Does Insurance Pay for CPT Code 97010
Technically, yes, UnitedHealthcare does pay for CPT code 97010, (Application of a modality to one or more areas; hot or cold packs).
I say “technically” because it is paid as a bundled payment. Ice packs, moist heat, and other similar modalities are reimbursed within the reimbursement of other treatment codes.
“Payment for CPT 97010 is considered bundled into the fee provided for other services.”
The 97010 CPT code is described in the CPT manual as a supervised modality:
Any physical agent applied to produce therapeutic changes to biologic tissue; includes but not limited to thermal, acoustic, light,
mechanical, or electric energy. The application of a modality that does not require direct (one-on-one) patient contact by the
provider. Application of a modality to one or more areas; hot or cold packs.
CMS national policy effective January 1, 1997 precludes separate payment for hot packs/cold packs (CPT 97010). Regardless
of whether billed alone or in conjunction with another code, CMS does not make payment separately for this code.
Reference Link: CMS LCD Policy L34049
Hot or cold packs therapy
Hot or cold packs (including ice massage) applied in the absence of associated procedures or modalities, or used alone to reduce discomfort are considered not to require the unique skills of a therapist.
Hot or cold pack therapy may be bundled with any therapy code. Regardless of whether code this is billed alone or in conjunction with another therapy code, this code is never paid separately. If billed alone, this code will be denied.
Supportive Documentation Recommendations for hot or cold pack therapy CPT Code 97010
The area(s) treated
The type of hot or cold application
Ice Packs (Cryotherapy) Delivered in the Clinic
While I was a physical therapy student back in early 2000’s, many outpatient orthopedic clinics would finish every treatment session with a 10-minute unit of CPT Code 97010.
This would usually involve a patient sitting in a chair or laying on a plinth with a gel pack strapped to their painful extremity.
Is Icing in the Clinic a Covered Service?
In the example above, passively placing an ice pack on a painful extremity is not seperately payable by all insurance companies.
The only way to know for certain is to call your specific insurance policy holder and ask about the coverage guidelines for CPT Code 97010.
Different Kinds of Icing (Cryotherapy)
1.) Gel Pack
My favorite icing gel packs for home use of in the clinic use is the
Chattanooga ColPac – Reusable Gel Ice Pack – Black Polyurethane – Oversize – 12.5 in x 18.5 in – Cold Therapy
We buy the black polyurethane model instead of the royal blue because it lasts longer and has never burst at the corners like less expensive models.
2.) Ice Machine
Polar Active Ice 3.0 Cold Therapy Ice Machine System
This is a relatively low cost yet durable unit for home use. In our experience patients have been able to use these devices safely and independently without frustration.
Frequently Asked Questions:
Is Ice Massage Billable As Manual Therapy?
No! Ice massage is only billable under cpt code 97010. It does not fall under the guidelines of CPT Code 97140 manual therapy. Nor does it qualify as CPT Code 97124 massage therapy.
Does insurance cover the cost of an ice machine system?
Traditional Medicare Part A or Part B does not cover the cost of at home ice machines. It is important to note that some Medicare Advantage plans and non-Medicare healthinsurance plans might cover the cost of an at home use ice machine when prescribed by your surgeon following total knee replacement, rotator cuff repair, ACL reconstruction, and other surgical procedures.
Below is a list of CPT Codes for cryotherapy (icing machines):
- E0218 Water circulating cold pad with pump
- E0236 Pump for water circulating pad
- E0650 Pneumatic Compressor, nonsegmental home model
- E0651 Pneumatic compressor, segmental home model without calibrated gradient pressure
- E0652 Pneumatic compressor, segmental home model with calibrated gradient pressure
- E1399 Durable medical equipment, miscellaneous
If an insurance plan does pay for cpt code 97010 is it a timed code?
No, CPT Code 97010 is not a timed code. If it is considered a covered service it is usually limited to a single unit per day.
Anthony Maritato, PT
Private Practice Owner / Physical Therapist
After starting a private practice physical therapy clinic in 2022 with his wife Kathy Maritato, PT, Tony and Kathy grew their practice to five locations across two states.
Now, Tony and Kathy enjoy spending time treating patients in the morning, coaching therapists in the evening, and being home to play with their dog Tucker and 4 boys.
