HNS Policy 

 

Revised 5/1/2019

 

When performed and billed to a payor, modalities/therapies must be properly documented in the healthcare 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 healthcare 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

 

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

 

If a time based code is provided for less than 8 minutes, the service should not be billed to the payor.

 

During the initial phase or 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.

 

Manual Therapy (CPT Code 97140) - for information related to Manual Therapy (CPT Code 97140), click here.

 

Massage Therapy (CPT Code 97124) - for information related to Massage Therapy (CPT Code 97124), click here.

 

Unlisted modality codes, as a general rule, should not be billed through HNS (including, but not limited to, 97039, 97139 and 97799).  If you need assistance with determining the appropriate code for a particular service, please contact your HNS Service Representative.