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Notice of HIPAA Code Conversion for Physical and Occupational Therapy Services

March 4, 2019

The physical and occupational therapy services code conversion replaces non-HIPAA-compliant HCPCS Level III codes, commonly referred to as local codes, with HIPAA-compliant CPT or HCPCS Level II national codes. HIPAA mandated these changes to billing requirements for physical and occupational therapy services.

Effective for dates of service on or after August 1, 2019, providers will bill claims using the following:

  • CPT or HCPCS Level II national code(s);
  • CPT or HCPCS Level II national code(s) with modifier(s);
  • Revenue code and CPT or HCPCS Level II code(s) or
  • Revenue code and CPT or HCPCS Level II code(s) with modifier(s).

Billing Instructions and Frequently Asked Questions (FAQs) will be available soon in the Physical and Occupational Therapy Services section of the HIPAA: Code Conversions web page. Additional information for this project will publish as details are determined.

Providers are encouraged to:

Providers may request additional onsite or telephone support via the Telephone Service Center (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Border providers and out-of-state billers billing for in-state providers call (916) 636-1200. Providers calling from outside of California call the Out-of-State Provider Unit at (916) 636-1960.

For electronic claim submission questions, providers may contact the TSC at 1-800-541-5555, select option 4 for the Technical Help Desk and option 2 for Computer Media Claims (CMC).

All other questions about the physical and occupational therapy services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.