Physical therapists, or PT for short, employ different techniques to help individuals lead fulfilling lives. They help patients with chronic pain or post-surgery, veterans, or people with disability experience improvement over time without medication. A respectable job, indeed!
But, unfortunately, the efforts of therapists go unnoticed when they are not paid for their valuable time spent with patients. This guide will help you understand how to prevent denials for manual therapy services covered under CPT code 97140.
So, if this is something you have been looking for, continue reading.
CPT Code 97140 – Description
CPT code 97140 covers the performance of manual therapy techniques on one or more regions. These may include manual lymphatic drainage, mobilization/manipulation, and manual traction. You can bill it for every 15 minutes of direct contact time spent with the patient.
For context, manual therapy uses controlled pressure and movement of hands to treat soft tissues and joint disorders.
Scenarios Where CPT Code 97140 is Applicable
Let’s go through a few real-world clinical scenarios where CPT 97140 applies:
Post-Surgical Knee Stiffness
Picture a 39-year-old male patient who recently underwent an anterior cruciate ligament (ACL) reconstruction. Post surgery, he complains about experiencing stiffness and a limited range of motion (ROM).
It has been 3 months since the surgery was performed. Besides, the patient has already completed the early strengthening (CPT code 97110). But unfortunately, he has hit a plateau in knee ROM recovery. Thus, the physician refers him for manual therapy to address the joint restrictions.
The physical therapist applies sustained, passive, accessory, or oscillatory joint mobilizations to the patellofemoral and the tibiofemoral joints. It focuses on restoring the arthrokinematics necessary for full extension of the knee. The entire session lasts for 15 minutes.
Here, the therapist should report 1 unit of CPT code 97140.
Chronic Neck Pain with Cervical Restriction
Assume a 35-year-old female game developer with a 5-year history of episodic neck pain. She reports to her primary care physician that the pain worsens with prolonged desk work and forward head posture.
Initially, the physician prescribes anti-inflammatory medications. But they only provide temporary relief. As a result, the physician refers her for physical therapy.
At the clinic, the therapist conducts a detailed physical examination. Active ROM reveals a 40% reduction in rotation to the right. Palpation reveals tight muscles and a joint restriction (hypomobility) in the mid-cervical spine.
Additionally, orthopedic tests such as Spurling’s test confirm mechanical joint restriction as the primary driver of limited motion.
The PT performs targeted grade III passive physiological intervertebral movements (PPIVMs) and sustained natural apophyseal glides (SNAGs) to the restricted cervical segments. In total, the PT spends 15 minutes on manual therapy.
Thus, he should report 1 unit of CPT code 97140.
Shoulder Impingement with T-Spine Hypomobility
Imagine a 40-year-old male weightlifter who developed chronic shoulder pain (impingement). However, basic home exercises and rest were unable to improve it.
The orthopedist noted that poor mobility in the middle back was a major underlying cause. As a result, he referred the patient for manual therapy to restore the thoracic joint mobility.
Thus, the PT spent a total of 30 minutes with the patient. He performed targeted posterior-to-anterior joint mobilizations to the restricted thoracic segments for 15 minutes. It was focused on restoring spinal rotation and extension.
After that, the therapist performed deep, sustained soft tissue mobilization release on two separate, restricted regions for 15 minutes. These included the subscapularis muscle (anterior rotator cuff) and the pectoralis minor and major muscles.
Here, the PT should bill 2 units of CPT code 97140 as per the 8-minute rule.
Applicable Modifiers for CPT Code 97140
Listed below are some of the applicable modifiers for CPT 97140:
Modifier 59
What happens when the same physician performs two different procedures in two distinct 15-minute time intervals for the same patient? You append modifier 59 to bypass unnecessary bundling of services.
Let’s assume a 50-year-old female patient with chronic lateral patellar tracking dysfunction and subjective difficulty with stairs.
Thus, the therapist spends the first 15 minutes conducting hands-on patellar glide mobilization to the knee joint and myofascial release to the restricted lateral retinaculum (CPT code 97140). He then performs and records a battery of standardized, timed functional testing to quantify the patient’s performance (CPT 97750).
Here, modifier 59 is applicable because both timed procedures were rendered in two different time blocks.
Modifiers GP & GO
When dealing with CPT code 97140, you must understand that it is a therapy code that can be used for both occupational and physical therapy.
Thus, the Centers for Medicare and Medicaid (CMS) mandates that you report it with a provider-specific modifier to identify the plan of care under which the therapist delivered the service.
Below are two applicable modifiers related to this procedural code:
- Modifier GP: Physical therapy service rendered under an outpatient care plan.
- Modifier GO: Occupational therapy service rendered under an outpatient care plan.
CPT Code 97140 – Billing & Reimbursement Guidelines
The following are the essential billing guidelines for CPT 97140:
Understand the Time-Based Billing Rules
The 8-minute rule applies to all time-based procedural codes, especially for outpatient care procedures, including CPT code 97140. As per this rule, therapists can bill one unit if at least 8 minutes of direct contact occur.
You can refer to the table below for a better understanding:
| Total Time Documented | Billable Units |
|---|---|
| 0 to 7 minutes | 0 Unit |
| 8 to 22 minutes | 1 Unit |
| 23 to 37 minutes | 2 Units |
| 38 to 52 minutes | 3 Units |
| 53 to 67 minutes | 4 Units |
Fulfill Documentation Requirements
Do not delay the reimbursement for CPT code 97140. Fulfill the following documentation requirements to expedite payment:
- Explain why the PT’s skills are needed or why the patient cannot perform the exercise/massage independently. For example, the patient’s grade II joint hypomobility at T6 requires the therapist’s specific direction and grading of force to restore accessory motion.
- Describe the techniques employed and the specific anatomical region treated. For example, myofascial release on the restricted lumbar paraspinal muscles located at the L4-L5 level.
- Document the total time spent performing the manual therapy accurately in minutes.
- State the measurable, objective change observed immediately after the therapy. For example, pain decreased from 6/10 to 4/10.
Demonstrate Medical Necessity
Most payers cover manual therapy (CPT code 97140) if it is medically necessary. Listed below is the key criterion that your documentation must support:
- The therapy session was directly tied to a measurable goal in the care plan. For example, increased internal rotation was needed to achieve the long-term goal of reaching behind the back.
- The manual therapy led to demonstrable improvement in a functional activity.
You must update the treatment plan over time as the patient’s condition changes. But why? What happens if the same technique is utilized for several sessions without noticeable improvement? The payer may regard it as routine or non-reimbursable.
Summary
With that said, it is time to conclude. However, before we bid farewell, let’s reiterate some key takeaways!
CPT code 97140 is a timed code that covers manual therapy techniques performed by a physical therapist on one or more regions. To avoid denials or audit risks, you must understand the 8-minute rule, focus on documentation accuracy, and justify the medical necessity.
However, if you still find yourself lost in the complex maze of time-based coding, feel free to partner with MediBillMD for professional physical therapy billing services.
