Copyright 2013 Sway Medical LLC

Reimbursement Guide Physical Performance Testing

For Balance Assessment

September 18th, 2013

The enclosed reimbursement recommendations are based on information gathered from third-party sources and is presented in this document for illustrative purposes only. This information

does not constitute reimbursement or legal advice. Sway Medical LLC makes no representation or warranty regarding this information or its completeness, accuracy, timeliness, or applicability with a particular patient. Sway Medical LLC disclaims liability or responsibility for the results or

consequences of any actions taken in reliance on information in this document.

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INTRODUCTION Sway is an innovative company focused on reinventing medical outcomes

measurements. Our mission is to advance outcomes-based patient care with

practical and sustainable medical grade mobile diagnostics that push

towards quantifiable outcomes and fit into the current reimbursement

model.

Our core product is the Sway Balance™ System,

an FDA-cleared mobile software application that

revolutionizes the way athletes and patients are

monitored for signs of musculoskeletal, neurological

and vestibular dysfunction. Health care professionals

can quickly evaluate postural stability by instructing the

patient to press the mobile device against their chest

while performing the instructed balance protocol.

Balance is measured by analyzing thoracic sway from

the mobile device motion sensors for the duration of

the protocol.

Assessment of balance has been established as

a medically necessary clinical measure for many health

conditions. Physicians can perform a balance test as a

physical performance test to evaluate patients who

show specific signs of neuromuscular dysfunction.

ICD-9 CODING Specific ICD-9 codes are required to determine medical necessity. The

most common ICD-9 Codes are listed below:

ICD-9 Description

728.2 Muscular Wasting and Disuse

781.2 Abnormality of Gait

728.85 Spasm of Muscle

728.87 Muscle Weakness

780.4 Dizziness

781.3 Lack of Coordination

719.46 Pain in Joint; Lower Leg

715.16 Osteoarthrosis, unspecified

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CPT CODING Balance assessments are physical performance tests that provide important

information on neuromuscular and vestibular function or to validate patient

progress. To properly code for a balance assessment, a physical performance

code should be used on the 1500 form with the appropriate modifier, code pairing

and documentation with a Sway Medical Report. Based on independent third part

review, Sway Medical recommends using the following coding structure for

Physicians, Physical and Occupational Therapists and Neuropsychologists.

Physicians

CPT Code

97750 – Physical Performance Test

Modifiers

No Modifier Required

Reimbursement

$32.34 National Average

Code Pairing

99201 – 99205 New Patient Evaluation 99211 – 99215 Established Patient Evaluation

Notes

Billable event ONLY if physician discusses results of the testing with the patient as a part of the evaluation.

Physical & Occupational Therapists

CPT Code

97750 – Physical Performance Test

Modifiers

GP (Physical Therapy Modifier) 52 (Reduced Services for less than 8 min)

Reimbursement

$32.34 National Average

Code Pairing 97110 Therapeutic exercise 97112 Neuromuscular Re-education

Notes

Cannot be billed with: Evaluation or Re-evaluation (97001 - 97004)

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Neuropsychologists

Performing a Sway Balance assessment in a Neuropsychology setting does

not typically include additional physical performance codes. Sway recommends

that Neuropsychologists include the Sway Balance technology into the standard

neurobehavioral exam with CPT codes 96116 or 96118. The value of Sway to the

Neuropsychologist is a reduction in the time it takes to perform a physical

performance tests as a part of the neurobehavioral exam. Sway provides an

easier and more objective tool to reduce the amount of time spent on testing

balance. REPORT REQUIREMENT

A requirement of the physical performance code 97750, is a written report

detailing the outcome of the test and specific treatment considerations as a result

of testing. Through the Sway Medical portal https://my.swaybalance.com you can

select the patient you have tested and produce a report. Provide comments in the

“Notes” section of the report and then print or export to your patient file.

 

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CONCLUSION The suggested billing recommendations are based on national Medicare standards and a third party assessment of the Sway Balance™ product. The recommendations are meant for illustrative purposes to highlight some of the known requirements in each field and are not a guarantee of claim payment. Independent insurers have both paid claims and denied the use of physical performance codes in the evaluation of patients based on the premise that performance codes should not be additional charges. It is important that providers consult with payers, reimbursement specialist and/or legal counsel regarding coding, coverage and reimbursement matters instead of solely relying on the recommendation in this guide. Sway Medical LLC encourages providers to submit accurate and appropriate claims for services. Laws, regulations and payer policies concerning reimbursement are complex and change frequently. Providers are responsible for making appropriate decisions relating to coding and reimbursement submissions.