Infrared therapy (CPT code 97026)
CPT Code Description
97026 Application of a modality to 1 or more areas; infrared (limited coverage)
Similar to the reasoning discussed above, AOTA requests that language limiting treatment to situations when “the patient’s condition is complicated by circulatory deficiency, areas of desensitization, open wounds, fractures or other complications” be deleted.
Electrical Stimulation (CPT code 97032)
Similar to the reasoning discussed under the Mechanical Traction section, patients with acute conditions may not be able to tolerate any therapeutic procedures initially. AOTA suggests revising the last sentence in the forth paragraph to:
Electrical stimulation is generally utilized with other therapeutic modalities and/or
procedures to affect continued improvement.
For the same reasons discussed above, AOTA takes issue with the suggestion that the typical treatment is limited to twelve (12) sessions per month and requests that this rule of thumb be removed.
Electric Current Therapy (CPT code 97033)
AOTA agrees that often “3-6 treatments are necessary to assess the effectiveness of this modality.” AOTA suggests some additional text to indicate that continued use beyond these initial treatments is covered when there is objective evidence of the clinical effectiveness of this modality.
The following provides guidance about the use of codes 96105, 97026, 97150, 97545, 97546, and G0128.
• CPT Codes 96105, 97545, and 97546.
Providers report code 96105, assessment of aphasia with interpretation and report in 1-hour units. This code represents formal evaluation of aphasia with an instrument such as the Boston Diagnostic Aphasia Examination. If this formal assessment is performed during treatment, it is typically performed only once during treatment and its medical necessity should be documented. If the test is repeated during treatment, the medical necessity of the repeat administration of the test must also be documented. It is common practice for regular assessment of a patient’s progress in therapy to be documented in the chart, and this may be done using test items taken from the formal examinations. This is considered to be part of the treatment and should not be billed as 96105 unless a full, formal assessment is completed.
Other timed physical medicine codes are 97545 and 97546. The interval for code 97545 is 2 hours and for code 97546, 1 hour. These are specialized codes to be used in the context of rehabilitating a worker to return to a job. The expectation is that the entire time period specified in the codes 97545 or 97546 would be the treatment period, since a shorter period of treatment could be coded with another code such as codes 97110, 97112, or 97537. (Codes 97545 and 97546 were developed for reporting services to persons in the worker’s compensation program, thus CMS does not expect to see them reported for Medicare patients except under very unusual circumstances. Further, CMS would not expect to see code 97546 without also seeing code 97545 on the same claim. Code 97546, when used, is used in conjunction with 97545.)
• CPT Code 97026
Effective for services performed on or after October 24, 2006, the Centers for Medicare & Medicaid Services announce a NCD stating the use of infrared and/or near-infrared light and/or heat, including monochromatic infrared energy (MIRE), is non-covered for the treatment, including symptoms such as pain arising from these conditions, of diabetic and/or non-diabetic peripheral sensory neuropathy, wounds and/or ulcers of the skin and/or subcutaneous tissues in Medicare beneficiaries. Further coverage guidelines can be found in the National Coverage Determination Manual (Pub. 100-03), section 270.6.
Contractors shall deny claims with CPT 97026 (infrared therapy incident to or as a PT/OT benefit) and HCPCS E0221 or A4639, if the claim contains any of the following diagnosis codes:
ICD-9-CM
250.60 – 250.63
354.4, 354.5, 354.9
355.1 – 355.4
355.6 – 355.9
356.0, 356.2-356.4, 356.8-356.9
357.0 – 357.7
674.10, 674.12, 674.14, 674.20, 674.22, 674.24
707.00 -707.07, 707.09-707.15, 707.19
870.0 – 879.9
880.00 – 887.7
890.0 – 897.7
998.31 – 998.32
Multiple Therapies
• If electrical stimulation, unattended (97014), electrical stimulation, attended (97032) and ultrasound (97035) are provided to the same area at the same session, attach medical records. If medical records are not attached, only 97032 (since it has the highest MAP) will be allowed.
• If infrared (97026) and ultraviolet (97028) are provided to the same area at the same session, attach medical records. If medical records are not attached, only 97028 (since it has the highest MAP) will be allowed.
• If diathermy, e.g., microwave (97024) and infrared (97026) are provided to the same area at the same session, attach medical records. If medical records are not attached, only 97024 (since it has the highest MAP) will be allowed.
• If infrared (97026) and electrical stimulation, attended (97032) are provided to the same area at the same session, attach medical records. If medical records are not attached, only 97032 (since it has the highest MAP) will be allowed. Multiple Units of Physical Medicine Modalities and Procedures on Same Date of Service
Code Description Special Instructions 95831- 95857
MUSCLE TESTING AND RANGE OF MOTION TESTING
Performing routine muscle testing and range of motion or muscle testing (i.e., tests that are an integral part of the assessment performed each visit to determine the patient’s status from one visit to the next and to determine the level of care required for the current visit) are considered content of the evaluation or therapy billed that particular day and should not be billed separately. 97010 CRYOTHERAPY Do not use procedure code 17340, as this is for direct application of chemicals to the skin. This code will deny content of service unless it is the only service provided on the date of service.
97010 HOT OR COLD PACKS
Unattended One or more areas is one unit of service
This code will deny content of service unless it is the only service provided on the date of service. 97012 TRACTION (MECHANICAL) Unattended One or more areas is one unit of service
This code is one or more areas so the unit of service is limited to one regardless of the time spent or the number of areas treated. Sending in medical records will not change the units reimbursed on this code. Roller bed is not considered mechanical traction and is not medically necessary.
97014 ELECTRICAL STIMULATION , INTERFERENTIAL THERAPY, HORIZONTAL THERAPY Unattended
This code is one or more areas so the unit of service is limited to one regardless of the time spent or the number of areas treated. Use this code for Horizontal Therapy. When electrical stimulation 97014 and ultrasound 97035 are performed at the same time using the same machine, only one modality should be billed.
The electrodes and other supplies used to administer any modality are content of service of the modality. Billing of electrodes The electrodes and other supplies used to administer any modality are content of service of the modality and should not be billed to the patient.
97024 DIATHERMY (e.g., microwave) This code is one or more areas so the unit of service is limited to one regardless of the time spent or the number of areas treated.
97026 INFRARED Unattended One or more areas is one unit of service This code is one or more areas so the unit of service is limited to one regardless of the time spent or the number of areas treated.
97032 ELECTRICAL STIMULATION (MANUAL) Attended One or more areas 15 minutes is one unit of service This code is one or more areas so the unit of service is limited to one regardless of the time spent or the number of areas treated. Billing of electrodes The electrodes and other supplies used to administer any modality are content of service of the modality and should not be billed to the patient.
97035 ULTRASOUNDAttended One or more areas 15 minutes is one unit of service
Anodyne Therapy
• This service should be coded using 97799 with a description of “anodyne therapy” submitted in the 2400 NTE segment or box 19. It should not be confused with Infrared Therapy that is coded 97026.
Cold Laser Therapy/Soft Laser Therapy/ Low-Level Laser Therapy
• Cold laser/soft laser threrapy should be coded using 97039 with a description of “cold laser therapy/ soft laser therapy” in the 2400 NTE segment of an electronic submission or box 19 of a CMS-1500 claim form. It should not be confused with Infrared Therapy that is coded 97026.
• Low-level laser therapy should be coded S8948.
• All are considered experimental/investigational and is a provider write-off unless a Limited Patient Waiver is signed before performance of the service.
• Use modifier “GA” to demonstrate waiver on file.
