HNS Policy 

Revised 8/6/2018

 

 

Supervised Modalities (Not time based)

 

Supervised modalities (CPT 97010-97028) are defined as the application of a modality that does not require direct (one-on-one) patient contact by the provider.  The provider can leave the room while the patient is receiving this service.

 

Common supervised modalities are electrical stimulation and mechanical traction, or hot and cold packs.

 

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

 

 

 

HNS Policies

 

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

 

 

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.

 

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

 

When reporting time based codes, the healthcare record must reflect the actual time the services were performed. (Ex: 15 minutes)

 

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

 

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