97014 CPT Code (2023) – Description, Guidelines, Reimbursement, Modifiers & Examples

The 97014 CPT code is used for billing services when electrical stimulation is provided to 1 or more body areas. This service is provided to the patient’s nerves or muscles that cannot move independently or respond independently. Physicians pass electrical current through the muscle or nerve that helps them contract and restore body function of the affected part resulting from a traumatic injury like a spinal cord or head injury.  

97014 CPT Code | Description & Explanation

CPT 97014 will aid the patient in promoting healing and stimulating muscle function. It will require the physician’s direct supervision, and treatment can be reported only once daily.

The official description of CPT code 97014 is: “Application of a modality to 1 or more areas; electrical stimulation (unattended).”

If multiple sessions are performed on the same day, reporting each treatment session separately is appropriate.

If one session is performed in different intervals, all intervals are included in CPT 97014. Medicare does not recognize CPT 97014. Therefore, it is appropriate to bill with HCPCS Level II codes G0281-G0283 for Medicare Part-B claims. 

Below are the following reasons or benefits of PT (Physical Therapy) when CPT 97014 is performed:

• To reduce pain in affected areas by electrical simulation
• To promote efficient blood circulation
• To strengthen muscles and aid in contraction
• For inflamed muscle, tendon, bursa, or ligaments 
• To help in traumatic healing wounds 

There are two types of electrical simulations like Neuromuscular Electrical Stimulation (NMES) and Iontophoresis.

Iontophoresis is treated with medication during PT, pushing through electrical impulses via the skin or body, while NMES targets muscles or groups of different muscles to contract by electrical stimulation.

It can cause tissue burn, irritation, and tearing in muscles. However, if electrical stimulation is provided effectively and correctly to the targeted area, it will block the pain triggers point on the muscles. 

The 97014 CPT code is used for billing service when applying a modality to 1 or more areas with electrical stimulation (unattended).

Unattended means that the therapist placed all the parameters electrodes set all the module requirements rest of the things will be done by the patient self with no therapist involvement.

Reimbursement

A maximum of 3 units of CPT 97014 can be billed when the documentation supports this service. Otherwise, CPT 97014 is not a reportable service for Medicare insurance. G0283 codes will be reported instead of CPT 97014.

Modifier 26 or TC are not applicable with CPT 97014.

The reimbursement rates of CPT 97014, which includes the cost and RUVS are as follows:

Facility: Cost $14.11, RUVS 0.40771

Non-Facility: Cost $14.11, RUVS 0.40771

Modifiers

Modifier 59, modifier 76, and modifier 77 are most frequently billed with CPT 97014.

If physicians perform two different sessions on the same patient on the same day, it is appropriate to append modifier 76 with the 97014 CPT code. In contrast, modifier 77 will be applicable when another Physician performs a different session on the same service date.

A patient is presented to SLP (speech-language pathologist) XYZ for 2 hours session in the morning.

For example, If the same patient comes again to Physician XYZ for another session on the day in the evening, Then Modifier 76 is appropriate with CPT 97014.

In contrast, If the same patient goes to a different Physician ABC for 3 hours session on the same day, modifier 77 will be applicable with modifier 77.

Modifier 59 is appropriate to append with CPT 97014 when service is bundled with another procedure on the same day, with service that is not usually performed on the same day.

Billing Guidelines

HCPCS Level 2 codes (G281, G0282, or G0283) will be reported for Medicare to treat wounds or other application treatments instead of the 97014 CPT code.

It will be appropriate to check other commercial insurance requirements and vary accordingly for reimbursement purposes.

CPT code 97014 cannot be performed by the patient or without physician assistance, and it requires the supervision of a physician. Documentation is significant to report CPT 97014.

Total treatments sessions of the same visit on the same date of service will be calculated as one service or unit of CPT 97014.

If CPT 97014 is performed with acupuncture, CPT codes (97813, 97814) are separately billable, and no modifier is required according to NCCI (National Correct Coding Initiative).

CPT 97014 is allowed to be billed together on the same day with the following CPT codes and append the appropriate modifier if required:

Electromyography (95860-95872, 95885, 95886, and 95887), EMG biofeedback training (90901), Nerve Conduction Studies (95905-95913), Muscle and motion range tests (97161-97172).

Each session with a different visit time will be reported separately on the same day.

Other procedure codes like CPT 64450 (anesthetic injection) might also be reported with CPT 97014 for pain relief, and no modifier will be required to report this service.

CPT 97014 is appropriate to billable for a condition that treatment is not taken more than 180 calendar days, considered an acute condition.

The physician must submit an appeal to the insurance if treatment goes beyond 180 days with supportive Documentation that the condition is still acute and has not moved to plateau.

 If a physician has performed CPT 97014 and has more than six sessions or visited the patient for electrical stimulation of pain.

There is no recovery seen within these six visits. Therefore, the documentation should support the services beyond six visits to continue therapy.

CPT 97014 will not be reported when SLP is not present to trigger the simulation at a specific moment to treat dysphagia. 

Billing Examples

The following are four billing examples of the 97014 CPT code.

Example 1

A 35-year-old male was presented to the therapist for a traumatic shoulder injury two weeks ago. A patient has 10/10 pain severity, and it was unbearable.

The physician sends the patient to the therapist for electrical stimulation of pain. The therapist attached all the modules electrodes and set all the parameters to the targeted site.

The patient did the rest of the simulation under the physician’s supervision without his involvement. After, he received 30-minute sessions comprised of two intervals. The patient feels reduced pain and is better than earlier.

Now patient pain severity is 2 out of 10, and feeling much better. The therapist scheduled three more sessions this week for electrical stimulation of pain.

Billing:

CPT Codes:

• CPT 97014: Application of a modality to one or more areas; electrical stimulation (unattended): This code documents the electrical stimulation therapy provided to the patient for pain management.

ICD-10 Codes:

• ICD 10 S46.011A: Strain of muscle(s) and tendon(s) of the rotator cuff of the right shoulder, initial encounter: This code is used to document the patient’s traumatic shoulder injury.
• ICD 10 G89.4: Chronic pain syndrome: This code is used to document the patient’s severe pain (10/10) before receiving electrical stimulation therapy.

Modifiers:

• Modifier 59: Distinct procedural service: This modifier can be used to indicate that the electrical stimulation sessions are separate and distinct services provided during the same encounter.

HCPCS Codes:

• HCPCS G0283: Electrical stimulation (unattended) to one or more areas for indications other than wound care, as part of a therapy plan of care: This code is used to document the provision of electrical stimulation therapy for pain management, which is unrelated to wound care.

Example 2

A 56-year-old male is presented to a therapist for the inflamed hip, ankle, and joints muscle. The patient had severe pain in the lower extremity joints. The pain was not healing by any medications and treatments.

The therapist decided to do an electrical stimulation of these joints. He placed all the electrodes in the targeted part and set the module parameters.

The patient rests the area and massages all the lower extremity joints. After a 15 to 20 minutes session, the patient felt better and less pain.

Therapies were given in four intervals of 20 minutes. The physician rescheduled electrical stimulation for the next 3 to 4 days of pain management.

Billing:

CPT Codes:

• CPT 97110: Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility: This code is used for the therapeutic exercise provided by the therapist to address the patient’s inflamed hip, ankle, and joints muscle.
• CPT 97014: Application of a modality to one or more areas; electrical stimulation (unattended): This code is used to document the unattended electrical stimulation therapy provided by the therapist for pain management. Please note that CPT 97014 is typically used for unattended therapy, while CPT 97032 is used for manual, attended therapy.

ICD-10 Codes:

• ICD 10 M25.551: Pain in right hip: This code documents the patient’s inflamed right hip.
• ICD 10 M25.571: Pain in right ankle and joints of the right foot: This code is used to document the patient’s inflamed right ankle and joints.
• ICD 10 M25.561: Pain in right knee: This code documents the patient’s inflamed right knee.