97016 CPT Code (2023) | Description, Guidelines, Reimbursement, Modifiers & Examples
97016 CPT code can be reported when a vasopneumatic device is applied during treatments to one (or more) area(s). CPT 97016 is a procedural code that falls under the range of supervised physical medicine and rehabilitation modalities.
97016 CPT Code | Description
Application of a modality to one or more areas; vasopneumatic devices.
Specific indications for the use of 97016 CPT code vasopneumatic devices include:
- reduction of edema after acute injury;
- lymphedema of an extremity; and/or
- education on the use of a lymphedema pump for home use.
Medical Necessity
Further treatment of lymphedema by a provider after the educational visits are generally not medically necessary. Education on using a lymphedema pump for home use can typically be completed in no more than three (3) visits.
The use of CPT 97016 vasopneumatic devices may be considered reasonable and necessary for the application of pressure to an extremity to reduce edema.
Reimbursement
The use of vasopneumatic devices would not be covered as a temporary treatment while awaiting receipt of ordered Jobst stockings.
Modifier 59 can be applied if more than one 90715 CPT code treatment is performed in a short period of time.
Report CPT 97016 as 1 unit regardless the time length of the treatment.
Additional visit constitutes as a separate treatment.
Reimbursement documentation should demonstrate that “the edema is clinically significant, interferes with a patient’s functional abilities, and fully meets the CPT code requirements. Make sure to provide the following documentation:
- A certified plan of care;
- Initial evaluation;
- Progress reports;
- Pre- and post-treatment measures;
- Treatment encounter nodes
