HNS Policy 

Therapeutic procedures are defined as "a manner of effecting change through the application of clinical skills and/or services that attempt to improve function".

Therapeutic procedures require direct (one-on-one) patient contact by a physician or licensed therapist.

With the exception of CPT Code 97150, which is NOT time-based, both therapeutic procedures and constant attendance therapies 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.

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

Manual Therapy (CPT Code 97140)
For information related to Manual Therapy, click here.

Massage Therapy (CPT Code 97124)
For information related to Massage Therapy, click here.

Neuromuscular Reeducation (CPT Code 97112)
For information related to Neuromuscular Reeducation, click here.

Therapeutic Exercise (CPT Code 97110)
For information related to Therapeutic Exercise, click here.

Therapeutic Activities (CPT Code 97530)
For information related to Therapeutic Activities, click here.

Self-Care/Home Management Training (CPT Code 97535)
For information related to Self-Care/Home Management Training, click here.

Therapeutic Procedure(s), Group, 2 or more individuals (CPT Code 97150)
For information related to Therapeutic Group Procedures, click here.

Common components included as part of Therapeutic Procedures include chart reviews for treatment, setup of activities and the equipment area, and review of previous documentation as needed.

HNS Policies: Documentation/Billing
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.

Note:  Unlisted modality codes, as a general rule, should not be billed through HNS (including, but not limited to, 97039, 97139, 97799 and 20999). If you need assistance with determining the appropriate code for a particular service, please email your HNS Service Representative.