Unlisted Modalities

(97039, 97139, 97799, 20999) 

 HNS Policy 

According to the American Medical Association (AMA), CPT 2017 Professional, unlisted codes are as follows: 

• 97039 - Unlisted modality (specify type and time if constant attendance) 

• 97139 - Unlisted therapeutic procedure (specify) 

• 97799 - Unlisted physical medicine/rehabilitation service or procedure 

• 20999 - Unlisted procedure, musculoskeletal system, general

Unlisted modality codes, as a general rule, should not be billed through HNS, including, but not limited to, 97039, 97139, 97799, and 20999.

CPT 97039, 97139, 97799 and 20999 all represent "unlisted modalities" and should only be reported when there is no other code that accurately describes the service provided.

Please keep in mind there are very few therapies/modalities utilized by chiropractors which are not represented by a specific code. As such, neither HNS, nor healthcare plans contracted with HNS, would expect to see any of the unlisted modality codes reported.

Please do not bill any of these unlisted modality codes without first contacting HNS to discuss what service you are providing.

Please email your HNS Service Representative and explain what service you want to provide, and HNS will assist you with ensuring you report the correct code on the claim form.

Note:  Low Level Laser
Never bill an unlisted modality code for this service. If laser is covered, it must be billed with the correct code which is S8948 (application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes).

HNS Policies: Documentation/Billing for all Therapies/Modalities
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.