Patient Summary Form - OptumHealth Provider
Post-surgical Diagnosis (ICD codes) Please ensure all digits are entered accurately Current Functional Measure Score Patient Summary Form PSF-750 (Rev: 7/1/2015)
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www.myoptumhealthphysicalhealth.com3 98943), “The chiropractic manipulative treatment codes include a pre-manipulation patient assessment. Additional Evaluation and Management services may be reported separately using the modifier -25, if the patient’s condition requires a significant separately
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www.myoptumhealthphysicalhealth.com2 A modifier provides the means by which the reporting health care practitioner can indicate that a CPT descriptor code (service or procedure), which has been performed, has been altered by a specific circumstance or in some way without changing the
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