How To Use CPT Code 97035

CPT 97035 describes the application of ultrasound as a modality by physical therapists to treat muscle-related problems in patients. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 97035?

CPT 97035 is used by physical therapists to apply ultrasound as a treatment modality for muscle-related issues in patients. Ultrasound machines are used to transmit high or low frequency sound waves to the target area, which helps increase circulation and promote healing. This modality is primarily used to treat inflammation, pain, muscle spasms, contractures, and adhesive scars.

2. Official Description

The official description of CPT code 97035 is: ‘Application of a modality to one or more areas; ultrasound, each 15 minutes.’

3. Procedure

1. Physical therapists assess the patient’s condition and determine the need for ultrasound treatment.
2. A water bath or ultrasound gel/lotion is used to facilitate the process.
3. The ultrasound machine is applied to the target area, and sound waves are transmitted to the surrounding tissue and vasculature.
4. The sound waves penetrate the muscles, causing deep tissue/muscle warming, relaxation, and increased circulation.
5. Treatment typically lasts for 15 minutes, and multiple sessions may be scheduled based on the patient’s needs.

4. Qualifying circumstances

CPT 97035 is used for patients who require ultrasound treatment for muscle-related problems. It is primarily used to treat inflammation of periarticular structures, neuromas, pain, muscle spasms, contractures, and adhesive scars. Treatment should not exceed four sessions per week for longer than one month.

5. When to use CPT code 97035

CPT code 97035 should be used when physical therapists apply ultrasound as a modality to treat muscle-related issues in patients. It is important to ensure that the treatment is necessary and appropriate for the patient’s condition. This code should not be used for other modalities or treatments.

6. Documentation requirements

To support a claim for CPT 97035, physical therapists must document the following information:

• Patient’s diagnosis and the need for ultrasound treatment
• Date and duration of each treatment session (15 minutes per session)
• Specific areas treated with ultrasound
• Progress made by the patient and any additional sessions scheduled
• Signature of the physical therapist providing the treatment

7. Billing guidelines

When billing for CPT 97035, ensure that the treatment is performed by a physical therapist and that each session lasts for 15 minutes. It is important to follow the guidelines set by insurance companies and Medicare for proper reimbursement. CPT code 97035 should not be reported with other codes unless medically necessary and supported by documentation.

8. Historical information

CPT 97035 was added to the Current Procedural Terminology system on January 1, 1995. The code was later changed on January 1, 2010, to its current description.

9. Examples

1. A physical therapist applies ultrasound to a patient’s shoulder to treat inflammation and promote healing.
2. A patient with muscle spasms receives ultrasound treatment on their lower back to relax the muscles and alleviate pain.
3. An athlete undergoes ultrasound therapy on their knee to reduce swelling and facilitate recovery from an injury.
4. A patient with adhesive scars receives ultrasound treatment to soften the scars and improve mobility.
5. A physical therapist uses ultrasound on a patient’s neck to relieve muscle tension and improve range of motion.
6. A patient with a neuroma undergoes ultrasound treatment to reduce pain and inflammation in the affected area.
7. An individual with contractures receives ultrasound therapy to help relax and stretch the affected muscles.
8. A patient with chronic pain undergoes ultrasound treatment on their back to alleviate discomfort and improve function.
9. A physical therapist applies ultrasound to a patient’s ankle to promote healing and reduce swelling after a sprain.
10. An individual with inflammation in their elbow receives ultrasound treatment to reduce pain and improve mobility.