CPT Code 97140 Manual Therapy

Medicare Coverage Policy for CPT Code 97140: Manual Therapy

Manual therapy, represented by the Current Procedural Terminology (CPT) code 97140, encompasses a range of therapeutic techniques aimed at treating musculoskeletal pain and disability. These techniques include manual traction, joint mobilization, myofascial release/soft tissue mobilization, manipulation, and manual lymphatic drainage/complex decongestive therapy (MLD/CDT). The Centers for Medicare and Medicaid Services (CMS) have established guidelines for the coverage of these services under Medicare.

Manual Traction

Manual traction, particularly for cervical dysfunctions such as cervical pain and cervical radiculopathy, may be considered reasonable and necessary under Medicare coverage.

Joint Mobilization

Joint mobilization, whether peripheral or spinal, may be considered reasonable and necessary if restricted or painful joint motion is present and documented. It may also be considered reasonable and necessary as an adjunct to therapeutic exercises when loss of articular motion and flexibility impedes the therapeutic procedure.

Myofascial Release/Soft Tissue Mobilization

This technique may be reasonable and necessary for treatment of restricted motion of soft tissues in involved extremities, neck, and trunk. Skilled manual techniques (active or passive) are applied to soft tissue to effect changes in the soft tissues, articular structures, neural or vascular systems.

Manipulation

Manipulation, which is a high-velocity, low-amplitude thrust technique or Grade V thrust technique, may be reasonable and necessary for treatment of painful spasm or restricted motion in the periphery, extremities or spinal regions.

Manual Lymphatic Drainage/Complex Decongestive Therapy (MLD/CDT)

MLD/CDT is indicated for both primary and secondary lymphedema. Coverage of MLD/CDT would only be allowed if all of the following conditions have been met:

• There is a physician-documented diagnosis of lymphedema (primary or secondary);
• The patient has documented signs or symptoms of lymphedema;
• The patient or patient caregiver has the ability to understand and comply with the continuation of the treatment regimen at home.

MLD/CDT is not covered for conditions reversible by exercise or elevation of the affected area, dependent edema related to congestive heart failure or other cardiomyopathies, patients who do not have the physical and cognitive abilities, or support systems, to accomplish self-management in a reasonable time, or continuing treatment for a patient non-compliant with a program for self-management.

* Image: Link

Documentation Requirements

Documentation must clearly support the need for continued manual therapy treatment beyond 12-18 visits. When the patient and/or caregiver has been instructed in the performance of specific techniques, the performance of these same techniques should not be continued in the clinic setting and counted as minutes of skilled therapy.

Supportive documentation recommendations for manual therapy include:

• Area(s) being treated
• Soft tissue or joint mobilization technique usedObjective and subjective measurements of areas treated (may include ROM, capsular end-feel, pain descriptions and ratings,) and effect on function
• For MLD/CDP, supportive documentation should include medical history related to onset, exacerbation and etiology of the lymphedema, comorbidities, prior treatment, cognitive and physical ability of patient and/or caregiver to follow self-management techniques, pain/discomfort descriptions and ratings, limitation of function related to self-care, mobility, ADLs and/or safety, prior level of function, limb measurements of affected and unaffected limbs at start of care and periodically throughout treatment, and description of skin condition, wounds, infected sites, scars.

Exclusions

Massage therapy is not covered on the same visit as this code.

How Much Does Medicare Pay for CPT Code 97140

* Reference: CMS Physician Fee Schedule 2023

CPT code 97140 modifier 59 - Billing Manual Therapy

As of the publishing of this article on 06/10/2023 NCCI edits do not require the use of a 59 modifier when billing CPT Code 97140 on the same date of service as a physical therapy evaluation (97161, 97162, 97163) or an occupational therapy evaluation (97165, 97166, 97167).

NCCI edits do not require the use of a 59 modifier when billing CPT Code 97140 and CPT Code 97530 on the same treatment visit. 

* For more information about using the 59 modifier when billing therapy services click here.