CPT Code 97035: Ultrasound Therapy - Chirotouch
February 10, 2024 by ChiroTouch Team Article Coding

In this quick-reference guide to CPT code 97035, we answer frequently asked questions from our community of chiropractors. Follow us for other articles in our ongoing series, courtesy of ChiroTouch, the cloud-based EHR designed specifically for chiropractors.

NOTE: CPT codes and guidelines can be revised over time. To avoid billing issues, be sure to stay current with annual coding updates and changes to payer guidelines. 

About CPT Code 97035: Ultrasound Therapy

CPT code 97035 refers to the application of ultrasound therapy to one or more areas of the body. Ultrasound therapy uses high-frequency sound waves to produce thermal and/or non-thermal effects in the body’s tissues for therapeutic purposes.

Here’s what chiropractors need to know about using CPT code 97035.

Category or Type of Service

CPT code 97035 falls under the category of Physical Medicine and Rehabilitation services. It is considered a therapeutic modality that requires constant attendance by the provider.

Billing Interval

This code is billed in 15-minute increments or units. Only the actual time the provider is in direct contact with the patient providing the ultrasound therapy counts towards the billable time.

When Should Chiropractors Use This Code?

Chiropractors should use CPT code 97035 when providing attended ultrasound therapy for conditions such as:

  • Reducing inflammation and pain. The thermal effects can increase blood flow and relax muscles.
  • Enhancing tissue healing. Non-thermal effects may stimulate cell activity and protein synthesis.
  • Improving joint and tissue flexibility. Deep heating effects can increase extensibility of connective tissues.
  • Decreasing calcium deposits. Ultrasound may help break up calcifications in chronic conditions.

The treatment area, clinical rationale, and equipment specifics (e.g. frequency, intensity, duration) must be clearly documented to support medical necessity.

When Should Chiropractors Not Use This Code?

Chiropractors should not use CPT code 97035 for:

  • Unattended ultrasound therapy. If the ultrasound device is set up to run without the provider present, use CPT code 97039 (unlisted modality) instead.
  • Combination therapy. If ultrasound is performed concurrently with electrical stimulation, but does not require constant provider attendance, do not use 97035.

Which Modifiers Can Be Used With CPT Code 97035?

The following modifier codes may be used with CPT code 97035:

  • Modifier 25. Used to indicate a service was performed by the same provider on the same day as an evaluation and management (E/M) service.
  • Modifier 59. Indicates a distinct procedural service, used if billing 97035 with other therapy codes.
  • Modifier GP. Indicates services delivered under an outpatient physical therapy plan of care.

Always verify modifier usage with the specific payer to ensure compliance with their guidelines.

What Are the Billing Guidelines and Documentation Requirements Specific to This Code?

Key billing and documentation points for code 97035 include:

  • Constant attendance. The provider must be in direct contact with the patient throughout the ultrasound application. Document specifics of the provider’s attendance.
  • Time-based billing. Bill in 15-minute increments. If performed for less than 8 minutes, the service is not billable. Document exact treatment time.
  • Area treated. Specify the body area(s) to which the ultrasound was applied (e.g. lumbar paraspinals, knee joint).
  • Equipment details. Note the ultrasound frequency, intensity, mode (continuous vs pulsed), and coupling medium used.
  • Clinical rationale. Clearly document the medical necessity and intended clinical benefit of the ultrasound treatment. Relate it to the patient’s diagnosis and treatment plan.

What Are Common Mistakes Made Specific to CPT code 97035?

Common errors when billing CPT code 97035 include:

  • Billing for unattended ultrasound. Code 97035 requires direct provider-to-patient contact throughout the treatment. Unattended ultrasound should be billed with code 97039 instead.
  • Billing concurrently with e-stim. If ultrasound and electrical stimulation are provided together without constant provider attendance, do not bill 97035.
  • Insufficient documentation. Clearly document the treatment time, clinical rationale, body area, and ultrasound specifics. Avoid vague descriptions.
  • Billing for non-covered indications. Verify that the patient’s condition and treatment goals align with payer coverage policies for ultrasound therapy.

What Are Potential Audit Triggers Specific to This CPT Code?

Potential red flags for audits of CPT code 97035 include:

  • High utilization. Overuse of ultrasound for conditions lacking medical necessity may invite scrutiny. Ensure documentation supports the service.
  • Billing without attendance. Billing 97035 without documenting constant provider attendance may trigger audits. Use 97039 for unattended ultrasound.
  • Lacking equipment specifics. Failure to document ultrasound frequency, intensity, and mode may appear suspicious. Provide detailed records.
  • Unjustified extended durations. Unreasonably long or identical treatment times across multiple patients may invite review. Individualize treatment based on clinical need.

What Can I Do to Improve the Accuracy and Efficiency of My Practice’s Billing and Coding Processes?

To optimize billing and coding accuracy for CPT code 97035 and other services, chiropractors can:

  • Provide detailed documentation. Paint a clear picture of the service provided, clinical rationale, and equipment used. Avoid cookie-cutter notes.
  • Stay updated on billing rules. Pursue ongoing education on coding and billing to stay current with payer policies and guidelines.
  • Implement compliance checks. Conduct regular self-audits to identify and correct documentation or coding issues before they trigger audits.
  • Use chiropractic-specific EHR systems. Utilize EHR and billing software tailored to the unique needs and codes used by chiropractors.
  • Consider outsourced billing services. Partner with a knowledgeable chiropractic billing service to optimize coding, billing and revenue cycle management.

Free Up More Time For Patients With ChiroTouch

Bringing together twenty years of experience working with over 36,000 satisfied customers, ChiroTouch is designed by chiropractors to meet the needs of providers and billers.

Created with an intuitive understanding of the chiropractic profession’s needs, ChiroTouch streamlines the entire billing cycle. From the initial patient visit to the final payment, every step is integrated into a single, user-friendly dashboard. This consolidation of features eliminates the clutter of disjointed applications, enabling a smoother workflow that prioritizes efficiency and accuracy.

And because it’s in the cloud, your data is protected with automatic backups and updates.

If you’re ready to modernize your practice and spend more time doing what you love, book a demo today!

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