WHAT IS MUSIC THERAPY?

Sleep - it is best to treat the underlying cause (insomnia, pain, anxiety, quiet room  , less phone use/change to black and white screen, lack of exercise, etc). Discuss these options with your PCP. 

SUPPLEMENTS FOR SLEEP: 

Melatonin – 1–3 mg, 30 minutes before bed. Magnesium – 200–400 mg, 30 minutes before sleep.

GABA – 500–750 mg, 30 minutes before bed. L-Theanine – 100–200 mg, 30 minutes before sleep.

Valerian Root – 400–900 mg, 30 minutes before bed. Ashwagandha – 300–500 mg, 1 hr b/f sleep.

Chamomile Extract – 200–400 mg, before bed.

VIDEOS FOR SLEEP:  DEEP SLEEP FOR RAINY NIGHT

Ginkgo Biloba – 120–240 mg/day
Boosts circulation, enhances memory and focus.
Mnemonic: “Get Incredible Neurons Keeping Old-time memories.”

Lion’s Mane Mushroom (extract) – 500–1000 mg/day
Stimulates nerve growth and brain regeneration.
Mnemonic: “Learn Information Over New Study.”

Omega-3 Fatty Acids (DHA/EPA) – 1000–2000 mg/day
Supports brain structure and cognitive performance.
Mnemonic: “Our Minds Engage Great Answers.”

Bacopa Monnieri (standardized extract) – 300–600 mg/day
Improves memory, reduces stress, enhances learning.
Mnemonic: “Brain Activity Clearly Operates Properly After.”

Acetyl-L-Carnitine (ALCAR)  🔋 Brain energy & age-related memory   Dose: 500–2,000 mg daily (split dose recommended)

ACH PRECURSORS.... Choline (as Alpha-GPC or CDP-Choline) – 250–600 mg/day   Essential for neurotransmitters and memory function.
Mnemonic: “Cognitive Highways Operate Logically In Neural Efficiency.”

L-Theanine   🌿 Calm focus, stress reduction  Dose: 100–200 mg (often taken with caffeine)
 

L-Tyrosine  ⚡ Focus & memory under stress   Dose: 500–2,000 mg (30–60 min before mental tasks)  

L-Serine  🧬 Neuroprotection, brain development   Dose: 500–2,000 mg daily (studied in neurodegenerative conditions)

Lecithin (Phosphatidylcholine source)   🧠 Supports acetylcholine, brain cell health   Dose: 1,200–3,600 mg daily (often in capsules or granules)

music for mood ... 

happy, relaxed, et al 

AFROBEATS  | ALTERNATIVE ROCK MIX | AMBIENTALIST | EVANESCENCE | ANITA BAKER 

BEBE/CECE / YOLANDA ADAMS  

CLASSICAL #2   | COUNTRY #2    

HANDPAN #2  | HIP-HOP INSTRUMENTALS - 80-90s LOFI  90s  | HOUSE - DEEP HOUSE 

GOSPEL - I GO TO THE ROCK 

ISOLATED  |  JAZZ  | MEDITATION | MIGRAINE |  

PORTUGUESE - CALEMA #1   #2  #3 

R&B NATHAL ALLEN SAX - R&B CLASSICS

PARAMORE

==========================================

Need productivity music to enter THE ZONE | FLOW STATE? 

ASMR Calm: ASMR stands for Autonomous Sensory Meridian Response. It's a tingling sensation that some people experience in response to certain visual, auditory, or tactile stimuli. ASMR Calm uses these types of stimuli in their videos, often including ambient music, which can be relaxing and conducive to focus, even if you don't experience ASMR itself.  

Chillhop Music: This is the full channel name. They specialize in lofi hip hop, which is popular for studying and working.

Idealism: This is the full channel name. They are known for lofi hip hop mixes that are often used for concentration.

The Sound of Nature: This is the full channel name. They provide nature sounds like rain, ocean waves, and forest sounds.

YellowBrickCinema: This is the full channel name. They offer long classical music pieces and compilations suitable for focus and study.

PROVIDING GREAT SERVICES. 

#1 - SEE THE PATIENT WITHIN 1 WEEK. 

#2 - PROVIDE SOME DEGREE OF IMMEDIATE RELIEF. 

#3 - EDUCATE ON KEEPING THE PATIENT SAFE & COMFORTABLE THROUGHOUT THE 3 STAGES. 

PRE PROCEDURE 

PROCEDURE 

https://aneskey.com/local-anesthetics-and-toxicity-2/

https://www.youtube.com/watch?v=GfWyXb7ijDI 

POST PROCEDURE

TYPES OF CLINICS - INJECTION THERAPY

BIOHAZARD | FL - BIOMEDICAL WASTE ,    FL |  CDC/NIOS  | GEORGIA 

FLUOROSCOPY SAFETY   PRINT 

Phase 1: Clinic Foundation & Consultations

1. Medical Zoning Laws & Regulations for Interventional Clinics

2. Licensing & Credentialing Requirements for Interventional Specialists

3. Establishing an Electronic Health Record (EHR) System for Efficiency

4. Developing an Effective Referral Network for Interventional Medicine

5. Patient Screening & Pre-Procedure Preparation Guidelines

6. Telemedicine Integration for Follow-Up & Consultations

7. Best Practices for Insurance & Reimbursement for Procedures

8. OSHA & HIPAA Compliance for an Interventional Pain Clinic

Phase 2: Adding DME (Durable Medical Equipment)

9. Medical Zoning & Compliance for DME Storage & Distribution

10. DME Licensing, Billing, & Reimbursement Strategies

11. Workflow Optimization for High-Volume Interventional Clinics

12. Hiring & Training Staff for a High-Performance Interventional Practice

13. Patient Education on DME Use & Compliance

14. Proper Ventilation & Air Quality Standards for Storage Areas

Phase 3: Adding Ultrasound-Guided Injections

15. Ultrasound Equipment Selection & Maintenance

16. Sterile Techniques & Infection Control for Ultrasound-Guided Procedures

17. Personal Protective Equipment (PPE) for Ultrasound-Guided Injections

18. Developing Injection Protocols for Common Pain Conditions

19. Post-Procedure Monitoring & Recovery Room Best Practices

20. Emergency Response Plans for Contrast Reactions & Anaphylaxis

Phase 4: Adding Fluoroscopy-Guided Injections

21. Fluoroscopy Radiation Safety & Dose Optimization

22. Radiation Shielding & Lead Apron Maintenance

23. Proper Handling & Storage of Fluoroscopy Contrast Media

24. Fluoroscopy Equipment Selection & Compliance with Safety Standards

25. Fire Safety & Hazardous Materials Handling in Medical Facilities

• REFERRAL FORMS - VISIT WITHIN 7 DAYS | PLAN TREATMENT ON DAY #1

• NEW PATIENT FORMS --> AUTOMATED INTO THE CHART 

• MRIS / IMAGING PULLED UP IN ROOM , REPORTS AVAILABLE 

==== VISIT

VIDEOS SHOW 

CHECKLIST BEFORE PATIENT ENTERS THE ROOM 

• CONSENT | MARKED SIDE/SITE | ALLERGIES REVIEWED | ALL PATIENT'S QUESTIONS ANSWERED. 

• MACHINES/DEVICES  - ( EMERGENCY EQUIPMENT = SUCTION - MONITORS - AIRWAY - IV - DRUGS )

• BIOHAZARD/SHARPS CONTAINER 

CHECKLIST AFTER  THE INJECTION 

• TAKE VITALS 

• PAIN DIARY - FOR DX INJECTIONS 

• 
  

BILL the mental health and behavioral health codes listed (including diagnostic evaluations, psychotherapy, and substance use counseling), certain qualifications and degrees are required depending on the type of service being provided and the provider’s role. Below are the degrees and credentials typically needed to bill for these services:

1. Psychiatric Diagnostic Evaluation (CPT 90791, 90792)

• Degree Needed: MD or DO  | Psychiatrist or Advanced Practice Registered Nurse (APRN) with specialization in psychiatry (Psychiatric Nurse Practitioner)

• Licensure/Certification: Must be licensed as a physician or APRN with psychiatric specialization. These evaluations require a medical background.

2. Psychotherapy (CPT 90832, 90834, 90837, etc.)

• Degree Needed: Licensed Clinical Social Worker (LCSW) (Master's degree), Licensed Professional Counselor (LPC) (Master's degree), Licensed Marriage and Family Therapist (LMFT) (Master's degree) , Psychologist (PhD or PsyD) (Doctoral degree), Psychiatrist (MD/DO) (Doctoral degree)

• Licensure/Certification: The therapist must be licensed in their respective field (e.g., LCSW, LPC, LMFT, PhD/PsyD). Psychiatrists can also provide psychotherapy, typically with a medical license.

3. Family Therapy (CPT 90846, 90847)

• Degree Needed: LCSW (Master's degree), LPC (Master's degree), LMFT (Master's degree), Psychologist (PhD or PsyD), Psychiatrist (MD/DO)

• Licensure/Certification: Same as individual psychotherapy; the clinician needs a relevant license in the field of family therapy or psychotherapy.

4. Group Therapy (CPT 90853)

• Degree Needed: LCSW (Master's degree), LPC (Master's degree), LMFT (Master's degree), Psychologist (PhD or PsyD), Psychiatrist (MD/DO)

• Licensure/Certification: The clinician must be licensed to provide group therapy within their professional scope.

5. Substance Use Counseling and Treatment (CPT 99406, 99407, 96150, 96151, G0442, G0443)

• Degree Needed: Certified Addiction Counselor (CAC, CADC, or similar certification), LCSW (Master's degree), LPC (Master's degree), Psychiatrist (MD/DO) (if medical management is involved), Psychologist (PhD or PsyD)

• Licensure/Certification: Counselors providing substance use treatment may require certification in addiction counseling, such as a Certified Addiction Counselor (CAC), or a similar certification specific to their state. Social workers, counselors, or psychologists can provide substance use counseling with proper training and certification.

6. Behavioral Health Assessments (CPT 96150, 96156, 96158)

• Degree Needed:  Psychologist (PhD or PsyD), LCSW (Master's degree), LPC (Master's degree)

• Licensure/Certification: Typically, a psychologist (PhD or PsyD) or a licensed counselor/social worker with specific behavioral health training would be the ones performing these assessments.

7. Cognitive Assessments (CPT 99483)

• Degree Needed:

  • Psychologist (PhD or PsyD) or Neuropsychologist

• Licensure/Certification: A licensed psychologist is typically required for performing cognitive assessments, as these services require expertise in the diagnosis of cognitive and mental health disorders, such as dementia.

8. Prolonged Service Codes (CPT 99354, 99355)

• Degree Needed: Psychiatrist (MD/DO) or Psychologist (PhD/PsyD), Licensed Therapist (LCSW, LPC, LMFT)

• Licensure/Certification: These codes are often used for extended therapy sessions that exceed the typical session time, so a licensed provider (as listed above) must be present to provide these services.

9. Smoking and Tobacco Use Cessation Counseling (CPT 99406, 99407, HCPCS G0442, G0443)

• Degree Needed: Physician (MD/DO), Psychiatrist (MD/DO), Nurse Practitioner (NP), LCSW, LPC, or LMFT (if providing counseling)

• Licensure/Certification: Providers should be licensed in their respective fields to offer tobacco cessation services, with physicians, nurse practitioners, and licensed therapists able to provide these services.

10. Annual Wellness Visits (HCPCS G0438)

• Degree Needed: Physician (MD/DO), Nurse Practitioner (NP), Physician Assistant (PA)

• Licensure/Certification: Annual wellness visits typically require a licensed physician, nurse practitioner, or physician assistant to conduct the health evaluation.

Summary of Required Degrees:

• Master's Level: LCSW, LPC, LMFT, and other licensed therapists.

• Doctoral Level: PhD, PsyD, and MD/DO (Psychiatrists).

• Certifications: Addiction counselors and behavioral health specialists may need specific certifications like CAC (Certified Addiction Counselor) or other state-specific certifications.

For most billing codes, the service must be provided by a licensed mental health professional with relevant training and certifications. For codes involving medical management (e.g., psychiatric evaluations or substance use treatments), a physician or nurse practitioner is often required.

References:

1. CPT Code Book (Current Procedural Terminology)
   
   

   • The American Medical Association (AMA) publishes the CPT Code Book, which includes the billing codes for psychiatric and psychological services. For detailed explanations of each CPT code, you can consult the latest version of the CPT code manual.

   • AMA CPT Codebook: https://www.ama-assn.org

2. The National Provider Identifier (NPI) Registry
   
   

   • This resource allows you to verify the qualifications and licensure of healthcare providers in the United States, including mental health professionals.

   • NPI Registry: https://npiregistry.cms.hhs.gov

3. American Psychological Association (APA)
   
   

   • The APA provides guidelines on licensure and certification requirements for psychologists, including the educational and professional standards.

   • APA Licensure Requirements: https://www.apa.org

4. National Association of Social Workers (NASW)
   
   

   • The NASW outlines the qualifications for licensed clinical social workers (LCSWs), including necessary degrees, licensure, and certification processes.

   • NASW: https://www.socialworkers.org

5. American Counseling Association (ACA)
   
   

   • The ACA provides information about the professional requirements for licensed professional counselors (LPCs), including degree and certification requirements.

   • ACA: https://www.counseling.org

6. Substance Abuse and Mental Health Services Administration (SAMHSA)
   
   

   • SAMHSA provides information about certifications for substance use counselors and guidelines for billing and coding in mental health and substance use disorder treatment.

   • SAMHSA: https://www.samhsa.gov

7. Health and Human Services (HHS) - Medicaid Billing Guidelines
   
   

   • Provides specific guidelines for billing mental health and substance use services through Medicaid, including the types of services and qualifications for providers.

   • HHS Medicaid Billing Guidelines: https://www.medicaid.gov

8. The Centers for Medicare & Medicaid Services (CMS)
   
   

   • CMS provides comprehensive guidelines for mental health professionals and the specific billing codes for services under Medicare and Medicaid programs, including mental health evaluations, therapy, and substance use counseling.

   • CMS Mental Health Services: https://www.cms.gov

9. American Medical Association (AMA) - Substance Use Treatment Coding
   
   

   • AMA provides a specific set of coding practices related to the treatment of substance use disorders, including the smoking cessation and substance abuse counseling codes.

   • Substance Use Treatment Coding by AMA: https://www.ama-assn.org/delivering-care/public-health

10. The National Certification Commission for Addiction Professionals (NCC AP)
    
    

    • The NCC AP provides certifications for addiction counselors, including the qualifications needed to provide services such as substance abuse counseling and mental health support.

    • NCC AP: https://www.naadac.org/nccap

Video Outline (Approx. 30 Minutes)

Minutes 0:00 - 5:00

• Introduction: Overview of the AI growth infrastructure concept.

• Target Audience: Highlighting the potential for service providers (agencies, coaches, consultants) to scale using these AI systems.

• Core Concept: Introduction to the principle of "removing friction" as the key to business success.

• Areas of Friction: Identifying the five main areas where friction occurs: Offer, Lead Flow, Appointments, Deal Flow, and Fulfillment.

• Framework Tool: Mention of using a Custom GPT for market/niche selection frameworks.

Minutes 5:00 - 10:00

• Illustrative Example: Using Meta as a case study for how removing friction leads to success.

• Introducing the Solution: Presenting the AI Appointment Setting Agent specifically.

• Platform Choice: Explaining the rationale for building the system on WhatsApp (high usage, better response rates, fewer restrictions).

Minutes 10:00 - 15:00

• System Structure: Detailing the five functional segments of the AI agent: Lead Qualification, Appointment Booking, Downselling, Appointment Reminders, and No-Show Follow-ups.

• AI Technology: Mentioning the use of Language Models to build the AI assistant.

• Workflow Start: Describing the initial step: AI contacts the lead immediately via WhatsApp upon opt-in.

• Workflow - Qualification: AI asks specific questions to qualify the lead.

• Workflow - Routing Logic: How the AI routes leads based on responses (book appointment, downsell, provide training).

Minutes 15:00 - 20:00

• Workflow - CRM Integration: AI gathers lead info and automatically inputs it into the CRM (Go High Level - GHL).

• Workflow - Needs Identification: AI identifies the prospect's main business inefficiencies during the conversation.

• Workflow - Financial Qualification: AI qualifies leads based on investment capacity before offering a call.

Minutes 20:00 - 25:00

• Workflow - Booking Automation: AI handles the complete appointment booking process, including time zone checks and sending meeting links (Google Meet).

• Benefit - Scalability & Cost: Highlighting the system's ability to handle thousands of conversations and reduce operational costs.

• Benefit - Lead Quality: Emphasizing that leads arriving at sales calls are better educated and pre-qualified.

Minutes 25:00 - 30:00 (End)

• Benefit - Revenue Potential: Suggesting significant monthly revenue generation with low overhead is possible.

• Opportunity: Pointing out the market opportunity for others to build and sell similar AI systems due to high demand.

• Call to Action 1: Encouraging viewers to implement such systems to remain competitive.

• Call to Action 2: Inviting those interested in building these systems to a masterclass.

• Call to Action 3: Offering additional support via Instagram.

#2  Video Outline (Approx. 3 hours 55 Minutes)

Part 1: Foundation & Strategy (Approx. 0:00 - 1:10)

• 0:00 - 5:00:

  • Introduction to the "Build and Release" model using AI.

  • Goal: Scaling businesses to $25k-$50k monthly revenue.

  • Emphasis on market evolution and the need for quick action.

  • Target: $25k/month profit by 2025, path to $1M in 3 years.

• 5:00 - 10:00:

  • Focus: Winning and making success inevitable vs. just being right.

  • Presenter's personal journey: From 9-to-5 to entrepreneur.

• 10:00 - 15:00:

  • Continued personal journey: Importance of betting on oneself and commitment.

• 15:00 - 20:00:

  • Key concept: Profit and scale depend on leverage, not just hard work.

  • Challenging the myth of financial freedom through typical small business ownership.

• 20:00 - 25:00:

  • Importance of picking the right "vehicle": Offer, market, and business model.

  • Examples (Hormozi, Gadzhi) of growth through model changes.

• 25:00 - 30:00:

  • The 3 Stages to $10M-$100M:

    1. Low-Leverage Agency Model (Start).

    2. High-Leverage Build & Release Model (Pivot).

    3. High-Barrier/Compounding Model (Software/Acquisitions - End goal).

• 30:00 - 35:00:

  • Goal: Deliver value without trading time for money.

  • Showcasing client results using these strategies.

• 35:00 - 40:00:

  • 5 Steps: Zero to $25k/month overview.

  • Importance of acquiring a case study ("insurance policy").

  • Focus on acquiring timelessly valuable skills, processes, systems.

• 40:00 - 45:00:

  • Step 1 Detailed: Picking the Right Niche.

  • Criteria: Avoid super-sophisticated, competitive, commoditized markets.

  • Conditions for niche selection.

• 45:00 - 50:00:

  • Continued discussion on niche selection criteria.

• 50:00 - 55:00:

  • Recommended Niche: Local service businesses.

  • Reasons: Accessibility, high LTV, large market, low sophistication, proof of efficiency available.

• 55:00 - 1:00:00:

  • Principles for building offers.

  • Key ideas: Customer focus ("always right"), leveraging market trends.

• 1:00:00 - 1:05:00:

  • Real-life case studies demonstrating success by embracing trends.

  • Emphasis: Give the market what it wants.

• 1:05:00 - 1:10:00:

  • Importance of "unique mechanisms" to bridge gaps and avoid commoditization.

  • Benefits of high-ticket pricing.

  • Structuring offers for "effortless growth."

Part 2: AI Implementation & Case Studies (Approx. 1:10 - 2:00)

• 1:10:00 - 1:15:00:

  • Continued discussion on offer structure.

• 1:15:00 - 1:20:00:

  • Details of the current offer used for clients/partners in the local market.

  • Focus on AI-enabled content and other applications.

• 1:20:00 - 1:25:00:

  • AI Content Engine Workflow explained: Find viral ideas -> Restructure -> AI Voice.

  • Client case study demonstrating results with this engine.

• 1:25:00 - 1:30:00:

  • Introduction of AI Dialer and WhatsApp AI systems.

  • Invitation for clients to share experiences.

• 1:30:00 - 1:35:00:

  • Continued discussion/lead-in to client testimonials.

• 1:35:00 - 1:40:00:

  • Client Testimonial #1: Building & releasing a WhatsApp AI sales agent (pre-qualifies, books appointments).

• 1:40:00 - 1:45:00:

  • Client Testimonial #2: Using AI voice agents, building client acquisition for real estate.

• 1:45:00 - 1:50:00:

  • Continued client testimonial #2.

• 1:50:00 - 1:55:00:

  • Continued client testimonial #2.

• 1:55:00 - 2:00:00:

  • Nuance: Not all AI solutions are equal; effectiveness varies.

  • Human role remains important in appointment setting.

  • Highlighting client success with tools like AI dialers.

Part 3: Scaling & Program Offer (Approx. 2:00 - 3:05)

• 2:00:00 - 2:05:00:

  • Process: Turning thoughts into money (execution focus).

  • Importance of client acquisition.

  • Steps for building a successful business outlined.

• 2:05:00 - 2:10:00:

  • Continued business building steps.

• 2:10:00 - 2:15:00:

  • Goal: Enable viewers to inevitably scale past stage one (agency model) for potential partnership.

• 2:15:00 - 2:20:00:

  • Concept: Build and release an entire transformation, not just infrastructure.

  • Connecting this approach to significant wealth creation.

• 2:20:00 - 2:25:00:

  • Scaling Paths (Stage 3):

    • Acquiring Companies (Rollups concept explained, valuation multiples).

    • Building Software (High barrier).

• 2:25:00 - 2:30:00:

  • Continued discussion on scaling paths.

• 2:30:00 - 2:35:00:

  • Mindset: Choosing between "being right" and "being rich."

  • Urging focus on market demand over personal preference.

• 2:35:00 - 2:40:00:

  • Reiteration: Execution is the key differentiator for success.

  • Call to action: Implement the information provided.

• 2:40:00 - 2:45:00:

  • Introduction of the "Clown Acquisition Growth Creator" incubator program.

  • Promise: Build and release everything needed for results in 4 weeks.

• 2:45:00 - 2:50:00:

  • Incubator Program - 5 Steps Detailed:

    • Build the Offer.

    • Build the Systems.

    • Generate Demand.

    • Generate Appointments & Deals.

    • Optimize Infrastructure.

• 2:50:00 - 2:55:00:

  • Continued overview of the incubator steps/process.

• 2:55:00 - 3:00:00:

  • Discussion of costs involved vs. value provided in the incubator.

  • Positioning the program as a high-value investment.

• 3:00:00 - 3:05:00:

  • Bonuses announced for the first five program participants:

    • 1-on-1 call with the presenter.

    • Week-long event in Cape Town.

    • Highly trained closer placement.

Part 4: Call to Action & Q&A (Approx. 3:05 - 3:55)

• 3:05:00 - 3:10:00:

  • Final encouragement to book a call for the incubator.

  • Emphasis on taking action now.

  • Q&A Session Begins:

    • Transitioning to a new market?

    • Revenue sharing details?

    • Target audience for AI solutions?

• 3:10:00 - 3:15:00:

  • Q&A Continued.

• 3:15:00 - 3:20:00:

  • Q&A: Best platform for free content? (YouTube mentioned).

  • Value of creating a case study?

  • Importance of a strong offer reiterated.

• 3:20:00 - 3:25:00:

  • Q&A Continued.

• 3:25:00 - 3:30:00:

  • Q&A: Program success rate?

  • Strategy for selling AI infrastructures?

  • Importance of positioning.

• 3:30:00 - 3:35:00:

  • Q&A Continued.

• 3:35:00 - 3:40:00:

  • Q&A: Targeting specific niches (further discussion).

  • Potential of AI across different industries.

  • Re-emphasis on offer strength.

• 3:40:00 - 3:45:00:

  • Q&A Continued.

• 3:45:00 - 3:50:00:

  • Q&A Conclusion.

  • Presenter reiterates incubator value.

  • Final push for viewers to take action.

• 3:50:00 - 3:55:25 (End):

  • Final remarks.

  • Presenter thanks the audience.

  • Presentation concludes.

Plan 1 – Knee Brace for OA

The patient presents with knee osteoarthritis, confirmed clinically and radiographically, with pain affecting function and mobility.

ICD-10: M17.11 (right knee OA), M17.12 (left knee OA), M17.0 (bilateral OA).

A hinged unloader brace (HCPCS L1843) is medically necessary to offload the affected compartment and reduce mechanical stress during ambulation. Medial OA requires the hinge placed laterally, while lateral OA requires a medial hinge to shift load appropriately.

Physical therapy and a structured walking program are advised, supported by CPT 97110 (therapeutic exercise) and CPT 97530 (therapeutic activities).

INJECTIONS 

Intra-articular steroid injections (CPT 20610) may be considered for inflammation and pain control when conservative measures are insufficient. The goal is to restore function, prevent reinjury, and reduce the need for surgical escalation.

Viscosupplementation with hyaluronic acid products such as Orthovisc (J7324), Hyalgan (J7321), or Synvisc (J7325), administered via intra-articular injection (CPT 20610), is medically necessary to restore joint lubrication, reduce pain, and improve shock absorption.

If s/p TKA 

Geniculate nerve blocks (CPT 64454) or radiofrequency ablation (CPT 64624) may be recommended if bracing and PT are insufficient. Continued weight loss and mobility maintenance are essential for long-term outcomes.

Plan 2 – Knee Brace for Meniscus Injury / Strain

The patient presents with a meniscus injury or ligamentous strain of the knee, resulting in instability and pain that interfere with walking, work, and daily activity.

ICD-10: S83.241A (medial meniscus tear, right), S83.242A (medial meniscus tear, left), S83.231A (lateral meniscus tear, right), S83.232A (lateral meniscus tear, left), S86.911A (knee strain, right), S86.912A (knee strain, left).

A short runner hinged knee brace (HCPCS L1832) is medically necessary to provide support and stability while protecting the joint from further injury. This brace is particularly indicated in cases involving ACL, PCL, MCL, or LCL injuries as well as meniscal pathology.

Physical therapy and strengthening are advised, with CPT 97110 and CPT 97530 documenting skilled therapeutic exercise and activity progression.

Intra-articular steroid injections (CPT 20610) may be considered for inflammation and pain control when conservative measures are insufficient. The goal is to restore function, prevent reinjury, and reduce the need for surgical escalation.

Plan 3 – Intra-Articular Steroid Injection

The patient has symptomatic knee osteoarthritis, meniscal injury with synovitis, or tibial plateau pathology causing inflammation and functional impairment.

ICD-10: M17.11 (right knee OA), M17.12 (left knee OA), S83.241A/S83.242A (meniscus tears), S82.141A/S82.142A (tibial plateau fractures).

An intra-articular steroid injection (CPT 20610) is medically necessary to reduce intra-articular inflammation and pain, thereby improving tolerance of physical therapy and weight-bearing activity. Ultrasound guidance (CPT 76942) may be used to ensure accurate intra-articular delivery.

This intervention is justified as the patient has not achieved adequate relief with oral anti-inflammatory medications alone. The injection supports rehabilitation progress, improves range of motion, and provides short-term relief to allow resumption of functional mobility.

While injections are effective, use is limited to three to four per year to avoid chondrotoxicity. Continued weight management and structured activity are recommended as part of the long-term treatment plan.

Plan 4 – Viscosupplementation Injections

The patient presents with symptomatic knee osteoarthritis that has not adequately responded to NSAIDs, activity modification, or prior corticosteroid injections.

ICD-10: M17.11 (right knee OA), M17.12 (left knee OA), M17.0 (bilateral OA).

Viscosupplementation with hyaluronic acid products such as Orthovisc (J7324), Hyalgan (J7321), or Synvisc (J7325), administered via intra-articular injection (CPT 20610), is medically necessary to restore joint lubrication, reduce pain, and improve shock absorption.

This treatment is indicated for patients with persistent functional limitations despite conservative management.

Physical therapy and walking programs should be continued concurrently to maximize outcomes, with CPT 97110 and CPT 97530 used for exercise and therapeutic activities.

This intervention is especially important in patients where surgery is not immediately indicated or who are poor surgical candidates. The goal is to delay disease progression, enhance mobility, and improve overall quality of life.

Plan 5 – Tibial Plateau / Complex Knee Injury Management

The patient has a tibial plateau fracture or complex knee injury involving instability, pain, and limited function.

ICD-10: S82.141A (nondisplaced medial condyle fracture, right), S82.142A (nondisplaced medial condyle fracture, left), S82.151A (displaced lateral condyle fracture, right), S82.152A (displaced lateral condyle fracture, left).

A hinged brace (HCPCS L1843) is medically necessary to stabilize the knee during healing, reduce mechanical stress, and protect against further displacement.

Intra-articular steroid injection (CPT 20610) or viscosupplementation may be considered if significant osteoarthritis overlap is present, while geniculate nerve blocks (CPT 64454) may be pursued for refractory pain.

Physical therapy is essential for recovery, with CPT 97110 and CPT 97530 documenting therapeutic exercises and activities that restore mobility and strength.

Continued weight reduction and a walking program will further reduce joint stress and optimize long-term outcomes. The combination of bracing, injection therapy, and rehabilitation is medically necessary to restore stability, prevent disability, and improve functional capacity.

Continue f/u with orthopedic surgery team

Sure no problem. I don't see any difficulty with this. Previously, we had discussed availability of a sink, which is important for staff to use for hygiene (CDC, OSHA, JACO recommendations) and anytime you have cleaning supplies that can be hazardous (for cleaning between patients, cleaning blood, etc), you need to have an eye wash (easy to get a portable one for less than $50 - OSHA requirement). I can help you get emergency equipment for unanticipated emergencies.  These are some examples of protocols we can develop for your office. If you decide to add other treatments, we can certainly do it at some point later, if needed. You'll want to make sure you have equipment (for any unanticipated emergencies, staff training, and biohazard for needles, etc). 

Weight Loss Injections

1. Semaglutide (Wegovy, Ozempic)

   • Dose: Start with 0.25 mg once weekly, gradually increasing to 1.0 mg or 2.4 mg weekly.

2. Liraglutide (Saxenda)

   • Dose: Start with 0.6 mg daily, increasing weekly by 0.6 mg until at 3 mg 

3. Tirzepatide (Mounjaro)

   • Dose: Start with 2.5 mg once weekly, increasing by 2.5 mg increments to 10-15 mg weekly.

Ketamine Therapy

1. Treatment-Resistant Depression

   • Dose: 0.5 mg/kg infused over 40 minutes, 1-2 times per week.

2. Chronic Pain Management

   • Dose: 0.3-0.5 mg/kg over 2-4 hours.

3. Post-Traumatic Stress Disorder (PTSD)

   • Dose: 0.5 mg/kg over 40 minutes, once or twice weekly.

IV Treatment

1. IV Hydration Therapy

   • Dose: 1-2 liters of balanced electrolyte solution over 30-60 minutes.

2. Vitamin C and Nutrient Infusions

   • Dose: 5-25 grams of Vitamin C per infusion.

3. Myers’ Cocktail

   • Dose: Magnesium (1-2 g), calcium (100-200 mg), B-vitamins (1-2 ml), and vitamin C (1-10 g).