CPT 97035 - Therapeutic Ultrasound

 

CPT 97035 - Therapeutic Ultrasound

 

(Time-based Code)

 

CPT Code 97035:  Ultrasound (to one or more areas)

 

CPT Code 97035 is a constant attendance code. Constant attendance codes are used to report various physical agents applied to the patient for the purpose of producing therapeutic changes to biological tissue. The services described by these codes require direct one-on-one contact by the provider. Throughout the procedure, the provider is required to maintain visual, verbal, and/or manual contact with the patient.

 

Constant attendance therapies are time-based and billed in 15-minute increments. Only the actual time of the provider's direct contact with the patient providing these services count toward total time. If a time-based code is provided for less than 8 minutes, the service should not be billed to the payor.

 

NOTE: Ultrasound not provided via direct one-on-one patient contact by the provider, and/or 'hands-free' ultrasound is NOT included in this code, and should be billed as an unlisted modality using the CPT code 97039.

 

Ultrasound and Electrical Stimulation:
If ultrasound is provided via direct one-on-one contact by the provider, and is provided concurrently with electrical stimulation, ultrasound (97035) is the only code which should be billed. Do not bill for both ultrasound and electrical stimulation for the same time period.

 

If ultrasound with electrical stimulation is provided concurrently, but did not require constant attendance by the provider, do NOT report 97035. Instead, bill either 97014 (electrical stim unattended) or 97039 (unlisted modality) for the ultrasound, but do not bill for both procedures.

 

Documentation/Billing Specific to Ultrasound with Electrical Stimulation
While your documentation should provide a record that both electrical stimulation and ultrasound were delivered, the area(s) treated, and the rationale for each service, as noted above, only one of the modalities should be billed.

 

Do not bill for gel or electrodes as the cost of both is inclusive to the code billed. 

 

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 97035 to BCBSNC, NC State Health Plan (SHP), MedCost, or any plan which utilizes Zelis edits, you must append 97035 with modifier GP.

 

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