CPT Code 97036: Hydrotherapy with Hub or Whirlpool - Chirotouch
June 5, 2024 by ChiroTouch Team Article Coding

In this quick-reference guide to CPT code 97036, 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 97036: Hydrotherapy with Hub or Whirlpool

CPT code 97036 refers to the application of water for therapeutic purposes, also known as hydrotherapy. This involves the patient’s immersion in a tank of agitated water, such as a Hubbard tank or whirlpool, in order to:

  • Relieve muscle spasm: The warm water and agitation helps relax tense muscles.
  • Improve circulation: The hydrostatic pressure and warmth promotes blood flow.
  • Cleanse wounds, ulcers, or exfoliative skin conditions: The water cleanses and debrides damaged tissue.

Here’s what chiropractors need to know about using CPT code 97036.

Category or Type of Service

CPT code 97036 falls under the Physical Medicine and Rehabilitation category of codes. It is considered a constant attendance modality, meaning the provider must provide direct one-on-one contact with the patient for the duration of the service.

Billing Interval

This code is billed in 15-minute increments. Only bill for the time the patient is actually receiving the hydrotherapy treatment. Do not include time spent assessing the patient, documenting, or assisting them in and out of the tank.

When Should Chiropractors Use This Code?

Chiropractors should use CPT code 97036 when providing hydrotherapy that requires constant attendance and one-on-one contact in order to:

  • Reduce muscle spasms and guarding prior to chiropractic manipulation
  • Improve circulation and promote healing of wounds or ulcers, when debridement is required.
  • Cleanse and treat exfoliative skin conditions like psoriasis or eczema.

The documentation must clearly establish the rationale for hydrotherapy and the complicating factors that require the unique skills of the chiropractor or qualified professional to administer the treatment.

When Should Chiropractors Not Use This Code?

Chiropractors should not use CPT code 97036 for:

  • Whirlpool treatments that do not require constant attendance. Use CPT code 97022 instead.
  • Wound care that does not involve hydrotherapy. Use appropriate wound care codes instead.
  • Hubbard tank treatments beyond 12 visits without clear documentation supporting the medical necessity of continued use.
  • More than one form of hydrotherapy (97022, 97036) during the same visit, as this is not considered medically necessary.

Which Modifiers Can Be Used With CPT Code 97036?

The GP modifier must be used when billing 97036 to Medicare to indicate it was provided under an outpatient physical therapy plan of care. Some payers may require the AT modifier to signify treatment of an acute or chronic subluxation.

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

Billing guidelines and documentation requirements for 97036 include:

  • Documenting the rationale for hydrotherapy, including complicating factors
  • Specifying the area(s) being treated
  • Noting the exact time spent providing the direct one-on-one hydrotherapy only
  • Including the hydrotherapy in the plan of care and obtaining a physician’s order when required
  • Using the GP modifier for Medicare claims

What Are Common Mistakes Made Specific to CPT code 97036?

Common mistakes when billing CPT 97036 include:

  • Billing for time not spent in direct one-on-one contact providing the hydrotherapy
  • Billing 97036 for whirlpool treatments that don’t require constant attendance. (Use 97022 instead)
  • Billing multiple units of 97036 for time longer than 15 minutes. (Bill additional units instead)
  • Failing to document the medical necessity of continued treatment beyond 12 visits.
  • Billing 97036 in addition to other hydrotherapy codes for the same visit.

What Are Potential Audit Triggers Specific to This CPT Code?

Potential audit triggers for CPT code 97036 include:

  • Frequent billing of 97036, especially beyond 12 visits, without supporting documentation.
  • Billing 97036 in combination with other hydrotherapy codes like 97022 on the same visit.
  • Billing excessive units of 97036 that exceed reasonable treatment times.
  • Insufficient or absent documentation supporting the skilled nature of the service.

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

To optimize billing and coding accuracy, 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.

ChiroTouch Helps You Avoid Red Flags

Did you know that insurance carriers actively mine chiropractic billing documents for red flags? Flagged practitioners face a higher chance of audits, demands for more documentation, and other problems.

Streamlined billing and payment clearinghouses will help you avoid the “red flags” insurers will raise as they mine their data and study your billing patterns.

Read our blog post Chiropractic Billing Red Flags: What Is External Data Mining? to learn more about data mining, the problems that are most likely to make you stand out, and how ChiroTouch helps you avoid them.

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