UR-Chiro Form Revised
WSI recently revised the UR-Chiro form and providers should use the revised form effective immediately.
Changes to the new form include the following:
- General wording changes
- Requested treatment and modality procedures now require indication of the specific CPT code(s). Below is an excerpt of the new UR-Chiro form that displays revised requested information in a mock example.
- The number of modalities section should match the number of CPT codes listed for modalities. For example, if a provider checks “1” modality per visit, the provider should only list one CPT modality code, e.g. 97014
- Treatment codes include manipulative treatment codes 98940-98943
- Modality codes include the following:
- Supervised (untimed) CPT codes 97010-97028
- Constant Attendance (timed) CPT codes 97032-97039
- Therapeutic Procedures (timed) CPT codes 97110-97546
- A new question has been incorporated to inquire if the patient is receiving physical or occupational therapy as indicated in the below excerpt.
Complete the UR-Chiro form in its entirety, as WSI will return incomplete forms back to the provider.