CPT 97140 - Manual Therapy

 

CPT 97140 - Manual Therapy

 

(Time-based Code)

 

CPT Code 97140:  Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes.

 

This is a therapeutic procedure, a manner of effecting change through the application of clinical skills and/or services that attempt to improve function. This procedure requires direct (one-on-one) patient contact by a physician or licensed therapist.

 

This is a time-based code billed in units of 15 minutes, using the eight-minute rule when necessary. If the service is provided for less than 8 minutes, it should not be billed to the payor.

 

Reporting Manual Therapy:
97140 is used to describe therapy which increases active pain-free range of motion, increased extensibility of myofascial tissue, and facilitates return to function activities. It's also been further described to include things like manual trigger point therapy and myofascial release. Manual therapy techniques are used to treat the restricted motion of soft tissues in the extremities, neck or trunk. Manual therapy is used in an active and/or passive fashion to help effect changes in the soft tissues, articular structures and neural or vascular systems.

 

Manual therapy
should be reported the same day as a manipulation
ONLY
if the therapy is provided to an anatomical region
different from the region(s) manipulated.

 

If the therapy is performed to the same region(s) manipulated, it is considered inclusive to the CMT code reported and should NOT be reported on the claim form.

 

Importantly, the primary diagnosis linked to the manual therapy must clearly indicate the manual therapy was performed to a different anatomical region than the region(s) manipulated.

 

Diagnoses
for manual therapy
cannot indicate 'unspecified areas'.

 

If the therapist is performing massage as a manual therapy technique in order to increase active pain-free range of motion, increase extensibility or myofascial tissue and facilitate the return to functional activities, and it is provided to a different anatomical region than the manipulation, then code 97140 should be used.

 

Note: If the therapist is performing therapeutic massage in order to increase circulation and promote tissue relaxation to the muscle(s), then code 97124 should be used.

 

Documentation Requirements Specific to this CPT Code:

  1. The clinical rationale for a separate and identifiable service must be documented (e.g., contraindication to CMT is present).

  2. Documentation for manual therapy provided on the same day as a manipulation must clearly show the therapy was provided to a different anatomical site than the region(s) manipulated.

  3. Documentation must substantiate the therapy is part of an active treatment plan directed at specific, documented objective treatment goals. 

 

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:
When reporting manual therapy with an E/M Code or with CMT, you must append the code with modifier 59 to make clear the service is distinct or separate from other services performed on the same day.

 

Importantly, when reporting 97140 to BCBSNC, NC State Health Plan (SHP), MedCost, or any plan which utilizes Zelis edits, and you are also billing a CMT code on the same date of service, you must append 97140 with modifier 59 and also modifier GP. (List 59 first, followed by GP.)

 

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