What is CPT Code 97140?

CPT Code 97140, which covers manual therapy procedures, is an important component of physical therapy treatment regimens, addressing issues such as joint limitations, muscular strain, and soft tissue injuries. Its appropriate usage and documentation are critical to optimizing reimbursement, maintaining compliance, and preventing claim rejections. Understanding the precise billing criteria for this code enables therapists to increase clinic income while providing good patient care.
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What is CPT Code 97140:

CPT Code 97140 is defined as application of manual therapy techniques to one or more regions of the body including any of the following: direct pressure, prolonged pressure and/or deeper massage, stretching, and resistance techniques. Each unit is reported for every 15 minutes. The American Medical Association describes the manual therapy as a range of hands-on methods that may include direct pressure, prolonged pressure and/or deeper massage, stretching, and resistance techniques.

The techniques are primarily intended for enhancing the functional performance of patients, the reduction of pain, and a greater increase in mobility. Therefore, every session of manual therapy must have the session documented by the practitioner who has carried out the session lasting 15 minutes.

Common Manual Therapy Techniques Under CPT Code 97140

• Soft Tissue Mobilization: Techniques of manipulating muscle and connective tissue to alleviate pain and increase mobility.
• Joint Manipulation: A high-velocity, low-amplitude thrusts to increase motion in the joint.
• Myofascial Release: Techniques to release tension in the fascia to decrease pain and improve function.
• Manual Lymphatic Drainage: Gentle massage techniques stimulating the lymphatic system to reduce swelling.
• Muscle Energy Techniques: Active techniques involving a patient's voluntary muscle contraction to a controlled counterforce applied by the therapist.
• Strain-Counterstrain: Correcting abnormal neuromuscular reflexes by the positioning of the body to relieve pain.

Key Requirements for Billing CPT Code 97140

With CPT Code 97140, when billing for such, there are specifics to be utilized by the physical therapists and all other medical professions to ensure an accurate claim. These must be known to ensure compliance in claims accuracy.

• Clearly Defined Treatment Goals

Usage of manual therapy shall have evidence of documentation with specific goals related to how the techniques would improve the function of the patient. The goals should relate to enhancing measurable means, like increased range of motion, reduction in pain, or better mobility within one body part.

For example, if treated manually in the shoulder, the goals of manual therapy would include the return of functional movement following a trauma or surgery. Ensure that these are appropriate to the general care plan for the patient.

• Clinical Necessity

Every session using CPT Code 97140 should meet the criteria of medical necessity. This means that the billed procedure should be essential for the patient's condition, and there should be clear documentation of why manual therapy is needed.

For example,the patient who is restricted in movement and is experiencing pain due to scar tissue from surgery may be helped by manual therapy in order to alleviate these symptoms. A note of the clinical necessity of the treatment should be included in the patient's record, referencing the condition or diagnosis that is being treated.

• Detailed Technique Description

It’s crucial to provide a detailed description of the exact manual therapy technique used in each session. Whether it’s joint manipulation, myofascial release, or soft tissue mobilization, describing the method accurately ensures transparency and improves claim approval rates.

Include terms like:

1. Joint mobilization for restoring range of motion.
2. Myofascial release for loosening up tight fascia to relieve pain and increase mobility.

• Precise Location of Treatment

The respective areas of the body treated by manual therapy should be clearly indicated by healthcare providers. Every area treated, for instance, shoulder, elbow, hand, and so forth, should be documented in such a way that the correct information is reflected regarding the condition of the patient and what kind of treatment is planned for him.

• Time-Based Documentation

Since 97140 CPT Code is time-based (15-minute units), inclusion of the start and end times of session will be important, as this will be useful to calculate the right number of units that should be included in billing for billing purposes and will ensure that the time-based coding standards are kept in mind, hence accounting for a 30-minute session being equivalent to billing two units of 97140. 

Pro Tip: Always use a precise time log to avoid under or over-billing

Time-Based Billing for CPT Code 97140

Billing under CPT code 97140 is time-based, being pegged on the amount of time the patient spends in therapy, thereby influencing the number of billable units. This code follows the "8-minute rule" generally imposed for Medicare, which says that there must be at least 8 minutes of therapy to bill for a single unit of 97140.

The 8-minute rule is a critical aspect of time-based CPT codes like 97140. This rule allows therapists to round up to the nearest 15-minute increment, provided that the total time spent on therapy exceeds 8 minutes in any given increment.

Example Scenarios:

• 35 Minutes of Manual Therapy (97140)some text
  • 1st 15 minutes: 1 unit
  • 2nd 15 minutes: 1 unit
  • Remaining 5 minutes: No additional unit as it doesn’t meet the 8-minute threshold.
  • Total Billable Units: 2 units
• 38 Minutes of Manual Therapy (97140)some text
  • 1st 15 minutes: 1 unit
  • 2nd 15 minutes: 1 unit
  • Remaining 8 minutes: 1 unit as it meets the 8-minute threshold.
  • Total Billable Units: 3 units

Reimbursement Rates for CPT Code across Different Insurance Companies:

Modifier Usage

Modifiers are essential for providing additional context to the services billed under CPT code 97140. Some commonly used modifiers include:

• GP: Indicates services provided by a physical therapist.
• GO: Indicates services provided by an occupational therapist.
• 59: Used to denote distinct procedural services, especially when 97140 is billed alongside other therapy codes like 97012.

For example, when billing CPT codes 97140 and 97012 (mechanical traction) together, the 59 modifier is necessary to indicate that the services were distinct and separate.

Common Reimbursement Challenges and Solution for CPT Code 97140

Good documentation and adherence to the guidelines on billing often do not remove challenges that healthcare providers face in terms of reimbursement for their services under CPT Code 97140. Some of the major challenge areas and some tips on making changes are presented in the remainder of this text.

• Incomplete Documentation

One of the leading causes of denied claims is incomplete or inadequate documentation. This often occurs when essential details, such as the specific manual therapy technique used or the exact duration of the session, are missing from patient records. Payers require precise information to verify the services provided and to justify payment.

• Tip: Always ensure that the therapy technique (e.g., joint mobilization, manual traction) is thoroughly described, along with the specific region treated (e.g., shoulder, knee) and the exact start and end times of the session. Regular audits of patient records can help catch documentation gaps before claims are submitted.

• Improper Use of Modifiers

When billing more than one CPT on the same day, proper use of modifiers is crucial to prevent denied claims. Modifiers are used to make service between services different and, therefore, reasonable and necessary. For example, if the therapeutic exercises code was assigned to the manual therapy code in error and Modifier 59 was not appended, that would make the service different and, in this case, the claim would be denied.

• Tip: Review coding guidelines carefully and use the appropriate modifiers to signal distinct services. Modifier 59 is commonly used when manual therapy is performed alongside other therapies, ensuring the payer understands the procedures are separate and justified.

• Inadequate Clinical Justification

The other common issue that may lead to reduced payments is under-sufficient clinical justification. Paying providers need evidence that they had a valid reason for requiring manual therapy and observing measurable and quantifiable results. If no such clear evidence is produced, they are most likely going to create some sort of question as to the medical necessity of treatment and receive lower payments or even outright denials.

• Tip: Document the clinical necessity for each session to the maximum extent possible. You would, therefore, state how it fits the condition and treatment intent for the patient, to increase range of motion, decrease levels of pain, or treat musculoskeletal dysfunction. Provide outcomes for example: increased percentage mobility, reduced levels of pain as quantifiable outcomes to build your case for reimbursement.

Conclusion:

To correctly bill for manual therapy with CPT Code 97140, you need to follow a methodical approach. This involves thoroughly assessing the patient, establishing clear therapy goals, documenting the techniques used, accurately recording session times, and tracking measurable outcomes. By doing so, you not only meet billing requirements but also improve the quality of care. Each step in this process helps justify the medical necessity of manual therapy and strengthens the therapeutic relationship with your patients. By following these guidelines, you ensure that your practice is both efficient and effective, leading to better patient outcomes and a more streamlined billing process.

FAQs:

1. What is the 8-minute rule in CPT Code 97140?

The 8-minute rule applies to time-based billing codes like 97140. To bill for one unit, the session must last at least 8 minutes. For example, if the session lasts between 8 and 22 minutes, you can bill for 1 unit. Longer sessions will require multiple units.

2. What are the reimbursement rates for CPT Code 97140?

Reimbursement rates for CPT Code 97140 vary by insurance provider. For example, Aetna Medicare reimburses around $28.28, while Anthem Blue Cross may reimburse up to $79.52 depending on the region and contract.

3. How can I ensure accurate claims for CPT Code 97140?

To ensure accurate claims, include clear documentation of treatment goals, clinical necessity, a detailed technique description, the specific body region treated, and the total time spent. This will prevent claim denials and ensure proper reimbursement.

4. What happens if I don't meet the time requirement for CPT Code 97140?

If the therapy session does not meet the minimum time requirement (8 minutes) for one unit, you cannot bill for the session. Accurate time logs are critical to avoid under-billing or over-billing.

5. Are there any restrictions on billing CPT Code 97140 for Medicare Advantage or private insurance plans?

Some Medicare Advantage and private insurance plans may have specific guidelines or restrictions regarding the use ofCPT Code 97140. These restrictions could include the number of allowable sessions, specific documentation requirements, or the need for prior authorization. It’s important to review each insurer’s policies to ensure compliance and avoid denied claims.

6. Can CPT Code 97140 be billed if manual therapy is used as part of a post-surgical rehabilitation plan?

Yes, CPT Code 97140 can be billed for post-surgical rehabilitation as long as the manual therapy is medically necessary and properly documented. The treatment should focus on improving mobility, reducing pain, and enhancing the functional recovery of the patient, with a clear description of how manual therapy fits into the patient’s overall care plan.