{
 "meta": {
  "compiled": "2026-09-09",
  "edition": "Appendix B (corrected) and Appendix E for Administrative Order 26-050, OAR 436-009",
  "effective": "1 April 2026",
  "lede": "A reference ledger of the CPT and HCPCS codes an Oregon chiropractic physician may bill, what each one requires, and the maximum the Oregon workers' compensation fee schedule allows for it. Compiled by an AI system from the published rules and tables; check every entry against the source before you rely on it."
 },
 "categories": [
  "Evaluation & management",
  "Chiropractic manipulation",
  "Physical medicine: modalities",
  "Physical medicine: procedures",
  "Radiology",
  "Minor procedures",
  "Tests & measurements",
  "Supplies, DME & orthotics",
  "Reports & administrative",
  "Telehealth"
 ],
 "facts": [
  {
   "title": "Scope comes first",
   "body": "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 It does not cover acupuncture or injections (Board Out of Scope list) or dry needling (Court of Appeals, 2014; rule repealed).",
   "cite": "OAR 436-009-0010(1)(a); ORS 684.010; OBCE Guide, Out of Scope list; OAR 811-015-0036 (repealed)"
  },
  {
   "title": "The type B clock: 60 days or 18 visits",
   "body": "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.",
   "cite": "ORS 656.005(12)(b)(B); OAR 436-010-0210(2)"
  },
  {
   "title": "Form 827 within 72 hours",
   "body": "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.",
   "cite": "OAR 436-010-0241; ORS 656.248(10)"
  },
  {
   "title": "Tell the worker at the first visit",
   "body": "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.",
   "cite": "OAR 436-010-0230(3)"
  },
  {
   "title": "What the bill must carry",
   "body": "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.",
   "cite": "OAR 436-009-0010(1)(b), (1)(c), (3), (7)"
  },
  {
   "title": "Deadlines",
   "body": "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.",
   "cite": "OAR 436-009-0010(2); 436-009-0030(3)"
  },
  {
   "title": "How much: lesser of the table or your usual fee",
   "body": "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.",
   "cite": "OAR 436-009-0040(1)(a)"
  },
  {
   "title": "Physical medicine: three codes a day, 8-minute units",
   "body": "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.",
   "cite": "OAR 436-009-0040(6)"
  },
  {
   "title": "Therapy frequency guideline",
   "body": "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.",
   "cite": "OAR 436-010-0230(9)(a); 436-010-0290"
  },
  {
   "title": "Not separately payable",
   "body": "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.",
   "cite": "OAR 436-009-0010(11), (13)"
  },
  {
   "title": "Excluded treatments",
   "body": "Surface EMG, thermography, prolotherapy, Rolfing and IDET are not compensable, whatever code is used; DMSO is excluded except for compensable interstitial cystitis.",
   "cite": "OAR 436-009-0010(12)"
  },
  {
   "title": "Progress reports and imaging requests",
   "body": "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.",
   "cite": "OAR 436-010-0240(6); 436-010-0230(12)"
  },
  {
   "title": "No NCCI edits in the rule",
   "body": "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.",
   "cite": "OAR 436-009-0004(5)(a); 436-009-0030(2)(c)"
  },
  {
   "title": "Impairment findings",
   "body": "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.",
   "cite": "OAR 436-010-0210(2)(d); 436-009-0060"
  },
  {
   "title": "Telehealth",
   "body": "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.",
   "cite": "OAR 436-009-0012"
  },
  {
   "title": "Supplies and orthotics",
   "body": "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.",
   "cite": "OAR 436-009-0080(6)"
  }
 ],
 "payment_rules": [
  {
   "name": "Listed code, performed in the office",
   "value": "Lesser of Appendix B non-facility amount or usual fee",
   "applies": "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)"
  },
  {
   "name": "Listed code, performed outside the office",
   "value": "Lesser of Appendix B facility amount or usual fee",
   "applies": "Hospital or facility settings. Outpatient therapy always uses the non-facility column."
  },
  {
   "name": "Codes the table marks '80% of billed'",
   "value": "80% of usual fee",
   "applies": "Reports (99080), unlisted modalities (97039, 97139), supplies (99070), closing exam codes, and similar."
  },
  {
   "name": "HCPCS code not in the schedule",
   "value": "80% of usual fee",
   "applies": "Also any service with no CPT, OSC or HCPCS code, billed with an unlisted code and a description."
  },
  {
   "name": "DMEPOS in Appendix E",
   "value": "New: lesser of table or usual fee · Used: 75% · Rental: 10% per month",
   "applies": "Braces, TENS units, supplies. Unlisted items pay 80% of usual fee. OAR 436-009-0080(6)"
  },
  {
   "name": "Radiology",
   "value": "Global, professional (-26) and technical (-TC) amounts",
   "applies": "Only diagnostic-quality films with a written report are payable; 14 by 36 inch lateral views are not. OAR 436-009-0040(4)"
  },
  {
   "name": "Telehealth, distant-site provider",
   "value": "Non-facility rate",
   "applies": "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"
  },
  {
   "name": "Modifier 22, unusual service",
   "value": "125% of Appendix B",
   "applies": "Surgical codes with a 0, 10 or 90 day global period only, with documentation of the extra work. OAR 436-009-0010(5)(b)"
  },
  {
   "name": "Additional surgical procedures, same session",
   "value": "50% of Appendix B (add-on codes exempt)",
   "applies": "Rarely relevant to chiropractic minor procedures. OAR 436-009-0040(3)"
  },
  {
   "name": "Oregon-specific codes with no dollar amount",
   "value": "As billed, or 80% of usual fee, per Appendix B",
   "applies": "Depositions, insurer consultations and IME responses are paid as billed; closing exams and record reviews at 80%."
  }
 ],
 "codes": [
  {
   "code": "99202",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "New patient office visit, straightforward decision making or 15-29 min total time",
   "requirements": "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",
   "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"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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.",
   "bundling_note": "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.)",
   "wc_note": "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).",
   "fee": {
    "amount": 164.05
   },
   "requirements_full": "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)."
  },
  {
   "code": "99203",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "New patient office visit, low-complexity decision making or 30-44 min total time",
   "requirements": "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",
   "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"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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.",
   "bundling_note": "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.)",
   "wc_note": "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).",
   "fee": {
    "amount": 256.64
   },
   "requirements_full": "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)."
  },
  {
   "code": "99204",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "New patient office visit, moderate-complexity decision making or 45-59 min total time",
   "requirements": "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",
   "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"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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.",
   "bundling_note": "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.)",
   "wc_note": "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).",
   "fee": {
    "amount": 387.15
   },
   "requirements_full": "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)."
  },
  {
   "code": "99205",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "New patient office visit, high-complexity decision making or 60-74 min total time",
   "requirements": "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",
   "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"
   ],
   "units": "Per visit (1 per date); add 99417 for each additional 15 minutes beyond 74",
   "scope_note": "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.",
   "bundling_note": "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.)",
   "wc_note": "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).",
   "fee": {
    "amount": 516.93
   },
   "requirements_full": "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)."
  },
  {
   "code": "99211",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "Minimal established-patient visit (e.g., staff BP recheck); no MDM or time requirement",
   "requirements": "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",
   "modifiers": [
    "25 is not typically accepted with 99211 for same-day CMT; most payers bundle it",
    "GY on Medicare"
   ],
   "units": "Per visit",
   "scope_note": "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.",
   "bundling_note": "Bundled into any same-day procedure; Medicare and many commercial payers will not pay 99211 with CMT.",
   "wc_note": "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).",
   "fee": {
    "amount": 53.22
   },
   "requirements_full": "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."
  },
  {
   "code": "99212",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "Established patient visit, straightforward decision making or 10-19 min total time",
   "requirements": "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)",
   "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"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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.",
   "bundling_note": "Bundled into CMT unless modifier 25 with separately identifiable documentation; routine pre-adjustment assessment is part of the CMT.",
   "wc_note": "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).",
   "fee": {
    "amount": 129.78
   },
   "requirements_full": "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)."
  },
  {
   "code": "99213",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "Established patient visit, low-complexity decision making or 20-29 min total time",
   "requirements": "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)",
   "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"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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.",
   "bundling_note": "Bundled into CMT unless modifier 25 with separately identifiable documentation; routine pre-adjustment assessment is part of the CMT.",
   "wc_note": "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).",
   "fee": {
    "amount": 207.79
   },
   "requirements_full": "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)."
  },
  {
   "code": "99214",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "Established patient visit, moderate-complexity decision making or 30-39 min total time",
   "requirements": "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)",
   "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"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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.",
   "bundling_note": "Bundled into CMT unless modifier 25 with separately identifiable documentation; routine pre-adjustment assessment is part of the CMT.",
   "wc_note": "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).",
   "fee": {
    "amount": 296.01
   },
   "requirements_full": "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)."
  },
  {
   "code": "99215",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "Established patient visit, high-complexity decision making or 40-54 min total time",
   "requirements": "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)",
   "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"
   ],
   "units": "Per visit (1 per date); add 99417 for each additional 15 minutes beyond 54",
   "scope_note": "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.",
   "bundling_note": "Bundled into CMT unless modifier 25 with separately identifiable documentation; routine pre-adjustment assessment is part of the CMT.",
   "wc_note": "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).",
   "fee": {
    "amount": 419.96
   },
   "requirements_full": "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)."
  },
  {
   "code": "99417",
   "type": "CPT",
   "category": "Evaluation & management",
   "description": "Prolonged office E/M time, each added 15 min beyond 99205 or 99215 on the same date",
   "requirements": "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",
   "modifiers": [
    "No modifier; list with the primary E/M",
    "GY on Medicare (and Medicare does not recognize 99417 anyway)"
   ],
   "units": "Per 15 minutes (add-on to 99205/99215 only)",
   "scope_note": "Rarely reached in chiropractic practice; expect payer scrutiny. Verify each payer's threshold (AMA 99417 vs CMS G2212 rules).",
   "bundling_note": "Cannot be reported with 99358/99359 on the same date.",
   "wc_note": "Oregon WC: paid per Appendix B when documented; time must be documented in the chart note.",
   "fee": {
    "amount": 69.02
   },
   "requirements_full": "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)."
  },
  {
   "code": "98940",
   "type": "CPT",
   "category": "Chiropractic manipulation",
   "description": "Spinal adjustment, 1 or 2 spinal regions",
   "requirements": "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",
   "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"
   ],
   "units": "1 unit per visit (code selection by number of spinal regions treated)",
   "scope_note": "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).",
   "bundling_note": "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.)",
   "wc_note": "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.",
   "fee": {
    "amount": 66.97
   },
   "requirements_full": "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."
  },
  {
   "code": "98941",
   "type": "CPT",
   "category": "Chiropractic manipulation",
   "description": "Spinal adjustment, 3 or 4 spinal regions",
   "requirements": "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",
   "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"
   ],
   "units": "1 unit per visit",
   "scope_note": "Core in-scope service. Medicare-covered with AT when active treatment of documented subluxations in each region billed.",
   "bundling_note": "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.)",
   "wc_note": "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.",
   "fee": {
    "amount": 93.75
   },
   "requirements_full": "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."
  },
  {
   "code": "98942",
   "type": "CPT",
   "category": "Chiropractic manipulation",
   "description": "Spinal adjustment, all 5 spinal regions",
   "requirements": "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",
   "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"
   ],
   "units": "1 unit per visit",
   "scope_note": "Core in-scope service. Medicare-covered with AT when supported.",
   "bundling_note": "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.)",
   "wc_note": "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.",
   "fee": {
    "amount": 119.65
   },
   "requirements_full": "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."
  },
  {
   "code": "98943",
   "type": "CPT",
   "category": "Chiropractic manipulation",
   "description": "Manipulation of one or more extraspinal regions (head/TMJ, extremities, ribs, abdomen)",
   "requirements": "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",
   "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"
   ],
   "units": "1 unit per visit (covers 1-5 extraspinal regions)",
   "scope_note": "In scope in Oregon. Medicare: statutorily non-covered (only spinal manipulation is covered) — use GY.",
   "bundling_note": "97140 in the same extraspinal region is bundled; use 59/XS only for a different region.",
   "wc_note": "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.",
   "fee": {
    "amount": 63.41
   },
   "requirements_full": "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."
  },
  {
   "code": "97010",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Hot or cold pack applied to one or more areas",
   "requirements": "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",
   "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)"
   ],
   "units": "1 unit per visit regardless of the number of areas or minutes",
   "scope_note": "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.",
   "bundling_note": "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)).",
   "wc_note": "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).",
   "fee": {
    "amount": 13.39
   },
   "requirements_full": "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."
  },
  {
   "code": "97012",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Mechanical traction (motorized/intermittent cervical or lumbar)",
   "requirements": "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",
   "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)"
   ],
   "units": "1 unit per visit regardless of the number of areas or minutes",
   "scope_note": "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.",
   "bundling_note": "Some payers bundle 97012 with CMT in the same region; check payer edits. Manual traction is 97140, not 97012.",
   "wc_note": "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).",
   "fee": {
    "amount": 28.78
   },
   "requirements_full": "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."
  },
  {
   "code": "97014",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Unattended electrical stimulation (e.g., IFC, TENS-type), one or more areas",
   "requirements": "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",
   "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)"
   ],
   "units": "1 unit per visit regardless of the number of areas or minutes",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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).",
   "fee": {
    "amount": 25.44
   },
   "requirements_full": "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."
  },
  {
   "code": "97016",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Vasopneumatic compression device, one or more areas",
   "requirements": "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",
   "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)"
   ],
   "units": "1 unit per visit regardless of the number of areas or minutes",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 24.1
   },
   "requirements_full": "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."
  },
  {
   "code": "97018",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Paraffin bath treatment",
   "requirements": "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",
   "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)"
   ],
   "units": "1 unit per visit regardless of the number of areas or minutes",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 12.05
   },
   "requirements_full": "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."
  },
  {
   "code": "97022",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Whirlpool therapy",
   "requirements": "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",
   "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)"
   ],
   "units": "1 unit per visit regardless of the number of areas or minutes",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 31.46
   },
   "requirements_full": "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."
  },
  {
   "code": "97024",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Diathermy (shortwave/microwave heating), one or more areas",
   "requirements": "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",
   "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)"
   ],
   "units": "1 unit per visit regardless of the number of areas or minutes",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 14.73
   },
   "requirements_full": "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."
  },
  {
   "code": "97026",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Infrared light therapy, one or more areas",
   "requirements": "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",
   "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)"
   ],
   "units": "1 unit per visit regardless of the number of areas or minutes",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 13.39
   },
   "requirements_full": "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."
  },
  {
   "code": "97028",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Ultraviolet light therapy, one or more areas",
   "requirements": "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",
   "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)"
   ],
   "units": "1 unit per visit regardless of the number of areas or minutes",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 16.74
   },
   "requirements_full": "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."
  },
  {
   "code": "97032",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Attended electrical stimulation (manual/probe), each 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 29.45
   },
   "requirements_full": "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."
  },
  {
   "code": "97033",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Iontophoresis: low-voltage current drives topical medication through skin, each 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 38.16
   },
   "requirements_full": "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."
  },
  {
   "code": "97034",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Contrast baths (alternating hot and cold immersion), each 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 28.11
   },
   "requirements_full": "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."
  },
  {
   "code": "97035",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Therapeutic ultrasound, each 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": "Phonophoresis is reported as 97035 (no separate drug payment). Not reportable with 97010 for the same area/time under most payer policies.",
   "wc_note": "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).",
   "fee": {
    "amount": 28.78
   },
   "requirements_full": "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."
  },
  {
   "code": "97036",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Hubbard tank hydrotherapy, each 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 69.62
   },
   "requirements_full": "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."
  },
  {
   "code": "97039",
   "type": "CPT",
   "category": "Physical medicine: modalities",
   "description": "Unlisted modality (e.g., low-level laser, shockwave); specify time if attended",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Appendix B lists no dollar amount; OAR 436-009-0040(1)(a)"
   },
   "requirements_full": "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."
  },
  {
   "code": "97110",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Exercise session to restore strength, stamina, motion or flexibility, per 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 58.24
   },
   "requirements_full": "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."
  },
  {
   "code": "97112",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Retraining of movement control: balance, coordination, posture, body awareness, per 15 min",
   "requirements": "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)",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": "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.)",
   "wc_note": "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).",
   "fee": {
    "amount": 65.6
   },
   "requirements_full": "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)."
  },
  {
   "code": "97113",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Aquatic therapy with therapeutic exercise in water, each 15 min",
   "requirements": "One-on-one in a pool; timed minutes, 8-minute rule; document exercises, region and goal; document why the water environment is medically necessary",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 74.3
   },
   "requirements_full": "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)."
  },
  {
   "code": "97116",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Gait training including stair climbing, each 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 58.24
   },
   "requirements_full": "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."
  },
  {
   "code": "97124",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Massage using stroking, kneading or percussion techniques, per 15 min",
   "requirements": "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)",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": "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.)",
   "wc_note": "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).",
   "fee": {
    "amount": 59.58
   },
   "requirements_full": "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."
  },
  {
   "code": "97139",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Unlisted therapeutic procedure",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Appendix B lists no dollar amount; OAR 436-009-0040(1)(a)"
   },
   "requirements_full": "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)."
  },
  {
   "code": "97140",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Hands-on soft-tissue and joint work other than an adjustment, per 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": "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.)",
   "wc_note": "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).",
   "fee": {
    "amount": 55.56
   },
   "requirements_full": "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."
  },
  {
   "code": "97150",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Therapeutic procedure(s) delivered to a group of 2 or more patients at once",
   "requirements": "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",
   "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"
   ],
   "units": "Per session per patient (untimed)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 36.15
   },
   "requirements_full": "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."
  },
  {
   "code": "97530",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Therapeutic activities: dynamic functional tasks to improve function, each 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": "Some payers edit 97530 against 97140/97110 on the same date; separate time blocks and distinct documentation required.",
   "wc_note": "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).",
   "fee": {
    "amount": 70.29
   },
   "requirements_full": "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."
  },
  {
   "code": "97535",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Self-care/home-management training (ADLs, body mechanics, home program), each 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 64.93
   },
   "requirements_full": "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."
  },
  {
   "code": "97750",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Measured test of physical function with a written report, per 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": "Bundled with same-day E/M by many payers unless clearly separate; 95851/95852 (ROM) are bundled into 97750.",
   "wc_note": "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).",
   "fee": {
    "amount": 67.61
   },
   "requirements_full": "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."
  },
  {
   "code": "97760",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Fitting and training with a brace or splint, first visit, per 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": "Bundled into the L-code supply by many payers when the fitting is simple; separately reportable only when skilled assessment/training time is documented.",
   "wc_note": "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).",
   "fee": {
    "amount": 92.38
   },
   "requirements_full": "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."
  },
  {
   "code": "97761",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Prosthetic training, initial encounter, each 15 min",
   "requirements": "One-on-one, timed minutes; 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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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).",
   "fee": {
    "amount": 81
   },
   "requirements_full": "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."
  },
  {
   "code": "97763",
   "type": "CPT",
   "category": "Physical medicine: procedures",
   "description": "Follow-up brace or splint check and training, per 15 min",
   "requirements": "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",
   "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"
   ],
   "units": "Per 15 minutes (timed; 8-minute rule)",
   "scope_note": "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.",
   "bundling_note": "Bundled into the L-code supply by many payers when the fitting is simple; separately reportable only when skilled assessment/training time is documented.",
   "wc_note": "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).",
   "fee": {
    "amount": 100.41
   },
   "requirements_full": "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."
  },
  {
   "code": "70250",
   "type": "CPT",
   "category": "Radiology",
   "description": "Skull, fewer than 4 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 81.87,
    "pc": 19.89,
    "tc": 61.97
   },
   "requirements_full": "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."
  },
  {
   "code": "70260",
   "type": "CPT",
   "category": "Radiology",
   "description": "Skull, complete study, 4 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 100.23,
    "pc": 29.84,
    "tc": 70.39
   },
   "requirements_full": "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."
  },
  {
   "code": "70328",
   "type": "CPT",
   "category": "Radiology",
   "description": "Temporomandibular joint, open and closed mouth views, one side",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "Bilateral TMJ is 70330, not 70328 x2.",
   "wc_note": "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)).",
   "fee": {
    "amount": 78.04,
    "pc": 19.89,
    "tc": 58.15
   },
   "requirements_full": "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."
  },
  {
   "code": "70330",
   "type": "CPT",
   "category": "Radiology",
   "description": "Temporomandibular joints, open and closed mouth views, both sides",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 122.42,
    "pc": 26.01,
    "tc": 96.4
   },
   "requirements_full": "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."
  },
  {
   "code": "71045",
   "type": "CPT",
   "category": "Radiology",
   "description": "Chest, single view",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 58.15,
    "pc": 19.13,
    "tc": 39.02
   },
   "requirements_full": "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."
  },
  {
   "code": "71046",
   "type": "CPT",
   "category": "Radiology",
   "description": "Chest, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 75.74,
    "pc": 22.95,
    "tc": 52.79
   },
   "requirements_full": "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."
  },
  {
   "code": "71100",
   "type": "CPT",
   "category": "Radiology",
   "description": "Ribs, one side, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 82.63,
    "pc": 23.72,
    "tc": 58.91
   },
   "requirements_full": "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."
  },
  {
   "code": "71101",
   "type": "CPT",
   "category": "Radiology",
   "description": "Ribs, one side, including a chest view, 3 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 96.4,
    "pc": 29.07,
    "tc": 67.33
   },
   "requirements_full": "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."
  },
  {
   "code": "71110",
   "type": "CPT",
   "category": "Radiology",
   "description": "Ribs, both sides, 3 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 98.7,
    "pc": 30.6,
    "tc": 68.09
   },
   "requirements_full": "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."
  },
  {
   "code": "71111",
   "type": "CPT",
   "category": "Radiology",
   "description": "Ribs, both sides, including a chest view, 4 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 117.83,
    "pc": 34.43,
    "tc": 83.4
   },
   "requirements_full": "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."
  },
  {
   "code": "72020",
   "type": "CPT",
   "category": "Radiology",
   "description": "Single view of the spine, any one region (e.g., lateral cervical follow-up)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "Not billable in addition to a regional series that includes that view.",
   "wc_note": "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)).",
   "fee": {
    "amount": 54.32,
    "pc": 17.6,
    "tc": 36.72
   },
   "requirements_full": "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."
  },
  {
   "code": "72040",
   "type": "CPT",
   "category": "Radiology",
   "description": "Cervical spine, 2 or 3 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 91.05,
    "pc": 23.72,
    "tc": 67.33
   },
   "requirements_full": "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."
  },
  {
   "code": "72050",
   "type": "CPT",
   "category": "Radiology",
   "description": "Cervical spine, 4 or 5 views (e.g., AP, lateral, obliques, open-mouth)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 126.24,
    "pc": 29.84,
    "tc": 96.4
   },
   "requirements_full": "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."
  },
  {
   "code": "72052",
   "type": "CPT",
   "category": "Radiology",
   "description": "Cervical spine, 6 or more views (adds flexion/extension)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 143.84,
    "pc": 32.9,
    "tc": 110.94
   },
   "requirements_full": "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."
  },
  {
   "code": "72070",
   "type": "CPT",
   "category": "Radiology",
   "description": "Thoracic spine, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 75.74,
    "pc": 22.19,
    "tc": 53.56
   },
   "requirements_full": "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."
  },
  {
   "code": "72072",
   "type": "CPT",
   "category": "Radiology",
   "description": "Thoracic spine, 3 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 88.75,
    "pc": 23.72,
    "tc": 65.03
   },
   "requirements_full": "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."
  },
  {
   "code": "72074",
   "type": "CPT",
   "category": "Radiology",
   "description": "Thoracic spine, 4 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 100.99,
    "pc": 26.01,
    "tc": 74.98
   },
   "requirements_full": "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."
  },
  {
   "code": "72080",
   "type": "CPT",
   "category": "Radiology",
   "description": "Thoracolumbar junction, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 80.34,
    "pc": 22.95,
    "tc": 57.38
   },
   "requirements_full": "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."
  },
  {
   "code": "72081",
   "type": "CPT",
   "category": "Radiology",
   "description": "Full-spine (scoliosis) study, 1 view",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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)).",
   "fee": {
    "amount": 101.76,
    "pc": 29.07,
    "tc": 72.68
   },
   "requirements_full": "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."
  },
  {
   "code": "72082",
   "type": "CPT",
   "category": "Radiology",
   "description": "Full-spine (scoliosis) study, 2 or 3 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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)).",
   "fee": {
    "amount": 164.5,
    "pc": 34.43,
    "tc": 130.07
   },
   "requirements_full": "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."
  },
  {
   "code": "72083",
   "type": "CPT",
   "category": "Radiology",
   "description": "Full-spine (scoliosis) study, 4 or 5 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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)).",
   "fee": {
    "amount": 182.86,
    "pc": 39.02,
    "tc": 143.84
   },
   "requirements_full": "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."
  },
  {
   "code": "72084",
   "type": "CPT",
   "category": "Radiology",
   "description": "Full-spine (scoliosis) study, 6 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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)).",
   "fee": {
    "amount": 226.47,
    "pc": 45.14,
    "tc": 181.33
   },
   "requirements_full": "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."
  },
  {
   "code": "72100",
   "type": "CPT",
   "category": "Radiology",
   "description": "Lumbosacral spine, 2 or 3 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 91.81,
    "pc": 23.72,
    "tc": 68.09
   },
   "requirements_full": "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."
  },
  {
   "code": "72110",
   "type": "CPT",
   "category": "Radiology",
   "description": "Lumbosacral spine, 4 or more views (adds obliques/spot)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 122.42,
    "pc": 29.07,
    "tc": 93.34
   },
   "requirements_full": "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."
  },
  {
   "code": "72114",
   "type": "CPT",
   "category": "Radiology",
   "description": "Lumbosacral spine complete study with bending views, 6 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "Includes the bending views; do not add 72120 or 72110.",
   "wc_note": "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)).",
   "fee": {
    "amount": 141.54,
    "pc": 32.9,
    "tc": 108.64
   },
   "requirements_full": "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."
  },
  {
   "code": "72120",
   "type": "CPT",
   "category": "Radiology",
   "description": "Lumbosacral spine bending views only, 2 or 3 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 96.4,
    "pc": 24.48,
    "tc": 71.92
   },
   "requirements_full": "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."
  },
  {
   "code": "72170",
   "type": "CPT",
   "category": "Radiology",
   "description": "Pelvis, 1 or 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 64.27,
    "pc": 19.13,
    "tc": 45.14
   },
   "requirements_full": "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."
  },
  {
   "code": "72190",
   "type": "CPT",
   "category": "Radiology",
   "description": "Pelvis, 3 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 99.46,
    "pc": 28.31,
    "tc": 71.15
   },
   "requirements_full": "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."
  },
  {
   "code": "72200",
   "type": "CPT",
   "category": "Radiology",
   "description": "Sacroiliac joints, fewer than 3 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 77.28,
    "pc": 19.13,
    "tc": 58.15
   },
   "requirements_full": "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."
  },
  {
   "code": "72202",
   "type": "CPT",
   "category": "Radiology",
   "description": "Sacroiliac joints, 3 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 88.75,
    "pc": 23.72,
    "tc": 65.03
   },
   "requirements_full": "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."
  },
  {
   "code": "72220",
   "type": "CPT",
   "category": "Radiology",
   "description": "Sacrum and coccyx, 2 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 73.45,
    "pc": 19.13,
    "tc": 54.32
   },
   "requirements_full": "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."
  },
  {
   "code": "73000",
   "type": "CPT",
   "category": "Radiology",
   "description": "Clavicle, complete study",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 76.51,
    "pc": 18.36,
    "tc": 58.15
   },
   "requirements_full": "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."
  },
  {
   "code": "73010",
   "type": "CPT",
   "category": "Radiology",
   "description": "Scapula, complete study",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 57.38,
    "pc": 20.66,
    "tc": 36.72
   },
   "requirements_full": "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."
  },
  {
   "code": "73020",
   "type": "CPT",
   "category": "Radiology",
   "description": "Shoulder, 1 view",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 49.73,
    "pc": 16.83,
    "tc": 32.9
   },
   "requirements_full": "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."
  },
  {
   "code": "73030",
   "type": "CPT",
   "category": "Radiology",
   "description": "Shoulder, 2 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 81.87,
    "pc": 20.66,
    "tc": 61.21
   },
   "requirements_full": "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."
  },
  {
   "code": "73050",
   "type": "CPT",
   "category": "Radiology",
   "description": "X-ray of both acromioclavicular joints, with or without weights",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 69.62,
    "pc": 21.42,
    "tc": 48.2
   },
   "requirements_full": "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."
  },
  {
   "code": "73060",
   "type": "CPT",
   "category": "Radiology",
   "description": "Humerus, 2 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 73.45,
    "pc": 18.36,
    "tc": 55.09
   },
   "requirements_full": "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."
  },
  {
   "code": "73070",
   "type": "CPT",
   "category": "Radiology",
   "description": "Elbow, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 67.33,
    "pc": 18.36,
    "tc": 48.97
   },
   "requirements_full": "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."
  },
  {
   "code": "73080",
   "type": "CPT",
   "category": "Radiology",
   "description": "Elbow, 3 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 75.74,
    "pc": 19.13,
    "tc": 56.62
   },
   "requirements_full": "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."
  },
  {
   "code": "73090",
   "type": "CPT",
   "category": "Radiology",
   "description": "Forearm, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 66.56,
    "pc": 17.6,
    "tc": 48.97
   },
   "requirements_full": "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."
  },
  {
   "code": "73100",
   "type": "CPT",
   "category": "Radiology",
   "description": "Wrist, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 78.81,
    "pc": 19.13,
    "tc": 59.68
   },
   "requirements_full": "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."
  },
  {
   "code": "73110",
   "type": "CPT",
   "category": "Radiology",
   "description": "Wrist, 3 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 97.93,
    "pc": 19.89,
    "tc": 78.04
   },
   "requirements_full": "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."
  },
  {
   "code": "73120",
   "type": "CPT",
   "category": "Radiology",
   "description": "Hand, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 71.92,
    "pc": 18.36,
    "tc": 53.56
   },
   "requirements_full": "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."
  },
  {
   "code": "73130",
   "type": "CPT",
   "category": "Radiology",
   "description": "Hand, 3 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 87.99,
    "pc": 19.89,
    "tc": 68.09
   },
   "requirements_full": "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."
  },
  {
   "code": "73140",
   "type": "CPT",
   "category": "Radiology",
   "description": "Finger(s), 2 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 90.28,
    "pc": 15.3,
    "tc": 74.98
   },
   "requirements_full": "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."
  },
  {
   "code": "73501",
   "type": "CPT",
   "category": "Radiology",
   "description": "X-ray of one hip, 1 view, pelvis included if taken",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "Includes the pelvis view when taken; do not add 72170/72190.",
   "wc_note": "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)).",
   "fee": {
    "amount": 77.28,
    "pc": 20.66,
    "tc": 56.62
   },
   "requirements_full": "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."
  },
  {
   "code": "73502",
   "type": "CPT",
   "category": "Radiology",
   "description": "X-ray of one hip, 2 or 3 views, pelvis included if taken",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "Includes the pelvis view when taken; do not add 72170/72190.",
   "wc_note": "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)).",
   "fee": {
    "amount": 111.7,
    "pc": 24.48,
    "tc": 87.22
   },
   "requirements_full": "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."
  },
  {
   "code": "73503",
   "type": "CPT",
   "category": "Radiology",
   "description": "X-ray of one hip, 4 or more views, pelvis included if taken",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "Includes the pelvis view when taken; do not add 72170/72190.",
   "wc_note": "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)).",
   "fee": {
    "amount": 143.84,
    "pc": 30.6,
    "tc": 113.23
   },
   "requirements_full": "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."
  },
  {
   "code": "73521",
   "type": "CPT",
   "category": "Radiology",
   "description": "X-ray of both hips, 2 views, pelvis included if taken",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "Includes the pelvis view when taken; do not add 72170/72190.",
   "wc_note": "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)).",
   "fee": {
    "amount": 96.4,
    "pc": 24.48,
    "tc": 71.92
   },
   "requirements_full": "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."
  },
  {
   "code": "73522",
   "type": "CPT",
   "category": "Radiology",
   "description": "X-ray of both hips, 3 or 4 views, pelvis included if taken",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "Includes the pelvis view when taken; do not add 72170/72190.",
   "wc_note": "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)).",
   "fee": {
    "amount": 124.71,
    "pc": 32.13,
    "tc": 92.58
   },
   "requirements_full": "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."
  },
  {
   "code": "73523",
   "type": "CPT",
   "category": "Radiology",
   "description": "X-ray of both hips, 5 or more views, pelvis included if taken",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": "Includes the pelvis view when taken; do not add 72170/72190.",
   "wc_note": "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)).",
   "fee": {
    "amount": 140.78,
    "pc": 33.66,
    "tc": 107.11
   },
   "requirements_full": "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."
  },
  {
   "code": "73552",
   "type": "CPT",
   "category": "Radiology",
   "description": "Femur, 2 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 81.87,
    "pc": 19.89,
    "tc": 61.97
   },
   "requirements_full": "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."
  },
  {
   "code": "73560",
   "type": "CPT",
   "category": "Radiology",
   "description": "Knee, 1 or 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 78.81,
    "pc": 18.36,
    "tc": 60.44
   },
   "requirements_full": "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."
  },
  {
   "code": "73562",
   "type": "CPT",
   "category": "Radiology",
   "description": "Knee, 3 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 97.17,
    "pc": 21.42,
    "tc": 75.74
   },
   "requirements_full": "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."
  },
  {
   "code": "73564",
   "type": "CPT",
   "category": "Radiology",
   "description": "Knee, complete study, 4 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 113.23,
    "pc": 25.25,
    "tc": 87.99
   },
   "requirements_full": "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."
  },
  {
   "code": "73565",
   "type": "CPT",
   "category": "Radiology",
   "description": "Both knees, standing AP view",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 96.4,
    "pc": 19.13,
    "tc": 77.28
   },
   "requirements_full": "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."
  },
  {
   "code": "73590",
   "type": "CPT",
   "category": "Radiology",
   "description": "Tibia and fibula, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 71.92,
    "pc": 17.6,
    "tc": 54.32
   },
   "requirements_full": "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."
  },
  {
   "code": "73600",
   "type": "CPT",
   "category": "Radiology",
   "description": "Ankle, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 74.21,
    "pc": 18.36,
    "tc": 55.85
   },
   "requirements_full": "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."
  },
  {
   "code": "73610",
   "type": "CPT",
   "category": "Radiology",
   "description": "Ankle, 3 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 84.93,
    "pc": 19.13,
    "tc": 65.8
   },
   "requirements_full": "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."
  },
  {
   "code": "73620",
   "type": "CPT",
   "category": "Radiology",
   "description": "Foot, 2 views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 65.8,
    "pc": 17.6,
    "tc": 48.2
   },
   "requirements_full": "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."
  },
  {
   "code": "73630",
   "type": "CPT",
   "category": "Radiology",
   "description": "Foot, complete study, 3 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 78.04,
    "pc": 18.36,
    "tc": 59.68
   },
   "requirements_full": "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."
  },
  {
   "code": "73650",
   "type": "CPT",
   "category": "Radiology",
   "description": "Heel bone (calcaneus), 2 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 65.03,
    "pc": 17.6,
    "tc": 47.44
   },
   "requirements_full": "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."
  },
  {
   "code": "73660",
   "type": "CPT",
   "category": "Radiology",
   "description": "Toe(s), 2 or more views",
   "requirements": "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",
   "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)"
   ],
   "units": "Per study (1 unit); the code encodes the number of views taken",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 65.8,
    "pc": 14.54,
    "tc": 51.26
   },
   "requirements_full": "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."
  },
  {
   "code": "76881",
   "type": "CPT",
   "category": "Radiology",
   "description": "Complete diagnostic ultrasound of a joint, real-time with image documentation",
   "requirements": "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)",
   "modifiers": [
    "26 / TC if split",
    "RT/LT",
    "GY on Medicare"
   ],
   "units": "Per joint/study",
   "scope_note": "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.",
   "bundling_note": "Not billable with 97035 therapeutic ultrasound as a diagnostic study.",
   "wc_note": "Oregon WC: imaging other than plain films requires a written preauthorization request.",
   "fee": {
    "amount": 123.18,
    "pc": 97.93,
    "tc": 25.25
   },
   "requirements_full": "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."
  },
  {
   "code": "76882",
   "type": "CPT",
   "category": "Radiology",
   "description": "Limited diagnostic ultrasound of a joint or extremity structure (e.g., single tendon)",
   "requirements": "Clinical indication documented; recorded images retained; written report of the specific structure examined; TC/26 if components split",
   "modifiers": [
    "26 / TC if split",
    "RT/LT",
    "GY on Medicare"
   ],
   "units": "Per study",
   "scope_note": "In scope for trained DCs (OBCE Diagnostic Imaging Policy); payer credentialing often required — verify.",
   "bundling_note": null,
   "wc_note": "Oregon WC: written preauthorization request required for non-plain-film imaging.",
   "fee": {
    "amount": 146.9,
    "pc": 73.45,
    "tc": 73.45
   },
   "requirements_full": "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."
  },
  {
   "code": "77080",
   "type": "CPT",
   "category": "Radiology",
   "description": "DXA bone density scan of the axial skeleton (hip, pelvis, spine)",
   "requirements": "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",
   "modifiers": [
    "TC / 26 if split",
    "GY on Medicare"
   ],
   "units": "Per study",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "Oregon WC: rarely related to a compensable injury; pre-authorization is optional but advisable for non-plain-film imaging (OAR 436-010-0230(12)).",
   "fee": {
    "amount": 90.28,
    "pc": 21.42,
    "tc": 68.86
   },
   "requirements_full": "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)."
  },
  {
   "code": "10060",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Incision and drainage of a simple abscess (boil, cyst, paronychia)",
   "requirements": "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",
   "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"
   ],
   "units": "Per lesion/procedure (10061 is complicated/multiple)",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 348.54
   },
   "requirements_full": "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.",
   "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."
  },
  {
   "code": "10120",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Removal of a subcutaneous foreign body through a simple incision",
   "requirements": "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",
   "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"
   ],
   "units": "Per procedure",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 426.4
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "11055",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Paring or cutting of a single corn or callus",
   "requirements": "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",
   "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"
   ],
   "units": "Per session (1 lesion)",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 190.11
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "11056",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Paring or cutting of 2 to 4 corns or calluses",
   "requirements": "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",
   "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"
   ],
   "units": "Per session",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 219.99
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "11057",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Paring or cutting of more than 4 corns or calluses",
   "requirements": "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",
   "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"
   ],
   "units": "Per session",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 240.81
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "11719",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Trimming of non-dystrophic nails, any number",
   "requirements": "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",
   "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"
   ],
   "units": "Per session",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 38.93
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "11720",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Debridement of 1 to 5 thickened/dystrophic nails",
   "requirements": "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",
   "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"
   ],
   "units": "Per session",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 88.72
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "11721",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Debridement of 6 or more nails",
   "requirements": "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",
   "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"
   ],
   "units": "Per session",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 122.22
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "11730",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Simple removal (avulsion) of a nail plate, partial or complete, one nail",
   "requirements": "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",
   "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"
   ],
   "units": "Per nail (11732 each additional)",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 302.37
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "12001",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Simple repair of superficial wounds (scalp, neck, trunk, limbs), 2.5 cm or less",
   "requirements": "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",
   "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"
   ],
   "units": "Per repair (sum lengths of same-classification wounds)",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 309.61
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "17110",
   "type": "CPT",
   "category": "Minor procedures",
   "description": "Destruction of benign skin lesions such as warts (not skin tags), up to 14",
   "requirements": "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",
   "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"
   ],
   "units": "Per session (up to 14 lesions; 17111 for 15+)",
   "scope_note": "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).",
   "bundling_note": "Global surgical package rules apply; an E/M for the same problem on the same day is usually bundled.",
   "wc_note": "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.",
   "fee": {
    "amount": 300.56
   },
   "requirements_full": "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.",
   "verify": "See 10060."
  },
  {
   "code": "36415",
   "type": "CPT",
   "category": "Tests & measurements",
   "description": "Routine venipuncture to collect a blood specimen",
   "requirements": "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",
   "modifiers": [
    "GY on Medicare"
   ],
   "units": "1 per encounter",
   "scope_note": "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.",
   "bundling_note": "Not billable with 36416 (capillary) for the same draw.",
   "wc_note": "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)).",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Appendix B lists no dollar amount; OAR 436-009-0040(1)(a)"
   },
   "requirements_full": "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."
  },
  {
   "code": "95851",
   "type": "CPT",
   "category": "Tests & measurements",
   "description": "Range-of-motion measurement with written report, per extremity or trunk section",
   "requirements": "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",
   "modifiers": [
    "59/XS when a payer edit pairs it with same-day E/M and the measurement is a separate service",
    "GY on Medicare"
   ],
   "units": "Per extremity or per trunk section measured",
   "scope_note": "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.",
   "bundling_note": "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.)",
   "wc_note": "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.",
   "fee": {
    "amount": 43.45
   },
   "requirements_full": "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."
  },
  {
   "code": "95852",
   "type": "CPT",
   "category": "Tests & measurements",
   "description": "Range-of-motion measurement of the hand with written report",
   "requirements": "Separate written report with measurements as for 95851; bundled into E/M and 97750 by NCCI",
   "modifiers": [
    "GY on Medicare"
   ],
   "units": "Per hand study",
   "scope_note": "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.",
   "bundling_note": "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.)",
   "wc_note": "Oregon WC: paid per Appendix B when separately documented.",
   "fee": {
    "amount": 35.65
   },
   "requirements_full": "Same documentation as 95851 — separate written report with measurements."
  },
  {
   "code": "96160",
   "type": "CPT",
   "category": "Tests & measurements",
   "description": "Patient-completed health risk questionnaire, scored and documented",
   "requirements": "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",
   "modifiers": [
    "25 on the E/M when billed together (payer-dependent)",
    "GY on Medicare"
   ],
   "units": "Per standardized instrument",
   "scope_note": "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.",
   "bundling_note": "Bundled with E/M by many payers; not with 96127/96161 same day.",
   "wc_note": "Oregon WC: no specific rule; outcome measures are expected within chart notes and are not usually paid separately.",
   "fee": {
    "amount": 5.01
   },
   "requirements_full": "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.",
   "verify": "Payer acceptance of health risk assessment codes from a chiropractic physician varies; confirm with the payer."
  },
  {
   "code": "96161",
   "type": "CPT",
   "category": "Tests & measurements",
   "description": "Caregiver-completed risk questionnaire about the patient, scored and documented",
   "requirements": "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",
   "modifiers": [
    "GY on Medicare"
   ],
   "units": "Per standardized instrument",
   "scope_note": "In scope in principle; rarely applicable to chiropractic care and rarely paid to a DC — verify.",
   "bundling_note": "Not with 96160/96127 same day; often bundled with E/M.",
   "wc_note": null,
   "fee": {
    "amount": 5.57
   },
   "requirements_full": "Caregiver completes the instrument (e.g., a parent for a pediatric patient); document instrument, score, and use. Not with 96160 on the same date.",
   "verify": "See 96160."
  },
  {
   "code": "99070",
   "type": "CPT",
   "category": "Supplies, DME & orthotics",
   "description": "Supplies used during a visit beyond what the visit normally includes",
   "requirements": "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",
   "modifiers": [
    "GY on Medicare"
   ],
   "units": "Per item (list quantity and description)",
   "scope_note": "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.",
   "bundling_note": "Ordinary in-office supplies (electrodes used during 97014, lotion for massage) are included in the procedure and not separately billable.",
   "wc_note": "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.",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Appendix B lists no dollar amount; OAR 436-009-0040(1)(a)"
   },
   "requirements_full": "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."
  },
  {
   "code": "A4556",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Electrodes, per pair (e.g., for a home TENS unit)",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 20.05,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "A4557",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Lead wires, per pair (TENS/NMES units)",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 26.19,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "A4570",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Splint (non-specific supply code)",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Not in Appendix E; OAR 436-009-0080(6)"
   },
   "requirements_full": "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."
  },
  {
   "code": "A4595",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Monthly supplies for a 2-lead TENS/NMES unit (electrodes, gel, tape, batteries)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": "Do not bill A4556/A4557 separately in a month billed with A4595 (A4595 includes them).",
   "wc_note": "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.",
   "fee": {
    "amount": 32.31,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "E0190",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Positioning cushion, pillow or wedge (e.g., cervical pillow, lumbar roll)",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Not in Appendix E; OAR 436-009-0080(6)"
   },
   "requirements_full": "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."
  },
  {
   "code": "E0191",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Heel or elbow protector, each",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 14.42,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "E0199",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Dry pressure pad for a mattress, standard size",
   "requirements": "Order and necessity documented; HCPCS with NU",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $46.30 new.",
   "fee": {
    "amount": 46.3,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "E0210",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Electric heating pad, standard",
   "requirements": "Order and necessity documented; HCPCS with NU; heating pads are DME under OAR 436-009-0080(1)",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $52.01 new.",
   "fee": {
    "amount": 52.01,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "E0215",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Electric heating pad, moist",
   "requirements": "As E0210",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $102.30 new.",
   "fee": {
    "amount": 102.3,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "E0217",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Water-circulating heat pad with pump",
   "requirements": "As E0210",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $843.38 new.",
   "fee": {
    "amount": 843.38,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "E0720",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "TENS unit, 2 leads, localized stimulation (home use)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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.",
   "fee": {
    "amount": 319.85,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "E0730",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "TENS unit, 4 or more leads, multiple nerve areas (home use)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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.",
   "fee": {
    "amount": 344.94,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "E0731",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Form-fitting conductive garment for TENS or NMES delivery",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 371.19,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "E0849",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Home cervical traction unit with a pneumatic or hydraulic force system",
   "requirements": "Report by the attending physician justifying the need for home traction (OAR 436-010-0230(13)); instructions given; HCPCS with NU or RR",
   "modifiers": [
    "NU (new)",
    "RR (rental)"
   ],
   "units": "Per item or per month",
   "scope_note": "Home traction is DME under OAR 436-009-0080(1).",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 875.52,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%; rental fixed at $98.40 per month (OAR 436-009-0080(7))"
   }
  },
  {
   "code": "E0855",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Cervical traction device with a stand or frame",
   "requirements": "As E0849",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $839.64 new; rental 10% per month.",
   "fee": {
    "amount": 839.64,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "E1399",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Miscellaneous DME not otherwise classified (e.g., home traction, foam roller)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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).",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Not in Appendix E; OAR 436-009-0080(6)"
   },
   "requirements_full": "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."
  },
  {
   "code": "L0120",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Soft foam cervical collar, prefabricated",
   "requirements": "Order and medical necessity in the note; item dispensed and fitted; HCPCS with NU modifier; usual fee billed",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": "Within scope under the Board's DME policy.",
   "bundling_note": null,
   "wc_note": "Appendix E maximum $46.52 new; used 75%; rental 10% per month.",
   "fee": {
    "amount": 46.52,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "L0140",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Semi-rigid cervical collar (Philadelphia type), prefabricated",
   "requirements": "As L0120",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $112.20 new.",
   "fee": {
    "amount": 112.2,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "L0172",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Cervical collar with a moulded rigid thermoplastic frame, prefabricated",
   "requirements": "As L0120",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $180.25 new.",
   "fee": {
    "amount": 180.25,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "L0174",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Cervical collar with thoracic extension, semi-rigid, prefabricated",
   "requirements": "As L0120",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $379.50 new.",
   "fee": {
    "amount": 379.5,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "L0450",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Flexible TLSO, upper thoracic trunk support, prefabricated off-the-shelf",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 233.87,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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.",
   "verify": "Descriptor paraphrased from partial sources; confirm against the 2026 HCPCS file."
  },
  {
   "code": "L0454",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Flexible TLSO from sacrococcygeal junction to above T-9, prefabricated off-the-shelf",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 475.92,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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.",
   "verify": "Descriptor paraphrased from partial sources; confirm against the 2026 HCPCS file."
  },
  {
   "code": "L0456",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Flexible TLSO with rigid posterior panel, prefabricated off-the-shelf",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 1364.78,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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.",
   "verify": "Descriptor paraphrased from partial sources; confirm against the 2026 HCPCS file."
  },
  {
   "code": "L0625",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Flexible lumbar orthosis (soft binder type), L-1 to below L-5, prefabricated OTS",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 62.27,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L0626",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Lumbar orthosis, rigid posterior panel(s), sagittal control, custom-fitted",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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.",
   "fee": {
    "amount": 106.94,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L0627",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Lumbar orthosis, rigid anterior and posterior panels, sagittal control, custom-fitted",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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.",
   "fee": {
    "amount": 564.08,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L0631",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "LSO, rigid anterior and posterior panels, sagittal control, custom-fitted",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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.",
   "fee": {
    "amount": 1408.7,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L0637",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "LSO, rigid front/back and lateral panels, sagittal-coronal control, custom-fitted",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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.",
   "fee": {
    "amount": 1542.34,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L0642",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Lumbar orthosis, rigid anterior and posterior panels, prefabricated OTS (OTS of L0627)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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.",
   "fee": {
    "amount": 464.7,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L0648",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "LSO, rigid anterior and posterior panels, prefabricated OTS (OTS of L0631)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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.",
   "fee": {
    "amount": 1160.51,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L0650",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "LSO, rigid front/back and lateral panels, prefabricated OTS (OTS of L0637)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "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.",
   "wc_note": "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.",
   "fee": {
    "amount": 1298.97,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L1832",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Knee brace with adjustable hinges and rigid support, prefabricated, custom-fitted",
   "requirements": "Order and necessity documented; fitting and adjustment by the office recorded; HCPCS with NU",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $799.23 new.",
   "fee": {
    "amount": 799.23,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "L1833",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Knee brace with adjustable hinges and rigid support, prefabricated, off the shelf",
   "requirements": "As L1832 without custom fitting",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $717.83 new.",
   "fee": {
    "amount": 717.83,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "L1851",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Single-upright knee brace with adjustable hinges and condylar pads, off the shelf",
   "requirements": "As L1833",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $1,035.64 new.",
   "fee": {
    "amount": 1035.64,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "L1902",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Ankle-foot orthosis, ankle gauntlet (lace-up/strap support), prefabricated OTS",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 128.68,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L1906",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Ankle-foot orthosis, multi-ligament ankle support (stirrup), prefabricated OTS",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 158.1,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L1932",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "AFO with rigid anterior tibial shell, carbon fiber, prefabricated, fitted/adjusted",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 1224.53,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L3000",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Custom foot insert molded to patient model, UCB/Berkeley shell type, each",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "Casting is included; do not bill 29799 or 97760 for the cast/scan. Dispensing/fitting time is included.",
   "wc_note": "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.",
   "fee": {
    "amount": 431.06,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L3010",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Custom foot insert molded to patient model with longitudinal arch support, each",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "Casting is included; do not bill 29799 or 97760 for the cast/scan. Dispensing/fitting time is included.",
   "wc_note": "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.",
   "fee": {
    "amount": 239.14,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L3020",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Custom foot insert molded to patient model, longitudinal and metatarsal support, each",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "Casting is included; do not bill 29799 or 97760 for the cast/scan. Dispensing/fitting time is included.",
   "wc_note": "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.",
   "fee": {
    "amount": 272.24,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L3030",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Foot insert formed directly to the patient's foot, each",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": "Casting is included; do not bill 29799 or 97760 for the cast/scan. Dispensing/fitting time is included.",
   "wc_note": "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.",
   "fee": {
    "amount": 104.73,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L3660",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Shoulder orthosis, figure-of-eight clavicle strap, canvas/webbing, prefabricated OTS",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 132.21,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L3670",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Shoulder orthosis, acromioclavicular support, canvas/webbing, prefabricated OTS",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 151.21,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L3807",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Wrist-hand-finger splint without joints, prefabricated, custom-fitted",
   "requirements": "Order and necessity documented; fitting recorded; HCPCS with NU",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $312.28 new.",
   "fee": {
    "amount": 312.28,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "L3809",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Wrist-hand-finger splint without joints, prefabricated, off the shelf",
   "requirements": "As L3807 without custom fitting",
   "modifiers": [
    "NU (new)"
   ],
   "units": "Per item",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "Appendix E maximum $312.28 new.",
   "fee": {
    "amount": 312.28,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   }
  },
  {
   "code": "L3908",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Wrist-hand orthosis, wrist extension cock-up splint, non-molded, prefabricated OTS",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 102.75,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L3914",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Wrist-hand orthosis, cock-up type, prefabricated custom-fitted (verify descriptor)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Not in Appendix E; OAR 436-009-0080(6)"
   },
   "requirements_full": "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.",
   "verify": "The HCPCS descriptor for this code has been revised and sources disagree on the current wording; check the 2026 HCPCS file."
  },
  {
   "code": "L3923",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Hand-finger orthosis without joints, prefabricated, custom-fitted",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 122.99,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L3960",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Shoulder-elbow-wrist-hand abduction ('airplane') orthosis, prefabricated, fitted",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 1063.06,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L4360",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Pneumatic/vacuum walking boot, prefabricated, custom-fitted",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 485.33,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L4361",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Pneumatic/vacuum walking boot, prefabricated off-the-shelf",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 485.33,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L4386",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Non-pneumatic walking boot, prefabricated, custom-fitted",
   "requirements": "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",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 217.54,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "L4387",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Non-pneumatic walking boot, prefabricated off-the-shelf",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); bilateral foot inserts = 2 units or RT/LT",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": 217.54,
    "basis": "Appendix E (DMEPOS), new purchase; used 75%, rental 10% per month"
   },
   "requirements_full": "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."
  },
  {
   "code": "S8450",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Prefabricated finger splint (specify digit with F-modifier)",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Not in Appendix E; OAR 436-009-0080(6)"
   },
   "requirements_full": "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."
  },
  {
   "code": "S8451",
   "type": "HCPCS",
   "category": "Supplies, DME & orthotics",
   "description": "Prefabricated wrist or ankle splint",
   "requirements": "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)",
   "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)"
   ],
   "units": "Per item (each); rentals per month with RR",
   "scope_note": "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.",
   "bundling_note": null,
   "wc_note": "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.",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Not in Appendix E; OAR 436-009-0080(6)"
   },
   "requirements_full": "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."
  },
  {
   "code": "99071",
   "type": "CPT",
   "category": "Reports & administrative",
   "description": "Educational supplies (books, pamphlets, videos) given to the patient at cost",
   "requirements": "Document the item and its cost; rarely covered, usually patient-pay",
   "modifiers": [
    "None"
   ],
   "units": "Per item",
   "scope_note": "In scope; almost never reimbursed by insurers.",
   "bundling_note": null,
   "wc_note": "Oregon WC: not a listed service; unlikely to be paid.",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Appendix B lists no dollar amount; OAR 436-009-0040(1)(a)"
   },
   "requirements_full": "Document the item and its cost; rarely covered — usually patient-pay."
  },
  {
   "code": "99072",
   "type": "CPT",
   "category": "Reports & administrative",
   "description": "Extra supplies and staff time during a declared respiratory public-health emergency",
   "requirements": "Only during a declared PHE; COVID-19 PHE ended May 11, 2023, so not billable now; verify current status before use",
   "modifiers": [
    "None"
   ],
   "units": "1 per visit during an applicable PHE",
   "scope_note": "Not currently applicable; retained for reference only.",
   "bundling_note": "Was not payable by Medicare even during the PHE.",
   "wc_note": null,
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Appendix B lists no dollar amount; OAR 436-009-0040(1)(a)"
   },
   "requirements_full": "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."
  },
  {
   "code": "99080",
   "type": "CPT",
   "category": "Reports & administrative",
   "description": "Special report or form beyond the usual record (narrative, disability/RTW paperwork)",
   "requirements": "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",
   "modifiers": [
    "None"
   ],
   "units": "Per report (some payers accept units of time; document minutes)",
   "scope_note": "In scope; payment is payer-specific. Medicare does not pay it.",
   "bundling_note": "Not payable for the standard chart note that Oregon WC requires to accompany every bill.",
   "wc_note": "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.",
   "fee": {
    "amount": null,
    "text": "80% of usual fee",
    "basis": "Appendix B lists no dollar amount; OAR 436-009-0040(1)(a)"
   },
   "requirements_full": "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."
  },
  {
   "code": "99358",
   "type": "CPT",
   "category": "Reports & administrative",
   "description": "Prolonged non-face-to-face service on a non-visit day (e.g., record review), first hour",
   "requirements": "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",
   "modifiers": [
    "None"
   ],
   "units": "1 unit per date (30-74 minutes)",
   "scope_note": "In scope; check payer — Medicare/Medicare Advantage: not payable.",
   "bundling_note": "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.",
   "wc_note": "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).",
   "fee": {
    "amount": 197.73
   },
   "requirements_full": "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."
  },
  {
   "code": "99359",
   "type": "CPT",
   "category": "Reports & administrative",
   "description": "Prolonged non-face-to-face service, each additional 30 min beyond the first hour",
   "requirements": "Add-on to 99358 on the same date; document total time",
   "modifiers": [
    "None"
   ],
   "units": "Each additional 30 minutes (add-on)",
   "scope_note": "Same as 99358 (Medicare invalid).",
   "bundling_note": "Cannot be reported without 99358.",
   "wc_note": "Same as 99358.",
   "fee": {
    "amount": 84.12
   },
   "requirements_full": "Add-on to 99358 on the same date; document total time."
  },
  {
   "code": "98000",
   "type": "CPT",
   "category": "Telehealth",
   "description": "New patient audio-video telehealth visit, straightforward decision making or 15 min",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 164.05
   },
   "requirements_full": "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."
  },
  {
   "code": "98001",
   "type": "CPT",
   "category": "Telehealth",
   "description": "New patient audio-video telehealth visit, low complexity or 30 min",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 256.64
   },
   "requirements_full": "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."
  },
  {
   "code": "98002",
   "type": "CPT",
   "category": "Telehealth",
   "description": "New patient audio-video telehealth visit, moderate complexity or 45 min",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 387.15
   },
   "requirements_full": "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."
  },
  {
   "code": "98003",
   "type": "CPT",
   "category": "Telehealth",
   "description": "New patient audio-video telehealth visit, high complexity or 60 min",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 516.93
   },
   "requirements_full": "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."
  },
  {
   "code": "98004",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Established patient audio-video telehealth visit, straightforward or 10 min",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 129.78
   },
   "requirements_full": "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."
  },
  {
   "code": "98005",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Established patient audio-video telehealth visit, low complexity or 20 min",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 207.79
   },
   "requirements_full": "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."
  },
  {
   "code": "98006",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Established patient audio-video telehealth visit, moderate complexity or 30 min",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 296.01
   },
   "requirements_full": "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."
  },
  {
   "code": "98007",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Established patient audio-video telehealth visit, high complexity or 40 min",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 419.96
   },
   "requirements_full": "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."
  },
  {
   "code": "98008",
   "type": "CPT",
   "category": "Telehealth",
   "description": "New patient audio-only telehealth visit, straightforward (over 10 min discussion)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 164.05
   },
   "requirements_full": "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)."
  },
  {
   "code": "98009",
   "type": "CPT",
   "category": "Telehealth",
   "description": "New patient audio-only telehealth visit, low complexity",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 256.64
   },
   "requirements_full": "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)."
  },
  {
   "code": "98010",
   "type": "CPT",
   "category": "Telehealth",
   "description": "New patient audio-only telehealth visit, moderate complexity",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 387.15
   },
   "requirements_full": "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)."
  },
  {
   "code": "98011",
   "type": "CPT",
   "category": "Telehealth",
   "description": "New patient audio-only telehealth visit, high complexity",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 516.93
   },
   "requirements_full": "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)."
  },
  {
   "code": "98012",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Established patient audio-only telehealth visit, straightforward (over 10 min)",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 129.78
   },
   "requirements_full": "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)."
  },
  {
   "code": "98013",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Established patient audio-only telehealth visit, low complexity",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 207.79
   },
   "requirements_full": "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)."
  },
  {
   "code": "98014",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Established patient audio-only telehealth visit, moderate complexity",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 296.01
   },
   "requirements_full": "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)."
  },
  {
   "code": "98015",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Established patient audio-only telehealth visit, high complexity",
   "requirements": "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",
   "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)"
   ],
   "units": "Per visit (1 per date)",
   "scope_note": "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).",
   "bundling_note": "Not reportable with 98016 or with an in-person E/M on the same date for the same problem.",
   "wc_note": "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.",
   "fee": {
    "amount": 419.96
   },
   "requirements_full": "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)."
  },
  {
   "code": "98016",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Brief 5-10 min patient-initiated virtual check-in to decide if a visit is needed",
   "requirements": "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",
   "modifiers": [
    "POS 02/10",
    "GY on Medicare (DC-furnished)"
   ],
   "units": "Per check-in (1 per 7 days)",
   "scope_note": "In scope under the OBCE telehealth policy for established patients.",
   "bundling_note": "Bundled if related to an E/M within 7 days before or 24 hours after.",
   "wc_note": "Oregon WC: telehealth (non-telemedicine) services use POS 02/10 without modifier 95 (OAR 436-009-0012(3)(b)).",
   "fee": {
    "amount": 37.91
   },
   "requirements_full": "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)."
  },
  {
   "code": "98966",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Telephone assessment by a qualified non-physician professional, 5 to 10 minutes",
   "requirements": "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",
   "modifiers": [
    "No modifier 95",
    "POS 02 or 10"
   ],
   "units": "Per call",
   "scope_note": "Physician telephone codes 99441 to 99443 were deleted in 2025; the audio-only E/M codes 98008 to 98015 are the physician equivalents.",
   "bundling_note": null,
   "wc_note": "Priced in Appendix B ($81.18). Oregon workers' compensation: POS 02 or 10, no modifier 95 (OAR 436-009-0012(3)(b)).",
   "fee": {
    "amount": 81.18
   }
  },
  {
   "code": "98967",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Telephone assessment by a qualified non-physician professional, 11 to 20 minutes",
   "requirements": "As 98966 with 11 to 20 minutes",
   "modifiers": [
    "No modifier 95",
    "POS 02 or 10"
   ],
   "units": "Per call",
   "scope_note": "See 98966.",
   "bundling_note": null,
   "wc_note": "Priced in Appendix B ($133.82).",
   "fee": {
    "amount": 133.82
   }
  },
  {
   "code": "98968",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Telephone assessment by a qualified non-physician professional, 21 to 30 minutes",
   "requirements": "As 98966 with 21 to 30 minutes",
   "modifiers": [
    "No modifier 95",
    "POS 02 or 10"
   ],
   "units": "Per call",
   "scope_note": "See 98966.",
   "bundling_note": null,
   "wc_note": "Priced in Appendix B ($194.07).",
   "fee": {
    "amount": 194.07
   }
  },
  {
   "code": "98970",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Online digital assessment by a qualified non-physician professional, 5 to 10 minutes over 7 days",
   "requirements": "Portal-based, patient-initiated, cumulative time over seven days; written for non-physician professionals, so a chiropractic physician normally reports 99421 to 99423",
   "modifiers": [
    "No modifier 95",
    "POS 02 or 10"
   ],
   "units": "Once per 7-day period",
   "scope_note": "See 98966 on which code family applies.",
   "bundling_note": null,
   "wc_note": "Priced in Appendix B ($81.18).",
   "fee": {
    "amount": 81.18
   }
  },
  {
   "code": "98971",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Online digital assessment by a qualified non-physician professional, 11 to 20 minutes over 7 days",
   "requirements": "As 98970 with 11 to 20 minutes",
   "modifiers": [
    "No modifier 95",
    "POS 02 or 10"
   ],
   "units": "Once per 7-day period",
   "scope_note": "See 98966.",
   "bundling_note": null,
   "wc_note": "Priced in Appendix B ($133.82).",
   "fee": {
    "amount": 133.82
   }
  },
  {
   "code": "98972",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Online digital assessment by a qualified non-physician professional, 21 or more minutes over 7 days",
   "requirements": "As 98970 with 21 or more minutes",
   "modifiers": [
    "No modifier 95",
    "POS 02 or 10"
   ],
   "units": "Once per 7-day period",
   "scope_note": "See 98966.",
   "bundling_note": null,
   "wc_note": "Priced in Appendix B ($194.07).",
   "fee": {
    "amount": 194.07
   }
  },
  {
   "code": "99421",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Online digital E/M for an established patient, 5 to 10 minutes over 7 days",
   "requirements": "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",
   "modifiers": [
    "No modifier 95 (not synchronous)",
    "POS 02 or 10 on workers' compensation claims"
   ],
   "units": "Once per 7-day period",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "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)).",
   "fee": {
    "amount": 95.5
   }
  },
  {
   "code": "99422",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Online digital E/M for an established patient, 11 to 20 minutes over 7 days",
   "requirements": "As 99421 with 11 to 20 cumulative minutes",
   "modifiers": [
    "No modifier 95",
    "POS 02 or 10"
   ],
   "units": "Once per 7-day period",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "See 99421.",
   "fee": {
    "amount": 157.44
   }
  },
  {
   "code": "99423",
   "type": "CPT",
   "category": "Telehealth",
   "description": "Online digital E/M for an established patient, 21 or more minutes over 7 days",
   "requirements": "As 99421 with 21 or more cumulative minutes",
   "modifiers": [
    "No modifier 95",
    "POS 02 or 10"
   ],
   "units": "Once per 7-day period",
   "scope_note": null,
   "bundling_note": null,
   "wc_note": "See 99421.",
   "fee": {
    "amount": 228.32
   }
  }
 ],
 "oregon_codes": [
  {
   "code": "CE001",
   "description": "Closing exam: measures impairment once the worker is medically stationary.",
   "fee": null,
   "fee_text": "80% of usual fee",
   "note": "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."
  },
  {
   "code": "CR001",
   "description": "Closing report capturing the closing exam findings.",
   "fee": null,
   "fee_text": "80% of usual fee",
   "note": "Same condition as CE001. Pays 80% of the usual fee."
  },
  {
   "code": "N0001",
   "description": "Brief narrative by the attending physician: treatment to date, current status, brief answers to up to five questions.",
   "fee": 122.17,
   "fee_text": null,
   "note": "Only the attending physician or authorized nurse practitioner may bill narratives. Insurer-requested."
  },
  {
   "code": "N0002",
   "description": "Complex narrative: history, treatment, status, impairment, prognosis, medically stationary date.",
   "fee": 243.62,
   "fee_text": null,
   "note": "Same as N0001."
  },
  {
   "code": "D0019",
   "description": "Review of an independent medical exam report and written response, at the insurer's request.",
   "fee": null,
   "fee_text": "As billed",
   "note": "Paid as billed; document the time spent (OAR 436-009-0040(7)(b))."
  },
  {
   "code": "D0030",
   "description": "Consultation with the insurer, including record review time.",
   "fee": null,
   "fee_text": "As billed",
   "note": "Paid as billed; document time."
  },
  {
   "code": "D0001",
   "description": "Consultation with the insurer's attorney, including record review time.",
   "fee": null,
   "fee_text": "As billed",
   "note": "Paid as billed; document time."
  },
  {
   "code": "D0002",
   "description": "Deposition time, including preparation, travel and the deposition itself.",
   "fee": null,
   "fee_text": "As billed",
   "note": "Paid as billed. A request for pre-payment of a deposition is permitted (OAR 436-009-0010(1)(d))."
  },
  {
   "code": "R0001",
   "description": "Paper copies of medical records requested by the insurer, beyond the chart notes sent with bills.",
   "fee": null,
   "fee_text": "$10.00 + $0.50/page",
   "note": "$10.00 for the first page and $0.50 per additional page (Appendix B)."
  },
  {
   "code": "R0002",
   "description": "Electronic copies of medical records requested by the insurer.",
   "fee": 35.7,
   "fee_text": null,
   "note": "Per request."
  },
  {
   "code": "99196",
   "description": "Physical capacity evaluation, first level: musculoskeletal measures of a specific body part, usually 30 to 45 minutes.",
   "fee": 171.46,
   "fee_text": null,
   "note": "Includes the report. Usually prescribed by the attending physician and performed by a therapist; confirm with the insurer before a chiropractic office bills it."
  },
  {
   "code": "99197",
   "description": "Physical capacity evaluation, second level: residual functional capacity, usually two hours or more.",
   "fee": 571.53,
   "fee_text": null,
   "note": "Includes the report. Same caution as 99196."
  },
  {
   "code": "99198",
   "description": "Work capacity evaluation, usually four hours or more of patient contact.",
   "fee": 1143.05,
   "fee_text": null,
   "note": "Includes the report. Same caution as 99196."
  },
  {
   "code": "99193",
   "description": "Each additional 15 minutes of a PCE or WCE.",
   "fee": 57.15,
   "fee_text": null,
   "note": "Add-on to 99196, 99197 or 99198."
  },
  {
   "code": "97659",
   "description": "Job site visit, first hour including travel.",
   "fee": 122.88,
   "fee_text": null,
   "note": "Must be pre-authorised by the insurer (OAR 436-009-0060(3)(d))."
  },
  {
   "code": "97660",
   "description": "Job site visit, each additional 30 minutes.",
   "fee": 61.43,
   "fee_text": null,
   "note": "Pre-authorisation required."
  },
  {
   "code": "97661",
   "description": "Ergonomic consultation, one hour including travel.",
   "fee": 165.74,
   "fee_text": null,
   "note": "Must be pre-authorised by the insurer."
  },
  {
   "code": "D0003",
   "description": "Independent medical exam: exam, report, addendum or file review at the insurer's request.",
   "fee": null,
   "fee_text": "As billed",
   "note": "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."
  },
  {
   "code": "W0001",
   "description": "Worker requested medical exam: exam, report or record review.",
   "fee": null,
   "fee_text": "As billed",
   "note": "Paid as billed; performed by a director-selected physician, not the treating provider."
  },
  {
   "code": "Q3014",
   "description": "Telehealth originating-site facility fee when the patient is at the provider's office and a different provider is remote.",
   "fee": 35.7,
   "fee_text": null,
   "note": "Per 15 minutes or portion (OAR 436-009-0012(5)(c)). Not payable to the distant-site provider."
  }
 ],
 "excluded": [
  {
   "code": "20560",
   "name": "Dry needling, 1 or 2 muscles",
   "reason": "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."
  },
  {
   "code": "20561",
   "name": "Dry needling, 3 or more muscles",
   "reason": "Not within Oregon chiropractic scope, for the same reason as 20560."
  },
  {
   "code": "97810",
   "name": "Acupuncture without electrical stimulation, first 15 minutes",
   "reason": "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."
  },
  {
   "code": "97811",
   "name": "Acupuncture without electrical stimulation, each additional 15 minutes",
   "reason": "Same as 97810."
  },
  {
   "code": "97813",
   "name": "Acupuncture with electrical stimulation, first 15 minutes",
   "reason": "Same as 97810."
  },
  {
   "code": "97814",
   "name": "Acupuncture with electrical stimulation, each additional 15 minutes",
   "reason": "Same as 97810."
  },
  {
   "code": "20550",
   "name": "Injection, tendon sheath or ligament",
   "reason": "The Board's Out of Scope list includes joint, trigger point and nutritional injections, and Oregon DCs cannot prescribe or administer legend drugs."
  },
  {
   "code": "20552",
   "name": "Trigger point injection, 1 or 2 muscles",
   "reason": "Same as 20550."
  },
  {
   "code": "20553",
   "name": "Trigger point injection, 3 or more muscles",
   "reason": "Same as 20550."
  },
  {
   "code": "96372",
   "name": "Therapeutic injection, subcutaneous or intramuscular",
   "reason": "Same as 20550."
  },
  {
   "code": "95831",
   "name": "Manual muscle testing, extremity or trunk",
   "reason": "Deleted from CPT on 1 January 2020 (manual muscle testing is part of the E/M exam). Not in Appendix B."
  },
  {
   "code": "95832",
   "name": "Manual muscle testing, hand",
   "reason": "Deleted from CPT in 2020; see 95831."
  },
  {
   "code": "95833",
   "name": "Manual muscle testing, total body without hands",
   "reason": "Deleted from CPT in 2020; see 95831."
  },
  {
   "code": "95834",
   "name": "Manual muscle testing, total body with hands",
   "reason": "Deleted from CPT in 2020; see 95831."
  },
  {
   "code": "97161",
   "name": "Physical therapy evaluation, low complexity",
   "reason": "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."
  },
  {
   "code": "97162",
   "name": "Physical therapy evaluation, moderate complexity",
   "reason": "See 97161."
  },
  {
   "code": "97163",
   "name": "Physical therapy evaluation, high complexity",
   "reason": "See 97161."
  },
  {
   "code": "97164",
   "name": "Physical therapy re-evaluation",
   "reason": "See 97161."
  },
  {
   "code": "G0283",
   "name": "Unattended electrical stimulation (Medicare code)",
   "reason": "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."
  },
  {
   "code": "97545",
   "name": "Work hardening or conditioning, first 2 hours",
   "reason": "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."
  },
  {
   "code": "97546",
   "name": "Work hardening or conditioning, each additional hour",
   "reason": "See 97545."
  },
  {
   "code": "A9270",
   "name": "Non-covered item or service",
   "reason": "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)."
  },
  {
   "code": "99024",
   "name": "Post-operative follow-up visit within a global period",
   "reason": "A zero-charge tracking code for surgical global periods. Chiropractic manipulation and physical medicine codes have no global period, so it does not apply."
  },
  {
   "code": "99455",
   "name": "Work-related evaluation by the treating physician",
   "reason": "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."
  },
  {
   "code": "99456",
   "name": "Work-related evaluation by other than the treating physician",
   "reason": "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": [
  {
   "title": "OAR 436-009, Oregon Medical Fee and Payment Rules, Administrative Order 26-050, effective 1 April 2026 (WCD)",
   "url": "https://wcd.oregon.gov/laws/Documents/New_rules/009%2c%20010%2c%20015%2c%20035%20-%20April%201%2c%202026/9-26050-perm.pdf"
  },
  {
   "title": "Appendix B, physician fee schedule, corrected edition effective 1 April 2026 (Excel)",
   "url": "https://wcd.oregon.gov/medical/Documents/payment-tables/appendix-b/4-26-Appendix-B.xlsx"
  },
  {
   "title": "Appendix B, physician fee schedule, corrected edition effective 1 April 2026 (PDF)",
   "url": "https://wcd.oregon.gov/medical/Documents/payment-tables/appendix-b/4-26-Appendix-B.pdf"
  },
  {
   "title": "Appendix E, DMEPOS fee schedule, effective 1 April 2026 (Excel)",
   "url": "https://wcd.oregon.gov/medical/Documents/payment-tables/appendix-e/4-26-Appendix-E.xlsx"
  },
  {
   "title": "WCD medical payment tables index",
   "url": "https://wcd.oregon.gov/medical/pages/payment-tables.aspx"
  },
  {
   "title": "WCD new and proposed rules (Order 26-054 temporary and 26-060 permanent implement HB 4040)",
   "url": "https://wcd.oregon.gov/laws/pages/new-rules.aspx"
  },
  {
   "title": "OAR 436-010-0210, Attending physician and authorized nurse practitioner (Oregon Secretary of State)",
   "url": "https://secure.sos.state.or.us/oard/view.action?ruleNumber=436-010-0210"
  },
  {
   "title": "OAR 436-010-0230, Medical treatment standards (Oregon Secretary of State)",
   "url": "https://secure.sos.state.or.us/oard/view.action?ruleNumber=436-010-0230"
  },
  {
   "title": "OAR 436-010-0290, Palliative care (Oregon Secretary of State)",
   "url": "https://secure.sos.state.or.us/oard/view.action?ruleNumber=436-010-0290"
  },
  {
   "title": "ORS 656.005, Definitions, including attending physician (Oregon Legislature)",
   "url": "https://www.oregonlegislature.gov/bills_laws/ors/ors656.html"
  },
  {
   "title": "ORS 684.010, Chiropractic definitions and scope (Oregon Legislature)",
   "url": "https://www.oregonlegislature.gov/bills_laws/ors/ors684.html"
  },
  {
   "title": "WCD handbook page for chiropractic physicians",
   "url": "https://wcd.oregon.gov/medical/provider-training/handbooks/pages/chiropractors.aspx"
  },
  {
   "title": "WCD matrix for health care provider types (type A and type B), rev. April 2026",
   "url": "https://wcd.oregon.gov/medical/Documents/matrix-health-care-providers.pdf"
  },
  {
   "title": "Oregon Board of Chiropractic Examiners, Guide to Practice and Policy Questions, 22 October 2025",
   "url": "https://www.oregon.gov/obce/Documents/Scope%20of%20Practice/25-10-22_P%26P.pdf"
  },
  {
   "title": "OAR 811-015-0036 history: dry needling rule repealed 2014 (Oregon Secretary of State)",
   "url": "https://secure.sos.state.or.us/oard/view.action?ruleNumber=811-015-0036"
  },
  {
   "title": "CMS National Correct Coding Initiative edits (used by many payers; Oregon WC does not adopt CMS policies by default, OAR 436-009-0004(5)(a))",
   "url": "https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits"
  }
 ]
}