Minor billing and coding errors can drain healthcare practices of significant revenue. By understanding when and how to apply the correct code, you ensure accurate payment every time. Therefore, mastering the use of CPT code 97140 can increase your practice’s effectiveness.
Our comprehensive blog will break down the billing of 97140 in detail. You will learn when to use this code, how to document it, and which modifiers to append. So let’s get the physical therapy (PT) billing right this time!
CPT Code 97140 – Description
In medical billing, CPT code 97140 is used to bill manual therapy techniques. It is usually billed by physical therapists and chiropractors who address joint stiffness, muscle tension, and pain with a set of hands-on techniques.
The code covers applying manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction) at one or more regions. It is billed in 15-minute increments.
Scenarios Where CPT Code 97140 is Applicable
Let’s look at some real-world clinical situations where CPT code 97140 is applicable.
Neck Pain and Stiffness
Imagine the first scenario where an office worker visits a physical therapy clinic complaining of persistent neck pain and limited range of motion, caused by poor posture and prolonged desk work. The physical therapist performs soft tissue mobilization and gentle joint mobilization on the cervical spine and surrounding muscles to reduce muscle tension and improve mobility.
Since the treatment involved hands-on manual therapy techniques, the therapist reports the service using CPT code 97140.
Post-Surgical Rehabilitation
Suppose a patient undergoes a shoulder surgery. His physician asks him to get physical therapy to restore mobility and reduce stiffness around the surgical site.
During the therapy session, the therapist performs manual joint mobilization and soft tissue techniques on the shoulder joint and surrounding muscles to improve flexibility and reduce scar tissue restriction.
Since the manual therapy was performed, the therapist must bill his services with CPT code 97140.
Sports Injury Recovery
Suppose an athlete comes to visit a physical therapist after suffering a hamstring strain during training. The physical therapist performs soft tissue mobilization and manual stretching techniques to improve blood flow, reduce muscle tightness, and promote healing.
As the therapist performed manual therapy for tissue mobilization, he can report therapeutic services using CPT code 97140.
Applicable Modifiers for CPT Code 97140
Here are two important modifiers that are usually appended to CPT code 97140.
Modifier GP
Modifier GP is applied to all physical therapy-related treatments, including CPT code 97140. The Centers for Medicare and Medicaid (CMS) requires billers to append this modifier to physical therapy services to indicate that the physical therapy was provided as part of an outpatient treatment plan. Furthermore, if physical therapy services are billed without GP, you may receive a denial from the payer.
Modifier 59
Modifier 59 is applied to the CPT code 97140 only when two timed procedures are performed in different blocks of time on the same day. This means that you cannot apply this modifier if two distinct services are provided in the same time block of 15 minutes.
For example, when a physical therapist renders manual therapy (97140) and therapeutic exercises (97110) to the same patient on the same day, modifier 59 is appended to the second procedural code for separate reimbursement.
CPT Code 97140 – Reimbursement Guidelines
Follow these reimbursement guidelines to prevent denials on CPT code 97140 claims.
Ensure Correct Use of 97140
To bill CPT code 97140 accurately, you must understand the difference between manual therapy techniques and therapeutic exercise (CPT code 97110).
Manual therapy technique is a hands-on approach to physical therapy, where practitioners use their hands to gently touch joints and soft tissues, rather than using tools or exercises, to alleviate discomfort, enhance range of motion, and reduce inflammation.
Furthermore, do not bill this code for general massage therapy. This code is only billed when manual therapy is performed to improve joint mobility, range of motion, or reduce pain, with supporting documents establishing the medical necessity of the therapy.
Follow the Documentation Guidelines
Your paperwork for CPT code 97140 must convey the following details to the insurance payer.
- Document treatment duration.
- Specify the manual technique used and body area treated.
- Demonstrate medical necessity.
- State the date of service (DOS).
- Mention the functional goals of the therapy.
- Document the patient’s response to therapy.
- Note the start and end times for the total session to accompany your charges.
Check the Payer’s Guidelines
Lastly, it is best to review the information provided by the insurance payer for billing details, as each payer may have different billing rules, such as varying modifier requirements and documentation standards.
Use Medicare’s 8-Minute Rule
CPT 97140 is a time-based code. Meaning, the sessions are billed in 15-minute increments for accurate unit reporting. According to Medicare’s 8-Minute Rule, the physical therapist must spend at least 8 minutes of one-to-one time with the patient to report 1 unit of code 97140.
Note that these 8 minutes should be dedicated to manual therapy and not other related activities, like documentation, patient consultation, etc.
Final Thoughts
Therapists can use CPT code 97140 to bill manual therapy techniques applied to one or more regions as part of a patient’s outpatient treatment plan. This technique is specifically used for soft tissue and joint mobilization, manipulation, manual lymphatic drainage, and manual traction.
Do you still feel unsure about PT billing and want to increase the profitability of your practice? NeuraBill provides reliable physical therapy billing services to manage complex medical billing and coding problems. You can relax knowing that we will handle claim creation, submission, and resolution on your behalf.
