HNS Policy 

Constant attendance modality codes (CPT 97032-97039) 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.

  

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. 

 

HNS Policies:

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

     

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 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.