Canalith Repositioning Code Change

For anyone who has ever suffered from vertigo—or more specifically, benign paroxysmal positional vertigo—you can attest that your life stands still while the rest of the world literally just spins around. That is why being able to see a rehab therapist to treat BPPV can be such a life-altering experience for patients. But in order for rehab therapists to continue to provide this service, they must also be able to be compensated for its delivery by using the canalith repositioning code.

When Applying Canalith Repositioning Code 95992

Canalith repositioning, a pivotal technique in vestibular rehabilitation, is coded under Current Procedural Terminology (CPT) with specific codes such as 95992. These American Medical Association (AMA) designated codes facilitate accurate billing and reimbursement for healthcare providers. In some instances, rehab therapists employ modifier 59 to distinguish distinct procedural services during a single session, ensuring proper coding integrity and clean claims. The integration of canalith repositioning within rehabilitation plans of care showcases the interdisciplinary approach to managing vestibular disorders. Health care practitioners rely on these CPT codes to streamline billing processes, enhancing transparency and efficiency in the reimbursement system. This adherence to coding standards ensures effective communication within the healthcare ecosystem, promoting quality patient care.

Since the physician fee schedule final rule in 2011, CPT code 95992, Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver) has had a status of “active”, allowing rehab therapists to submit for payment for this procedure. As WebPT is a cloud-based EMR, it is able to update its system to accommodate new rules and any code changes, and you can see these changes take effect automatically.

Since then, physical therapists have been able to bill for 95992 independently of any other codes. However, there has been some ongoing confusion about this as CMS initially assigned the code a bundled status because it believed that canalith repositioning would be paid through the evaluation and management (E/M) service that it would accompany. Because therapists do not bill E/M service codes, CMS subsequently issued guidance instructing therapists to bill using the 97112 code when providing canalith repositioning services. In the 2010 Physician Fee Schedule Final Rule, CMS changed the status of 95992 from bundled to "not recognized for payment under Medicare." Due to feedback from the provider community encouraging CMS to reconsider its decision, the agency changed the status of 95992 in CY 2011 once again to make it "active," allowing PTs to submit for payment for canalith repositioning using 95992. APTA has updated its Medicare physician fee schedule calculator to include CPT code 95992.

Another common CPT code to use in conjunction with canalith repositioning would include neuromuscular re-education (97112), but not for the actual repositioning procedure. Instead, 97112 should be utilized when completing treatment with the intent to treat ongoing balance and vestibular deficits related to the BPPV and after the repositioning procedure was done. For instance, gaze stabilization exercises and balance exercises will go a long way to improve a patient’s stability beyond the canalith repositioning to focus on vestibular function and fall prevention. Furthermore, you can complete additional training for self-care/home management training (975735) on the management of BPPV, any guidelines to follow post-treatment, and what the patient should expect to feel after the canalith repositioning procedure. 

When Addressing Ongoing Concerns

In our annual billing webinar with Heidi Jannenga, Co-Founder and Chief Clinical Officer of WebPT, and John Wallace, PT, MS, Senior Vice President of Member Value at WebPT, one viewer expressed frustration and concern over the ongoing discrepancy over whether or not the canalith repositioning code 95992 could be billed by itself. In response, Wallace stated, “Canalith repositioning can be billed by itself unless the payer has a medical policy stating otherwise — which is very rare.” 

If you or another rehab therapist is having issues with the canalith repositioning code—or any other CPT code for that matter—from a specific insurance payer, the best course of action is to directly contact that payer and express your concerns citing the aforementioned final rule changes. And if you continue to run into roadblocks, I would quote the compliance guru, Rick Gawenda, PT, President of Gawenda Seminars who in our most recent webinar on the final rule said, “Appeal, appeal, appeal.” If you have a legitimate concern—and the medical record reflects it—you should always appeal and advocate for fair payment from insurance payers.