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97035 CPT Code Guide and Its Role in Physical Therapy

A professinal women give the physical therapy services at table doctor use the 97035 CPT Code

CPT Code 97035 important for billing medical stuff stands for ultrasound treatment by a physical therapist. This treatment uses sound waves, not cutting or anything, it helps with pain and swelling and makes tissues heal better.

Knowing this code well is necessary to follow rules, make the right documents, and get paid.

What is CPT Code 97035?

CPT Code 97035 means ultrasound therapy that’s measured by time, billed in parts of 15 minutes. The “constant attendance” part means the physical therapist must be with the patient all the time during this procedure.

Therapeutic ultrasound is used a lot for:

  • Dealing with muscle and joint issues like tendinitis, bursitis, or sprains.
  • After surgery, it helps reduce scar tissue and supports healing better.
  • Helping with ongoing pain and making joints more flexible.

When to Use CPT Code 97035

You can use therapeutic ultrasound with CPT Code 97035 when:

  • The treatment is needed for health reasons, matching the patient’s diagnosis and physical therapy check-up code.
  • The therapist keeps direct contact, be it sight, speech, or touch, during the whole time.
  • The therapy lasts enough time to meet billing rules (minimum of 8 minutes as stated in the 8-Minute Rule).

Important Note: Ultrasound therapy provided without direct supervision or using hands-free devices should be billed under CPT 97039, an unlisted modality code.

Related Physical Therapy CPT Codes

Several related pt CPT codes often accompany CPT 97035 for comprehensive patient care:

  • 97110 CPT Code: Therapeutic exercises to enhance rehabilitation frequently paired with ultrasound therapy.
  • CPT 97116: Gait training, applicable for patients with mobility challenges.
  • CPT 97014: Electrical stimulation (unattended), used to manage pain or muscle spasms.
  • CPT 97039: For unlisted modalities, including hands-free ultrasound treatments.

Step-by-Step Guide to Using CPT Code 97035

  • Patient Assessment: Begin with a thorough evaluation to determine if ultrasound therapy is medically necessary. Document the patient’s condition and treatment goals.
  • Preparation: Clean and prepare the treatment area. Apply a conductive ultrasound gel to ensure effective sound wave transmission.
  • Therapy Administration:
    • Use an ultrasound device to apply sound waves to the targeted area.
    • Maintain direct contact with the patient (manual, visual, or verbal).
    • The session must last at least 8 minutes to qualify for billing under the 8-Minute Rule.
  • Concurrent Treatments: If combining modalities like electrical stimulation, only bill for the primary treatment under direct supervision.
  • Documentation: Record the following:
    • Treatment details (e.g., area targeted, duration, and purpose).
    • Patient’s response and progress.
    • Updates to the treatment plan as necessary.
  • Billing and Compliance: Submit claims using CPT Code 97035 with all necessary modifiers (e.g., GP for physical therapy services). Verify payer-specific guidelines for accurate reimbursement.

Time-Based Billing and the 8-Minute Rule

CPT Code 97035 follows the 8-Minute Rule, which specifies the minimum treatment time required to bill for a single unit:

Time Spent (Minutes)

Billable Units

8-22 minutes

1 unit

23-37 minutes

2 units

38-52 minutes

3 units

Proper time tracking is essential to avoid billing errors and ensure compliance.

Common Billing Mistakes to Avoid

  • Billing for ultrasound therapy without direct contact.
  • Failing to document the medical necessity of the treatment.
  • Combining diathermy and thermal ultrasound for the same body region.
  • Insufficient or incomplete documentation of time and treatment details.

Reimbursement Considerations for CPT Code 97035

Reimbursement rates and policies for CPT Code 97035 can vary across insurers. Some key points include:

  • Most insurers cover therapeutic ultrasound when billed correctly.
  • Medicare applies the 8-Minute Rule and may require modifiers like GP.
  • Missteps in documentation or non-compliance with payer-specific guidelines can lead to claim denials.

CPT Code

Description

Billing Unit

Coverage

97035

Ultrasound

15 minutes

Covered

97014

Electrical Stimulation

15 minutes

Covered

97110

Therapeutic Exercises

15 minutes

Covered

Key Takeaways for CPT Code 97035

  • Accurate Documentation: Detailed records of the treatment area, duration, and patient response are crucial for successful claims.
  • Training and Audits: Regular staff training and billing audits can help prevent common errors.
  • Compliance is Crucial: Follow payer-specific rules and ensure each session is medically necessary.

By knowing how to use CPT Code 97035 and other similar codes for physical therapy, healthcare workers can give good treatments, miss fewer medical billing mistakes, and get more money back. If done right with the paperwork and rules, therapeutic ultrasound can still be a useful way to help manage pain and rehabilitation.

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