Does 97140 need a modifier?
Time (e.g., number of minutes spent performing the services associated with this procedure) meets the timed-therapy services requirement. CPT code 97140 is appended with the modifier -59 or the appropriate –X modifier. Click to see full answer.
Does 97110 require a modifier?
Modifiers When billed on the same visit as 97110, it may be necessary to add an appropriate modifier to 97002 or 97004. When billed on the same visit as 97150, add modifier 59, or one of the X modifiers, to 97110. Dr. Gwilliam is a licensed chiropractic physician with a master's in business administration.
Does Medicare cover 97140?
The CPT guidelines state that 97140 services are included in the CMT codes (9894-98942) when performed on the same spinal regions as a CMT codes. Also, Medicare NCCI edits categorized 97140 as a component of CMT, unless a modifier (e.g., -59) is used for a different region(s). However, Medicare law prohibits coverage and payment for non-CMT services.
Does CPT code 97110 need a modifier?
Per CPT guidelines, “A minimum of eight minutes of therapeutic exercises is required to report code 97110. Services of less than eight minutes would not be reported.” This means that this code cannot be reported with modifier 52 (reduced services) if less than eight minutes was performed.
What is 97140 chiropractic?
What is the adjustment code for 97410?
Why is it easier to wait for a denial?
Does Aetna pay for more than 4 modalities?
Does Aetna cover chiropractic?
Does Aetna pay on 4 codes?
Who is Renee Dustman?
See 4 more
About this website
Does 97140 need a GP modifier?
Published by Sam Collins on April 16, 2021 Any PT now billed to Anthem will require the GP modifier. Note this modifier may be in addition to other modifiers that may be necessary such as 59 or XS on 97112, 97124, or 97140, Note the order of the modifiers is not critical but that both must appear.
How do I bill CPT 97140?
For the timed manual therapy CPT code, the service has to be performed for a minimum of 8 minutes to bill one unit. Modifier 59 should be appended to 97140 to indicate that it is a distinct procedure and is performed at a different anatomic region than the chiropractic adjustment that day.
What is the 59 modifier used for?
Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. It is the most reported modifier that affects National Correct Coding Initiative (NCCI) processing.
What does CPT code 97140 include?
CPT® code 97140: Manual therapy techniques, 1 or more regions, each 15 minutes (Mobilization/manipulation, manual lymphatic drainage, manual traction)
What is the GP modifier?
The GP modifier indicates that a physical therapist's services have been provided. It's commonly used in inpatient and outpatient multidisciplinary settings. It's also used for functional limitation reporting (FLR), as physical therapists must report G-codes, severity modifiers, and therapy modifiers.
What modifier do I use for massage therapy?
The use of modifier 59 or XS indicates the service is a separate and distinct service from manipulation; however, the use of modifier XS would technically be more correct or accurate than 59. Make sure you are only using 59 or XS for massage and manual therapy; and only on the same visit as a CMT service.
What CPT codes need a 59 modifier?
The CPT Manual defines modifier 59 as follows: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services performed on the same day.
When should CPT modifier 59 be used?
Modifier 59 should be used to distinguish a different session or patient encounter, or a different procedure or surgery, or a different anatomical site, or a separate injury. It should also be used when an intravenous (IV) protocol calls for two separate IV sites.
What is modifier 51 used for?
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to: Different procedures performed at the same session. A single procedure performed multiple times at different sites.
Can you bill multiple units of 97140?
33 minutes of therapeutic exercise, code 97110 7 minutes of manual therapy, code 97140 Total timed code treatment time is 40 minutes. If you look up 40 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes).
Who can bill for 97140?
American Medical Association (AMA) coding guidelines dictate that it is only appropriate to bill for Chiropractic Manipulative Treatment (CMT) and manual therapy (CPT code 97140) for the same patient on the same visit under certain circumstances.
Can CPT code 97110 and 97140 be billed together?
Can CPT Code 97110 And 97140 Be Billed Together? Yes, they can be billed together. CPT 97110 and CPT 97140 can be performed on the same day for the same patient; instead, using these codes together on the same day is very common.
Who can bill CPT code 97140?
American Medical Association (AMA) coding guidelines dictate that it is only appropriate to bill for Chiropractic Manipulative Treatment (CMT) and manual therapy (CPT code 97140) for the same patient on the same visit under certain circumstances.
Can you bill multiple units of 97140?
33 minutes of therapeutic exercise, code 97110 7 minutes of manual therapy, code 97140 Total timed code treatment time is 40 minutes. If you look up 40 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes).
How Much Does Medicare pay for 97140?
Manual therapy (97140) sees a similar percentage decrease, from $28.87 to $27.91. Neuromuscular reeducation (97112) drops by 2.35%, from $36.09 to $35.34.
Can CPT code 97110 and 97140 be billed together?
Can CPT Code 97110 And 97140 Be Billed Together? Yes, they can be billed together. CPT 97110 and CPT 97140 can be performed on the same day for the same patient; instead, using these codes together on the same day is very common.
CPT Code 97140 Problems & Strategies for Chiropractors to Get Paid
A few years back, I wrote about challenges that chiropractors were having with CPT Code 97140 and getting reimbursed from Aetna.Since that time, there has been some progress, some frustrations over the lack of it and a few distinct changes that affect chiropractors getting paid for CPT Code 97140 (Manual Therapy) on the same day as their chiropractic adjustment.
98941 & 97140 | Medical Billing and Coding Forum - AAPC
Hi, I have a patient that has the following DX: M54.2, S33.5XXA, M25.519 (bilateral shoulder), and S23.3XXA. I have enough regions to bill a 98941 but can I also bill 97140-59 since there is an extremity in the DX? Or, do I have to bill 98940 & 98943 to be able to bill the 97140-59? Any...
Can you bill manipulation and the manual therapy 97140 CPT code?
Does your documentation allow you to bill both a manipulative treatment and manual therapy with the 97140 CPT code? I started working for the American Chiropractic Association (ACA) in June 1999 in the Professional Development Department, which had responsibility for coding. From my very first day, I fielded calls from members asking about the newfangled manual therapy 97140 CPT code that went ...
CPT 97140, 97530, 97112, 97760, 97750 – Therapeutic procedure
Procedure CODE AND Description 97140 - Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 97530 - Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 97112 - Therapeutic procedure, 1 or more…
CPT® code 97140: Manual therapy techniques, each 15 minutes
Disclaimer: Information provided by the AMA contained within this resource is for medical coding guidance purposes only.It does not (i) supersede or replace the AMA’s Current Procedural Terminology manual (“CPT® Manual”) or other coding authority, (ii) constitute clinical advice, (iii) address or dictate payer coverage or reimbursement policy, and (iv) substitute for the professional ...
How would you answer these questions?
Considering the increasing scrutiny and number of audits, it’s time for a self-check to make sure you have what’s necessary to properly bill both CMT and 97140 on the same visit:
What to do if you are performing both CMT and 97140?
If you routinely perform both CMT and 97140, make sure you pay attention to the coding guidelines provided by the payers with whom you deal. Look for MRP that outlines their rules for billing both services at a time and what they expect to be present in the documentation.
What is the CPT code for manual therapy?
Can you bill manipulation and the manual therapy 97140 CPT code?
Is CMT contiguous to myofascial structures?
The treatment of myofascial structures using manual therapy techniques in the same organ (spine), where CMT was performed and was not contiguous (cervical and lumbar), does constitute treatment of different anatomic sites.
Which anatomic site does constitute treatment of different anatomic sites?
The treatment of the cervical spine and a shoulder joint does constitute treatment of different anatomic sites.”
Is 97140 a mutually exclusive CMT?
Many payers took the position at that time that 97140 was to be considered “mutually exclusive” with the CMT service in many circumstances. Providers were advised to use the 59 modifier when providing both CMT and 97140 to delineate that the services were separately identifiable. That was supposed to mean a separately identifiable area for the 97140 vs. the CMT service. That was not always the case.
Is Optum a VA payer?
We have a member who deals with Optum as the payer for Veterans Affairs (VA) patients, and who is dealing with this situation now. They hadn’t kept up with the rules, and were billing both services at the same time, incorrectly. So far, almost $20,000 has been recouped from the provider due to the billing errors. Let’s make sure you don’t find yourself in a similar situation.
What is neuromuscular re-education?
Definition: Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and proprioception for sitting and standing activities. Therapeutic procedure, one or more areas, each 15 minutes.
What modifier is used in Humana?
According to this Humana video resource, modifier 59 can be applied to either code in the edit pair.
How long is manual therapy?
For example, manual therapy might be performed for 10 minutes, followed by 15 minutes of therapeutic activities, followed by another 5 minutes of manual therapy. CPT code 97530 should not be reported and modifier 59 should not be used if the two procedures are performed during the same time block.”
What is 97110 exercise?
97110: Therapeutic Exercises. Definition: Therapeutic exercises to develop strength, endurance, range of motion, and flexibility. Therapeutic procedure, one or more areas, each 15 minutes. Granted, this is a vague definition, which makes it tempting to use this code for all movement interventions.
What is direct contact?
Definition: Direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes.
What is the second column code for Humana?
Anthem, Aetna, and Humana, however, have decided to deny providers use of the second column code (97530) as mutually exclusive, thus forcing providers to appeal the coverage decision and show their documentation. If you receive this type of a denial, then your billing team should absolutely appeal the decision.
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It’s a psychological fact: the human brain loves symbols. They can evoke emotion, inspire movements, and communicate...
What is CPT code 97140?
CPT description for code 97140 (manual therapy ) includes manual therapy and techniques such as manipulation, soft tissue mobilization or joint mobilization. Individual techniques should not be separately coded or billed since it is a time-based code. All techniques applied on the same date of service should be totaled into the time calculated for the code. This procedure may be medically necessary as an adjunct to other therapeutic procedures such as those represented by code 97110 (therapeutic exercises), 97112 (neuromuscular re-education) or 97530 (therapeutic activities).
Is CPT 97124 billed for myofascial release?
It is not appropriate to bill CPT 97124, massage, for myofascial release. For myofascial release, CPT 97140 should be reported. When reporting or billing for CPT 97112 (neuromuscular re-education) and CPT 97124 (massage), as well as all other physical medicine modalities and therapeutic procedures, the details of the procedure shall be recorded in the medical record, including clinical rationale, anatomical site, description of service, and time (as required by the selected CPT code).
What are therapeutic activities?
1. Therapeutic activities are considered reasonable and necessary for patients needing a broad range of rehabilitative techniques. Activities can be for a specific body part or could involve the entire body. This procedure involves the use of functional activities to improve performance in a progressive manner. The activities are usually directed at a loss or impairment of mobility, strength, balance, coordination or cognition. They require the skills of occupational therapists and are designed to address a specific functional need of the patient. These dynamic activities must be part of an active written plan of treatment and be directed at a specific outcome.
What is the most effective method of application?
1. Massage is the application of systemic manipulation to the soft tissues of the body for therapeutic purposes. Although various assistive devices and electrical equipment are available for the purpose of delivering massage , use of the hands is considered the most effective method of application, because palpation can be used as an assessment as well as a treatment tool.
What is the code for neuromuscular reeducation?
This procedure may be medically necessary as an adjunct to other therapeutic procedures such as codes 97110 (therapeutic exercises), 97112 (neuromuscular re-education) or 97530 (therapeutic activities).
What is 97110 in medical terms?
97110 – Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
How long does modifier 52 take?
Modifier 52 should not be used for therapy services less than 15 minutes. At least eight minutes of a physical therapy timed service must be provided in order to use a therapy procedure code (i.e. 97140 – manual therapy techniques, one or more regions, each 15 minutes).
What is CPT code 97124?
CPT 97124 describes a service that is a separate and distinct service from Chiropractic Manual Therapy codes 98940-98943. CPT 97124 describes work including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) and is based on each 15 minutes of treatment per unit. When using this code on the same day as a CMT code service, it may be necessary to append a modifier-59 (Distinct Procedure). It should also be noted that this therapy procedure attempts to improve function by direct hands on and one-on-one patient-practitioner/therapist contact. All that is stated in this paragraph should be noted in the documentation.
What is the CPT code for massage?
AOTA requests that the reference to connective tissue massage and therapeutic massage be removed from this code, as massage is appropriately billed under CPT code 97124. To the extent that the reference was intended to include connective tissue mobilization and transverse friction massage as manual therapy techniques, AOTA would support these inclusions.
What is massage therapy?
Massage is the application of systemic manipulation to the soft tissues of the body for therapeutic purposes. Although various assistive devices and electrical equipment are available for the purpose of delivering massage, use of the hands is considered the most effective method of application, because palpation can be used as an assessment as well ...
What are the criteria for CPT code 97140?
When reporting the CPT code 97140 in conjunction with CMT codes, there are six criteria that must be documented to validate the#N#service:#N#1. Manipulation was not performed to the same anatomic region or a contiguous anatomic region e.g., cervical and thoracic#N#regions are contiguous; cervical and pelvic regions are noncontiguous
What is therapeutic procedure?
The CPT Manual defines a therapeutic procedure as “a manner of affecting change through the application of clinical skills and/or services that attempt to improve function.”
What are the goals of massage?
This would include such goals as to decrease pain, decrease muscle spasms, decrease muscle soreness, and increase circulation.
What is manual technique?
Skilled manual techniques (active or passive) are applied to soft tissue to effect changes in the soft tissues, articular structures, neural or vascular systems. Examples are facilitation of fluid exchange, or stretching of shortened muscular or connective tissue.
How long should a CPT be billed?
For any single timed CPT code in the same day measured in 15 minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single modality or procedure in a day is greater than or equal to 23 minutes, through and including 37 minutes, then 2 units should be billed. Time intervals for 1 through 8 units are as follows:
How long is 15 minute service?
If any 15 minute timed service that is performed for 7 minutes or less than 7 minutes on the same day as another 15 minute timed service that was also performed for 7 minutes or less and the total time of the two is 8 minutes or greater than 8 minutes, then bill one unit for the service performed for the most minutes.
What is a therapeutic procedure?
A Therapeutic Procedure is defined as “a manner of effecting change through the application of clinical skills and/or services that attempt to improve function .” These procedures require direct one-on-one patient contact by a physician or therapist. The descriptions for most of these codes reflect 15-minute intervals.
What is 97110 procedure?
97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
What is the appropriate billing code for a CPT?
The qualified professional (See definition in Pub. 100-02, chapter 15, section 220) shall select one appropriate CPT code (97112, 97110, 97140) to bill since each unit was performed for the same amount of time and only one unit is allowed.
How long does a CPT treatment last?
For any single CPT® code, providers would bill Medicare a single 15-minute unit for treatment greater than or equal to 8 minutes and less than 23 minutes. If the duration of a single modality or procedure is greater than or equal to 23 minutes to less than 38 minutes, then 2 units should be billed.
How many units are billed for 15 minutes?
If a service represented by a 15 minute timed code is performed in a single day for at least 15 minutes, that service shall be billed for at least one unit. If the service is performed for at least 30 minutes, that service shall be billed for at least two units, etc. It is not appropriate to count all minutes of treatment in a day toward the units for one code if other services were performed for more than 15 minutes. See examples 2 and 3 below.
What is 97140 chiropractic?
Per CPT® guidelines, 97140 describes manual therapy techniques, such as mobilization and manipulation, manual lymphatic drainage, and manual traction. Chiropractic adjustments have their own set of codes (98940-98942, or 98943 for an extremity). If you report a subluxation diagnosis code, you must perform an adjustment — especially if you are in a state where you need a nexus to the spine to bill anything other than the adjustment.#N#National Correct Coding Initiative (NCCI) claim edits bundle manual therapy (97140) to chiropractic adjustment codes (98940-98942) when performed in the same anatomic region. If the procedures are performed in separate anatomic regions, you may report them separately by appending modifier 59 to the adjustment code (97410 is the “column 2” procedure). If the claim is properly filed and supported by documentation, the insurer should pay for both procedures.#N#Example 1: The chiropractor performs chiropractic adjustment (98940 Chiropractic manipulative treatment (CMT); spinal, 1-2 regions) on the cervical region. He then performs manual therapy (97140) to the same cervical region. The patient’s diagnosis codes reflect a cervical subluxation (739.1 Nonallopathic lesions, cervical region) and muscle spasms (728.85 Spasm of muscle). The manual therapy (97140) would not be reimbursable in this scenario.#N#Example 2: The chiropractor performs chiropractic adjustment (98941 Chiropractic manipulative treatment (CMT); spinal, 3-4 regions) on the cervical and lumbar regions. He or she then performs manual therapy (97140) on the patient’s shoulder. The patient’s diagnosis codes are cervical subluxation (739.1), lumbar degenerative disc disease (722.52 Degeneration of lumbar or lumbosacral intervertebral disc), adhesive capsulitis (726.0 Adhesive capsulitis of shoulder), and muscle spasms (728.85). The diagnosis pointers link the manual therapy (97140) to the diagnosis codes adhesive capsulitis (726.0) and muscle spasms (728.85). In this scenario, the manual therapy would be separately reimbursable if reported with modifier 59 appended.#N#To best support payment and minimize audit red flags, the provider’s notes should include:
What is the adjustment code for 97410?
If the procedures are performed in separate anatomic regions, you may report them separately by appending modifier 59 to the adjustment code (97410 is the “column 2” procedure). If the claim is properly filed and supported by documentation, the insurer should pay for both procedures.
Why is it easier to wait for a denial?
For smaller offices, it may be easier to wait for the denial because it will be easier to track the appeals. For medium to larger offices, it may be easier to submit the original claims with the notes, so you do not have to track tons of appeals. Decide what works best for your practice.
Does Aetna pay for more than 4 modalities?
Note that Aetna usually only allows payment for four modalities per visit. This raises a question: If you bill for five or six modalities, for instance, and Aetna only pays for four modalities, should you bother appealing 97140?#N#I suggest you don’t have to appeal because you won’t receive additional compensation, in any case. But be aware some Aetna plans will reimburse for more than four modalities. Be sure, however, that your definition of a modality is the same as Aetna’s. For example, office visits are not part of the four-modality cap. This means that when supported by medical necessity, you can render an office visit in addition to four modalities. Just because Aetna paid on four codes, doesn’t mean they’ve paid on four modalities.#N#To help ensure your claims are processed correctly, in addition to sending your doctor’s notes with the original claim, use diagnosis pointers. Most billing programs default diagnosis pointers to 1, 2, 3, etc., or now A, B, C, etc., on the new claim forms, depending on how many diagnosis codes you input. Diagnosis pointing is under-utilized in billing, especially in the chiropractic world. Using diagnosis pointers can help differentiate the region (s) adjusted/manipulated from the region (s) on which the doctor performed manual therapy (97140).#N#Additional resources: Aetna Clinical Policy Bulletin: Chiropractic Services Number: 0107
Does Aetna cover chiropractic?
Aetna has made a nationwide policy decision for chiropractic reimbursement, which states that when manual therapy (97140 Manual therapy techniques, one or more regions, each 15 minutes) is performed on the same date of service (DOS) as a chiropractic manipulative treatment (98940-98943), the manual therapy will be denied, automatically.
Does Aetna pay on 4 codes?
Just because Aetna paid on four codes, doesn’t mean they’ve paid on four modalities. To help ensure your claims are processed correctly, in addition to sending your doctor’s notes with the original claim, use diagnosis pointers.
Who is Renee Dustman?
Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.
Background
Commercial Payer Denials and Appeals
- Anthem, Aetna, and Humana, however, have decided to deny providers use of the second column code (97530) as mutually exclusive, thus forcing providers to appeal the coverage decision and show their documentation. If you receive this type of a denial, then your billing team should absolutely appeal the decision. You’ll need to demonstrate that you are using modifier 59 appro…
Alternate Codes
- Alternatively, you can avoid the edit entirely by delivering interventions other than therapeutic activities (97530) when performing manual therapy (97150) during the same patient visit. These interventions might include therapeutic exercise (97110) and/or neuromuscular reeducation (97112). However, you cannot simply perform a therapeutic activity and bill it as a therapeutic ex…
Therapeutic Activities
- Definition: Direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes. Key words here are “dynamic activities” and “functional performance.” Think of “dynamic” as “big” body movements or multi-segment movements. Think of “functional” as meaning “real-life” movements—like lifting, carrying, squatti…
Neuromuscular Re-Education
- Definition: Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and proprioception for sitting and standing activities. Therapeutic procedure, one or more areas, each 15 minutes. This code emphasizes specific feedback to the patient about the quality and/or specificity of instruction in movement, mechanics, posture, and balance, as well as facilit…
Therapeutic Exercises
- Definition: Therapeutic exercises to develop strength, endurance, range of motion, and flexibility. Therapeutic procedure, one or more areas, each 15 minutes. Granted, this is a vague definition, which makes it tempting to use this code for all movement interventions. And that’s exactly why it tends to be overused. Instead, only code for therapeutic exercise if the movement doesn’t meet t…
Advocacy Efforts
- The APTA has been working with Aetna, Anthem, and Humana for well over a year now to address their claim edit policies—and to push for reversal of the policies described in this article. Progress has been slow, but Aetna has indicated that it is monitoring appeal overturn rates to determine whether the policy should be rescinded. For this reason, it is essential that providers appeal thes…