Supervised Modalities

(Not Time-based)

 HNS Policy 

Supervised modalities are defined as the application of a modality which does not require direct (one-on-one) patient contact by the provider. 

These services may be performed by an appropriately trained CA, and billed by the provider. The provider must be present in the office when a CA performs these therapies, but is not required to be present in the room while the patient is receiving this service.

Common supervised modalities are electrical stimulation (unattended) and mechanical traction.

The services are NOT timed codes
and may only be billed once per encounter,
regardless of the number of applications. 

Below are commonly reported procedures. For important information regarding requirements for reporting each of these services, please click on the appropriate link.

Hot/Cold Packs (CPT Code 97010)
For important information regarding this code, and important information regarding modifier requirements, click here.

Mechanical Traction (CPT Code 97012)
For important information regarding this code, and important information regarding modifier requirements, click here.

Electrical Stimulation (unattended) (CPT Code 97014)
For information related to Electrical Stimulation, click here.

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

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 97010 and 97012 to BCBSNC, NC State Health Plan (SHP), MedCost, or any plan which utilizes Zelis edits, you must append the codes with modifier GP. This modifier is not needed for CPT 97014 (electrical stim, unattended).

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