Does S9117 require prior authorization?

No, S9117 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for S9117?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S9117`, Back school, per visit

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Physician prescription/order for back school or physical therapy program (program must be prescribed by the member's doctor).
Evidence that the back school program is conducted by a physical therapist or other appropriate recognized healthcare professional.

Documentation that isokinetic/exercise/testing machines are used as part of medically necessary physical therapy (i.e., justification that device use is integral to the course of PT and medically necessary).

Documentation that manual muscle testing using hand-held dynamometer is part of the manual muscle testing exam (note: hand-held dynamometer measurements are considered integral to manual muscle testing and are not separately reimbursed).

Key Coverage Criteria

Covered ICD-10 diagnosis range for these interventions: "M54.00 - M54.9 Dorsalgia."
Back school is medically necessary for the treatment of persons with chronic or recurrent back pain when prescribed by the member’s doctor and the program is conducted by a physical therapist or other appropriate recognized healthcare professional.
Isokinetic devices (e.g., Biodex, Cybex, Kin-Com) and other exercise and testing machines (e.g., Isostation B-2000 and MedX) are considered acceptable alternatives for provision of medically necessary exercise in physical therapy (can be used for muscle testing and/or administering exercise therapy).
Therapeutic procedures and manual therapy CPT codes (97110, 97140) are covered when criteria are met.
Therapeutic activities CPT code 97530 is covered when criteria are met (note: not covered when used for Khan Kinetic Treatment).
HCPCS S9117 (Back school, per visit) is covered if selection criteria are met.

4 Active Policies

AETNA-CPB-0232, Back Pain - Noninvasive Treatments

AETNA-CPB-0198, Work Hardening Programs

CIGNA-CPG278, Chiropractic Care

CIGNA-CPG155, Occupational Therapy

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S9117, Back school, per visit