CPT 97010 - Hot and Cold Packs

 

CPT 97010 - Hot and Cold Packs

 

(NOT a Time-based Code)

 

CPT Code 97010 is defined as "Any physical agent applied to produce therapeutic changes to biologic tissue; includes but not limited to thermal, acoustic, light, mechanical, or electric energy."

 

CPT Code 97010 is a supervised modality. Supervised modalities are defined as the application of a modality to 1 or more areas, which does not require direct (one-on-one) patient contact by the provider.

 

These services may be performed by an appropriately trained CA, and billed by the provider. The provider must be present in the office when a CA performs these therapies, but is not required to be present in the room while the patient is receiving this service.

 

The services are NOT timed codes and may only be billed once per encounter, regardless of the number of applications.

 

Please note:  Many payors consider CPT Code 97010 a 'bundled' service. When a service is bundled, it means that the reimbursement for the code is built into or grouped with the reimbursement for another code and as such, no payment will be made for the 'bundled' code.

 

HNS Policies: Documentation/Billing
When performed and billed to a payor, modalities/therapies must be properly documented in the health care record and accurately reported using the most appropriate code.

 

When performed and billed to a payor, modalities/therapies must be medically necessary and consistent with the chief complaint/clinical findings, diagnoses and treatment plan.

 

Documentation in the health care record must include the rationale for each therapy and must clearly establish the medical necessity for each therapy billed to the payor.

 

For ALL modalities and therapies, documentation must include:

  • Type of modality

     

  • Rationale

     

  • Area of application (specific region treated)

     

  • Setting and frequency (as applicable)

     

  • If time based code, actual time service performed

  

During the initial phase of care, no more than two therapies or modalities per visit are considered usual and customary.

 

There should be a reduction in the use of therapies as the patient's condition improves.

 

Modifiers Needed:
Importantly, when reporting 97010 to BCBSNC, NC State Health Plan (SHP), MedCost, or any plan which utilizes Zelis edits, you must append 97010 with modifier GP.

 

Please click here
for the HNS NCCI Edit - Modifier Help Sheet,
which is a list of therapy codes requiring special modifiers.