98966. Workers' comp: Priced in Appendix B ($194.07).
98970CPT	Online digital assessment by a qualified non-physician professional, 5 to 10 minutes over 7 days	Once per 7-day period	$81.18	Portal-based, patient-initiated, cumulative time over seven days; written for non-physician professionals, so a chiropractic physician normally reports 99421 to 99423 Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Modifiers: No modifier 95; POS 02 or 10 Oregon scope: See 98966 on which code family applies. Workers' comp: Priced in Appendix B ($81.18).
98971CPT	Online digital assessment by a qualified non-physician professional, 11 to 20 minutes over 7 days	Once per 7-day period	$133.82	As 98970 with 11 to 20 minutes Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Modifiers: No modifier 95; POS 02 or 10 Oregon scope: See 98966. Workers' comp: Priced in Appendix B ($133.82).
98972CPT	Online digital assessment by a qualified non-physician professional, 21 or more minutes over 7 days	Once per 7-day period	$194.07	As 98970 with 21 or more minutes Oregon scope noteWorkers' comp note Full notes, modifiers and bundling Modifiers: No modifier 95; POS 02 or 10 Oregon scope: See 98966. Workers' comp: Priced in Appendix B ($194.07).
99421CPT	Online digital E/M for an established patient, 5 to 10 minutes over 7 days	Once per 7-day period	$95.50	Patient-initiated message through a secure portal; cumulative provider time over seven days documented; not within seven days of a related visit; established patients only Workers' comp note Full notes, modifiers and bundling Modifiers: No modifier 95 (not synchronous); POS 02 or 10 on workers' compensation claims Workers' comp: Oregon workers' compensation treats online digital services as telehealth: POS 02 or 10, no modifier 95, paid at the non-facility rate (OAR 436-009-0012(3)(b)).
99422CPT	Online digital E/M for an established patient, 11 to 20 minutes over 7 days	Once per 7-day period	$157.44	As 99421 with 11 to 20 cumulative minutes Workers' comp note Full notes, modifiers and bundling Modifiers: No modifier 95; POS 02 or 10 Workers' comp: See 99421.
99423CPT	Online digital E/M for an established patient, 21 or more minutes over 7 days	Once per 7-day period	$228.32	As 99421 with 21 or more cumulative minutes Workers' comp note Full notes, modifiers and bundling Modifiers: No modifier 95; POS 02 or 10 Workers' comp: See 99421.

Oregon-specific codes

Codes that exist only in the Oregon workers' compensation rules, for work that CPT does not describe. Use them on workers' compensation claims only.

Code	Description	Fee	Notes
CE001	Closing exam: measures impairment once the worker is medically stationary.	80% of usual fee	A chiropractic physician may perform this only while serving as attending physician at the time of claim closure (OAR 436-010-0210(2)(d)). Pays 80% of the usual fee.
CR001	Closing report capturing the closing exam findings.	80% of usual fee	Same condition as CE001. Pays 80% of the usual fee.
N0001	Brief narrative by the attending physician: treatment to date, current status, brief answers to up to five questions.	$122.17	Only the attending physician or authorized nurse practitioner may bill narratives. Insurer-requested.
N0002	Complex narrative: history, treatment, status, impairment, prognosis, medically stationary date.	$243.62	Same as N0001.
D0019	Review of an independent medical exam report and written response, at the insurer's request.	As billed	Paid as billed; document the time spent (OAR 436-009-0040(7)(b)).
D0030	Consultation with the insurer, including record review time.	As billed	Paid as billed; document time.
D0001	Consultation with the insurer's attorney, including record review time.	As billed	Paid as billed; document time.
D0002	Deposition time, including preparation, travel and the deposition itself.	As billed	Paid as billed. A request for pre-payment of a deposition is permitted (OAR 436-009-0010(1)(d)).
R0001	Paper copies of medical records requested by the insurer, beyond the chart notes sent with bills.	$10.00 + $0.50/page	$10.00 for the first page and $0.50 per additional page (Appendix B).
R0002	Electronic copies of medical records requested by the insurer.	$35.70	Per request.
99196	Physical capacity evaluation, first level: musculoskeletal measures of a specific body part, usually 30 to 45 minutes.	$171.46	Includes the report. Usually prescribed by the attending physician and performed by a therapist; confirm with the insurer before a chiropractic office bills it.
99197	Physical capacity evaluation, second level: residual functional capacity, usually two hours or more.	$571.53	Includes the report. Same caution as 99196.
99198	Work capacity evaluation, usually four hours or more of patient contact.	$1,143.05	Includes the report. Same caution as 99196.
99193	Each additional 15 minutes of a PCE or WCE.	$57.15	Add-on to 99196, 99197 or 99198.
97659	Job site visit, first hour including travel.	$122.88	Must be pre-authorised by the insurer (OAR 436-009-0060(3)(d)).
97660	Job site visit, each additional 30 minutes.	$61.43	Pre-authorisation required.
97661	Ergonomic consultation, one hour including travel.	$165.74	Must be pre-authorised by the insurer.
D0003	Independent medical exam: exam, report, addendum or file review at the insurer's request.	As billed	Paid as billed. Only for a non-treating examiner on the division's authorized IME provider list (OAR 436-010-0265); a DC may serve as an IME examiner in the chiropractic field.
W0001	Worker requested medical exam: exam, report or record review.	As billed	Paid as billed; performed by a director-selected physician, not the treating provider.
Q3014	Telehealth originating-site facility fee when the patient is at the provider's office and a different provider is remote.	$35.70	Per 15 minutes or portion (OAR 436-009-0012(5)(c)). Not payable to the distant-site provider.

Commonly asked about, not billable by an Oregon chiropractic physician

Services other states allow, or that appear on chiropractic superbills elsewhere, but that sit outside the Oregon scope of practice or outside the fee schedule for this licence.

20560 Dry needling, 1 or 2 muscles. Not within Oregon chiropractic scope. The Court of Appeals held on 23 January 2014 that dry needling is not the practice of chiropractic and invalidated the Board's 2011 rule (OAR 811-015-0036), which the Board repealed on 4 June 2014. The Board's Out of Scope list includes acupuncture. Appendix B prices the code, but only for licensees who may perform it.
20561 Dry needling, 3 or more muscles. Not within Oregon chiropractic scope, for the same reason as 20560.
97810 Acupuncture without electrical stimulation, first 15 minutes. Acupuncture is a separately licensed profession in Oregon (ORS chapter 677) and is on the Board's Out of Scope list. A DC who also holds an Oregon acupuncture licence bills under that licence, not the chiropractic one.
97811 Acupuncture without electrical stimulation, each additional 15 minutes. Same as 97810.
97813 Acupuncture with electrical stimulation, first 15 minutes. Same as 97810.
97814 Acupuncture with electrical stimulation, each additional 15 minutes. Same as 97810.
20550 Injection, tendon sheath or ligament. The Board's Out of Scope list includes joint, trigger point and nutritional injections, and Oregon DCs cannot prescribe or administer legend drugs.
20552 Trigger point injection, 1 or 2 muscles. Same as 20550.
20553 Trigger point injection, 3 or more muscles. Same as 20550.
96372 Therapeutic injection, subcutaneous or intramuscular. Same as 20550.
95831 Manual muscle testing, extremity or trunk. Deleted from CPT on 1 January 2020 (manual muscle testing is part of the E/M exam). Not in Appendix B.
95832 Manual muscle testing, hand. Deleted from CPT in 2020; see 95831.
95833 Manual muscle testing, total body without hands. Deleted from CPT in 2020; see 95831.
95834 Manual muscle testing, total body with hands. Deleted from CPT in 2020; see 95831.
97161 Physical therapy evaluation, low complexity. Editorial exclusion. The 97161 to 97164 descriptors are physical therapy evaluations, and a chiropractic physician normally documents and bills the evaluation as an E/M visit (99202 to 99215). OAR 436-009 does not restrict these codes by licence type (Appendix B prices them at $196.80 for 97161 to 97163 and $135.22 for 97164, and exempts them from the three-code limit), but many payers deny them from a DC. Confirm with the payer before using them.
97162 Physical therapy evaluation, moderate complexity. See 97161.
97163 Physical therapy evaluation, high complexity. See 97161.
97164 Physical therapy re-evaluation. See 97161.
G0283 Unattended electrical stimulation (Medicare code). A Medicare-only substitute for 97014. Oregon workers' compensation does not list it in Appendix B (an unlisted HCPCS code pays 80% of the usual fee); bill 97014, which is priced at $25.44.
97545 Work hardening or conditioning, first 2 hours. Appendix B pays 80% of billed, but OAR 436-009-0060(3) only pays for work hardening delivered by a CARF or Joint Commission accredited program. Not a solo-practice code.
97546 Work hardening or conditioning, each additional hour. See 97545.
A9270 Non-covered item or service. A denial-tracking HCPCS code, not a billable service. Oregon workers' compensation has no use for it; unlisted supplies use 80% of the usual fee under OAR 436-009-0080(6).
99024 Post-operative follow-up visit within a global period. A zero-charge tracking code for surgical global periods. Chiropractic manipulation and physical medicine codes have no global period, so it does not apply.
99455 Work-related evaluation by the treating physician. Appendix B lists it at 80% of billed, but Oregon workers' compensation has its own closing exam and report codes (CE001, CR001) and narrative codes (N0001, N0002) for the work the descriptor covers, so in practice those are billed instead.
99456 Work-related evaluation by other than the treating physician. Appendix B lists it at 80% of billed, but an insurer-arranged independent medical exam in Oregon is billed with Oregon code D0003 (as billed) by an examiner on the division's IME list, so 99456 is not used in practice.

Sources

Primary sources consulted when this page was compiled. The rule text at the Oregon Secretary of State and the Workers' Compensation Division's published tables control over anything written here.

The underlying data is available as codes.json.

Read this before you use the table

The basics

Scope comes first

The type B clock: 60 days or 18 visits

Form 827 within 72 hours

Tell the worker at the first visit

What the bill must carry

Deadlines

How much: lesser of the table or your usual fee

Physical medicine: three codes a day, 8-minute units

Therapy frequency guideline

Not separately payable

Excluded treatments

Progress reports and imaging requests

No NCCI edits in the rule

Impairment findings

Telehealth

Supplies and orthotics

How the schedule sets the amount

The ledger

Oregon-specific codes

Commonly asked about, not billable by an Oregon chiropractic physician

Sources