Unique Plan Description: PT OT ST General Clinic
Plan Selection Display: PT OT ST General Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-04 20:04:02
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-06 10:49:12
Available at all facilities: No

PT OT ST General Clinic
Consults/Follow-up
	Follow-up Appointment
		Follow Up Visit, 1 week
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 1 month
		Follow Up Visit, 3 months
		Follow Up Visit, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, See Special Instructions
Charges/Supplies
	Ankle AFO Splint
		T;N, Routine
	Arch Support - Flatfoot Insole
		
	Benik Elbow Strap
		
	Neoprene/Elastic Wrist Splint
		T;N, Routine
	Cubital tunnel elbow splint
		T;N, Routine
	Custom Dynamic E/W/H Splint
		
	Custom Dynamic H/F Splint
		
	Custom Dynamic W/H Splint
		
	Custom Dynamic W/H/F Splint
		
	Custom static E/W/H splint
		T;N, Routine
	Custom static elbow splint
		T;N, Routine
	Custom static finger splin
		T;N, Routine
	Custom Static H/F Splint -
		
	Custom static W/H splint
		T;N, Routine
	Custom static W/H/F/splint
		T;N, Routine
	Edema Glove
		
	Heel/Elbow Flotation Pad, pr
		T;N, Routine
	Adjustable Heel Lift
		T;N, Routine
	Resting Hand Splint
		
	Maternity Belt
		
	Rolyan D-Ring Wrist Brace
		T;N, Routine
	Podus Boot with Strap
		
	Serola SI Belt
		
	Finger splint; spring type
		T;N, Routine
Procedures in Office
		Modalities Supervised(NOTE)*
	97014 Apply electrical stimulation (unattended)
		
		Modalities Constant Attendance(NOTE)*
	97032 Apply electrical stimulation/15min
		
	97532 Cognitive skills development/15min
		
	97535 Self-care mgmt training/15min
		
		Test / Measurement(NOTE)*
	97760 Orthotic manage & train/15min
		
	97750 Physical performance test w/report/15min
		
	95851 ROM measure, each extremity or spine section
		
		Strapping(NOTE)*
	29086 Application, Cast, Finger
		
	29540 Strapping ankle
		
	29260 Strapping elbow or wrist
		
	29280 Strapping hand or finger
		
	29530 Strapping knee
		
	29240 Strapping shoulder

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase