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Therapy and Active Care FAQ

Therapy and Active Care FAQ

Q: We use Therapeutic Exercise (97110) in the office with our patients. The code description says “one on one”. Does this mean someone has to be working individually with the patient the whole time?

A: These activities are performed one-on-one with the patient. This code represents a distinctly separate and unrelated procedure not considered inclusive of the CMT codes 98940-98943. If these activities are performed with multiple patients at once, the code 97150 would be used for group exercise.

Q: I have been told that billing massage therapy (97124) or manual therapy (97140) can be a red flag to third party payers. Is this true?

A: These codes can certainly be provided to your patient, billed to an insurance carrier or the patient, without any cause for concern when performed as part of an active treatment episode and properly documented. Each payer may have specific guidelines or exclusions for these codes, but overall these services make up a vital portion of patient care in a chiropractic office, and when done appropriately, can be reimbursed without concern.

Q: We use mechanical (intersegmental traction) tables in the office. I used to get paid for these, but in recent years, have been receiving denials. What am I doing wrong?

A: Many third-party payers will no longer cover intersegmental traction as traction. To be covered, most traction must include stabilizing or immobilizing the patient’s spine causing some resistance. It is critical that you read any third-party payer contracts and medical review policies for the specifics of coverage or non-coverage for this particular type of traction therapy.

Q: Someone told me that I cannot collect for hot/cold packs (97010) from my Medicare patients. I know I cannot give away free services to these patients. What do I do?

A: Medicare considers CPT Code 97010 (hot/cold packs) a ‘bundled’ service. When a service is bundled, it means that the reimbursement for the code is built into or grouped with the reimbursement for another code. In this instance, it means services described by 97010 are not separately billable when rendered to a Medicare patient. It is considered a part of whatever primary service is rendered to the patient, and in the case of chiropractic that will be a CMT code (98940-98942). This is different than a ‘non-covered’ service, which can be charged to the patient. A bundled service cannot be charged to the patient, as it is being reimbursed within another code’s value.