CATEGORY
Physical medicine and rehabilitation therapeutic Procedures
CODE TYPE
Timed-based code
Billed in 15 minutes increment
ADD-ON CODE
No add-on code
MANUAL THERAPY
Manual Therapy is a type of specialized form of physical therapy in which a physical therapist uses advance hand-on techniques to produce a change in soft tissues, articular structures, neural or vascular systems in order to treat a wide variety conditions instead of modalities.
This CPT should be used when a qualified healthcare professional performs any manual therapy technique including manual traction, manual lymphatic drainage and mobilization and manipulation techniques in a clinical setting.
Types of Techniques that are included:
Manual Therapy may include any of the following techniques:
- Soft Tissue Mobilization
- Strain-Counter strain (designed to correct abnormal neuromuscular reflexes that cause structural and postural problems, resulting in painful ‘tender points)
- Muscle Energy Technique (to mobilize restricted joint and shortened muscles)
- Joint Mobilization
- Joint Manipulation (high velocity and low amplitude thrust designed to regain lost range of joint motion)
CODING GUIDELINES
Require the skills of qualified healthcare professionals that includes:
- Physical Therapist
- Occupational Therapist
- Chiropractors
- Physical Therapist Assistant
- Occupational Therapy Assistant
» Billed in 15 minutes increment
» Requires physical therapy modifier (GP, GN, GO, CO, CQ)
» CMS 8-minute rule and AMA rule of Eights are applied
CMS 8-Minute Rule:
A minimum of 8 minutes of direct contact with the patient must be provided for a single unit of 97140 to be billed:
| Units | Number of Minutes |
|---|---|
| 1 unit | ≥ 08 minutes through 22 minutes |
| 2 units | ≥ 23 minutes through 37 minutes |
| 3 units | ≥ 38 minutes through 52 minutes |
| 4 units | ≥ 53 minutes through 67 minutes |
| 5 units | ≥ 68 minutes through 82 minutes |
| 6 units | ≥ 83 minutes through 97 minutes |
| 7 units | ≥ 98 minutes through 112 minutes |
| 8 units | ≥ 113 minutes through 127 minutes |
The pattern remains the same for treatment times of more than 2 hours.
AMA Rule of Eights:
“AMA guidelines state that incremental intervals of treatment performed on the same session may be added together when determining total time in direct contact of a qualified healthcare provider with the patient is necessary. Each unique timed service is counted separately instead of combining the time from multiple units”
PHYSICAL THERAPY MODIFIERS
Below mentioned modifiers are used when services are provided for the respective plan of care:
| MODIFIERS | PLAN OF CARE |
|---|---|
| GP | Outpatient Physical Therapy |
| GO | Outpatient Occupational Therapy |
| GN | Outpatient Speech-Language Pathology |
| CQ | Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially) |
| CO | Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially) |
TOTAL NO. OF BILLABLE UNITS
06 units are allowed to be billed per date of service by CMS but more units can be billed if justified by the medical notes.
MEDICAL NECESSITY
May be considered medically necessary if one of the following condition is present and documented:
» Cervical Radiculopathy
» Restricted joint motion of any region, peripheral or spinal
» As an adjunct to therapy exercises when a patient cannot perform these exercises due to loss of joint motions
» As an adjunct to other therapy (CPTs 97110, 97112, 97530)
» Myofascial release or soft tissue mobilization on 1 or more regions of the body
» Skilled manual techniques applied to soft tissue to treat conditions of soft tissues, articular structures, neural or vascular systems
» These techniques may be active or passive and include:
- Nerve gliding techniques
- Joint manipulation
- Muscle and soft tissue stretching
- Lymphatic drainage technique
REIMBURSEMENT GUIDELINES
For reimbursement following elements must be documented in the Physical Therapy Notes:
- Documentation of medical condition to justify the medical necessity.
- Documentation of the necessity of skill intervention required as well as documentation of the type and level of skilled assistance given to the patient and continued analysis of patient progress(Services that do not require the skill of a licensed therapy provider are not considered skilled services, even if they are performed or supervised by a qualified professional).
- Total direct time spent by the provider with the patient.
- Part of an active treatment plan tailored to the specific needs of the patient.
