Vasopneumatic Device Modality

Effective Date: 08/13/2020

Responsible Department: Medical Services

Revised Date: 09/11/2020 

Reviewed Date: 09/11/2020

Introduction

Workforce Safety & Insurance (WSI) has adopted the documentation standards from the American Physical Therapy Association’s Guidelines: Physical Therapy Documentation of Patient/Client Management and will only reimburse a therapy service supported by the medical documentation. See Physical and Occupational Therapy Documentation Medical Policy. The purpose of this document is to establish the criteria WSI requires for reimbursement of a Vasopneumatic Device Modality (CPT® 97016).

 

Policy 

For a charge of CPT® 97016, WSI will audit submitted medical documentation for the following:

  • Application required the unique skills of a qualified clinician
    • Evaluation of the patient’s condition to determine the medical necessity of the device, e.g., the type and amount of edema
    • Treatment parameters which must include:
      • Specific level of pressure in mmHg
      • Duration of use
  • Pre- and post-girth measurements
  • Area of the body receiving treatment
  • Device used for treatment
    • Must have different compartments with adjustable settings Units with low, medium or high settings are not reimbursable 

The Vasopneumatic Device Modality is a supervised modality, so a provider may only report it once per visit, regardless of the number of treated areas or time spent. 

WSI will deny reimbursement if the submitted documentation does not meet the criteria outlined in this policy. 

 

References 

CMS Internet Only Manual, Publication 100-2, Chapter 15, Section 220.2 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf. Last accessed on 7/15/2020 

Coding and Payment Guide for the Physical Therapist 2010. Ingenix Inc; 2009. 

U.S. Centers for Medicare & Medicaid Services (CMS). (2002, January 14). National Coverage Determination (NCD) for Pneumatic Compression Devices. https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=225&ncdver=1&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=A ll&CptHcpcsCode=e0675&bc=gAAAABAAAAAAAA%3d%3d&. Last accessed 7/15/2020.