97039 – Unlisted modality (specify type and time if constant attendance)
97039 Unlisted modality (specify type and time if constant attendance)
For all claims submitted for unlisted services or procedures, the following documentation must be submitted:
* A description of the service or procedure; and,
* A treatment plan including information indicating the medical necessity of the service or procedure.
* Microamperage E-stimulation (MENS) has not been proven effective and will be denied as such. It is inappropriate to use code 97039 for this service. Please refer to code 97799 for further instructions.
* Vertebral Axial Decompression (VAX-D®)
This CPT code should not be used routinely or on a recurring basis.
Documentation must support the need for the service provided and document the modality which was provided.
If constant attendance, the amount of time should be documented.
The coverage of this code will be limited to 1 unit/day.
Utilization parameters (i.e. number of units/visits) mentioned throughout the Indications and Limitations section of this policy, except CPT codes 97039 and 97139, serve as only a guideline and DO NOT infer coverage or non-coverage of a service or units therein. Services and units of services must be reasonable and necessary for each individual and be supported by the Plan of Treatment and the therapists’ documentation.
As noted in Medicare National Coverage Determination Manual, Pub. 100-3, Section 160.11 (formerly Coverage Issues Manual (CIM) 35-97), Vertebral Axial Decompression (VAX-D®) is not covered by Medicare. Medicare notes that there is insufficient scientific data to support a finding of significant benefits of this technique. If billing for a denial for the provision of this service, you must use procedure code 97799 (Unlisted physical medicine/rehabilitation service or procedure) and enter “VAX-D®” in Item 19 on the CMS 1500 claim form, or electronic equivalent. An Advance Beneficiary Notice (ABN) should be obtained when VAX-D® is utilized. DO NOT bill using 64722, decompression, unspecified nerves, or 97012, application of modality.
* MedX, SPINEX®,or DRX9000™
When billing Fluidotherapy, Current Procedural Terminology (CPT) 97039 should be used. The description of this code states: Unlisted modality (specify type and time if constant attendance). CPT 97039 is not a time based code therefore only one unit should be billed. Providers may assist with the claim processing by utilizing the comment or remark section on the claim by indicating the unlisted procedure, CPT 97039, is for fluidotherapy. CPT 97022 is to be used for water whirlpool only.
Currently, NAS does not cover the following services, as there is insufficient scientific data, including evidence-based clinical studies, to support the benefits. NAS will review any requests for a coverage determination if accompanied by literature that supports the request for coverage.
1. Constraint Induced Movement Therapy (CIMT) Program: Medicare only covers the individualized treatment of specific patients’ illnesses or injuries. Unless specifically written into the law, Medicare may not cover services provided as programs developed for a population of patients. Treatment must be individualized for each beneficiary.
2. Craniosacral Therapy: Craniosacral Therapy is a technique of manually applying pressure to achieve subtle movement of the spinal and cranial bones to impact the central nervous system.
3. Infrared (e.g., MIRE): Infrared may be used as a treatment for multiple medical conditions and is completed by applying irradiation to the affected area through pads placed on the skin.
4. Iontophoresis (CPT 97033): Iontophoresis is a means of delivering analgesic or anti-inflammatory medication through the skin. The medication is injected into a patch, which is applied to the skin. An electrical current is then applied to the patch. Studies demonstrate that iontophoresis enhances the penetration of some drugs across the skin tissues and into the vasculature. Reimbursement for the topical administration of drugs alone is statutorily excluded.
5. Phonophoresis: Phonophoresis is an ultrasonic technique that enhances the delivery of topically applied analgesics or anti-inflammatory medications, increasing skin penetration and entrance into the vasculature. Reimbursement for the topical administration of drugs alone is statutorily excluded.
However, when clinically indicated (e.g. muscle spasms) the ultrasound component of this application may be reimbursable. In these instances, providers should bill for the ultrasound per se (using CPT 97035). Any additional supplies/medications used during the application process are not separately billable.
6. Spinal Cord Stimulation (SCS): This service is non-covered when provided as a therapy service. SCS requires surgical implantation of a device and is beyond the scope of practice of a therapist. Spinal Cord Stimulation therapy involves the use of a small pulse generator and electrodes implanted in the back to produce electrical impulses that block the central perception of pain. This treatment is currently being used on individuals suffering from chronic low back or leg pain and numbness.
7. Visceral Manipulation: Visceral Manipulation is a method of therapy based on specific placement of manual forces to encourage normal mobility, motion, and tone of the viscera (organs) and their connective tissue.
