Is CPT code 97140 covered by Medicare?
Asked by: Ward Cummerata | Last update: April 25, 2025Score: 4.8/5 (31 votes)
Does Medicare cover procedure code 97140?
Coding Considerations
Medically necessary hands-on MLD is a covered Medicare service and is coded using CPT® 97140 for manual therapy.
Is manual lymphatic drainage covered by Medicare?
Medically necessary hands-on MLD is a covered Medicare service and is coded using CPT 97140 for manual therapy.
What are the rules for 97140 billing?
Understanding the Time-Based Billing Rules for 97140
This means that in order to bill a unit, at least 8 minutes of that 15-minute increment must be spent providing direct patient contact. Any time less than 8 minutes within an increment cannot be counted towards billing.
What is medical necessity for 97140?
Clinical Necessity
Every session using CPT Code 97140 should meet the criteria of medical necessity. This means that the billed procedure should be essential for the patient's condition, and there should be clear documentation of why manual therapy is needed.
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How much is the CPT code 97140?
97140 $65/unit
It is used to treat the restricted motion of soft tissues in order to increase pain-free range of motion and facilitate a return to functional activities. 97124 $160/hour Massage Therapy Massage is the application of systematic manipulation to the soft tissues of the body for therapeutic purposes.
What is the difference between 97110 and 97140?
On the other hand, CPT code 97140 is used for manual therapy techniques that require direct (one-on-one) patient contact. The key difference lies in the type of therapy provided, with 97110 focusing on exercises and 97140 on hands-on techniques.
How many PT appointments will Medicare pay for?
There's no limit on how much Medicare pays for your medically necessary outpatient physical therapy services in one calendar year.
Can a massage therapist bill 97140?
Can a massage therapist bill 97140? Yes, a massage therapist can bill 97140, however, it is important to note that CPT code 97124 is more closely associated with massage therapy, so ensure you cite the exact treatment procedures in your claim for coverage.
How to get lymphatic drainage covered by insurance?
Coverage largely depends on whether the massage is deemed medically necessary. For instance, if a doctor prescribes lymphatic drainage massage as part of treatment for a specific medical condition like lymphedema, your insurance might cover it.
Does blood supply include lymphatic drainage?
Blood vessels deliver oxygen and nutrients to virtually all cells in developing mammalian embryos and adults, whereas lymphatic vessels drain the interstitial fluid that collects in tissues, and serve as a conduit for immune cell trafficking and fat absorption.
Will Medicare pay for lymphedema treatment?
Medicare pays for lymphedema compression treatment items. The items and services included in this benefit category are defined in section 1861(s)(2)(JJ) of the Social Security Act (the Act), and further defined in Medicare regulations at 42 Code of Federal Regulations (CFR) 410.36(a)(4).
What CPT codes are not covered by Medicare?
Certain services are never considered for payment by Medicare. These include preventive examinations represented by CPT codes 99381-99397. Medicare only covers three immunizations (influenza, pneumonia, and hepatitis B) as prophylactic physician services.
What is health code 97140?
CPT code 97140 is a code from the American Medical Association (AMA). It covers manual therapy techniques for 15 minutes or more. This includes manipulation, mobilization, and more. It's for billing procedures that help improve function or manage pain.
What is the 8-minute rule for rehab?
What is the 8-Minute Rule? To receive payment from Medicare for a time-based CPT code, a therapist must provide direct treatment for at least eight minutes. Providers must add the total minutes of skilled, one-on-one therapy and divide by 15. If eight or more minutes remain, you can bill one more unit.
Is there a copay for PT with Medicare?
Medicare pays for inpatient and outpatient physical therapy services, but it does not cover the full cost. An individual will usually need to pay a deductible and copayment. Physical therapy can help people regain movement and reduce pain and discomfort due to injuries, chronic conditions, or disabilities.
How do I get Medicare to pay for home care?
A doctor or other health care provider (like a nurse practitioner) must assess you face-to-face before certifying that you need home health services. A doctor or other health care provider must order your care, and a Medicare-certified home health agency must provide it.
What is the PT cap for Medicare 2024?
For CY 2024 this KX modifier threshold amount is: $2,330 for PT and SLP services combined, and. $2,330 for OT services.
Does Medicare cover 97140?
Medicare covers multiple manual therapy techniques with proper documentation. Manual therapy is reported using CPT code 97140. CPT code 97140 – Manual Therapy Techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, every 15 minutes.
Is 97140 PT or OT?
In summary, CPT code 97140 allows therapists to bill for timed, hands-on, manual therapy as part of a patient's care plan. Manual therapy has a place in occupational therapy treatment plans as manual techniques can enhance functional range of motion and manage pain for improved participation in daily tasks.
Can you bill 3 units of 97140?
33 minutes of therapeutic exercise, code 97110 7 minutes of manual therapy, code 97140 Total timed code treatment time is 40 minutes. If you look up 40 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes). You can bill 2 units of 97110 and 1 unit of 97140.
Is manual therapy the same as physical therapy?
Manual therapy is a specialty within the field of physical therapy. Traditional physical therapy focuses more on managing and treating the symptoms of the disease process, while manual therapy focuses more on performing biomechanical, tissue-based examination to identify the cause of the disease process.
Does Aetna cover CPT code 97140?
A few months ago, Aetna released a new policy indicating they will no longer pay for 97140 (manual therapy techniques) when performed on the same date of service as a CMT code (9894x). This even includes billings where the provider appends the -59 modifier (appropriately or inappropriately).