HNS Policy 

The AMA CPT (Current Procedural Terminology) 2019 edition describes 97140 as "Manual therapy techniques (eg. mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes".


Manual therapy is classified as a Therapeutic Procedure (time-based).  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".


Therapeutic procedures require direct one-on-one patient contact by a physician or therapist and can only be performed by the physician or an appropriately licensed therapist


The National Correct Coding Initiative (NCCI) edits created by CMS require that manual therapy be performed to a separate anatomical site than the chiropractic adjustment in order to be reimbursed.



            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 manual therapy is performed to the same region(s) manipulated,

it is considered inclusive to the CMT code billed and

should NOT be separately reported


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


Modifier 59: If the manual therapy is performed to a different anatomical site than the CMT and this is substantiated by an appropriate primary diagnosis linked to the 97140 code, the 97140 code must be appended with modifier 59.


As a time-based code, manual therapy may only be billed if performed for 15 minutes.


The specific anatomical region, and the rationale for the manual therapy but be clearly documented in the patient's healthcare record.



The ACA Chiropractic Coding Solutions Manual gives the following example of the appropriate use of 97140 on the same day of a manipulation:


"A patient has severe injuries from an auto accident with a neck injury that contraindicates CMT in the neck region.  Therefore, the provider performs MANUAL THERAPY to the neck region and CMT to the lumbar region.  In this instance, it would be appropriate to report both the 97140 and the CMT."


If it is appropriate to report 97140 (manual therapy) together with a CMT, the manual therapy code (97140) must be appended with the modifier -59 to indicate a "distinct procedural service".




All time-based therapies (both therapeutic procedures and constant attendance) are billed in 15-minute increments.


If provided for less than 8 minutes, the service should not be billed to the payor.


It is important to recognize that 15 minutes must be spent in performing the pre-, intra-, and post-service work in order to report code 97140.  Common components included as part of Therapeutic Procedures include chart reviews for treatment, setup of activities and the equipment area, and review of previous documentation as needed.


Medical Necessity:

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



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.


Documentation must clearly establish the rational for the manual therapy.


When performed and billed to a payor, modalities/therapies must be properly documented in the health care record.  Documentation 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



All therapies/modalities must be accurately reported using the most appropriate CPT or HCPCS Code.


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.