Does CPT code 97530 need a modifier?
Coding Guidelines & Modifier The 97530 CPT code is commonly billed with procedure code CPT 97140 (manual therapy techniques) with modifier 59 to override CCI edits. According to CCI guidelines, it is only appropriate to report these procedures separately when performed in two distinct and separate 15-minute intervals.
What modifier should be used with 97530?
59 modifier
When using the 59 modifier, you are indicating to the insurance company that each service was medically necessary and performed independently of the other. One typical example of when to use this modifier is if you bill for manual therapy (97140) and therapeutic activities (97530), in the same session.
What is the 59 modifier used for?
Distinct Procedural Service
The definition of the 59 modifier per the CPT manual is as follows: Modifier 59: “Distinct Procedural Service” – Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day.
Which CPT code does modifier 59 go on?
If the circumstance calls for a Level 3 established patient visit (CPT code 99213) to be billed with psychological testing (such as CPT code 96101), modifier 59 would be appended to the testing code.
How do I bill a 97530?
CPT code 97530 requires “use of dynamic activities to improve functional performance. Examples of such activities include lifting, pushing, pulling, reaching, throwing, etc.” Billing this code also requires direct, one on one contact, billed in 15-minute increments.
What CPT code is 97530?
CPT 97530: Therapeutic activities, direct (one on one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes.
How does modifier 59 affect reimbursement?
Modifier 59 allows you to unbundle — separately report and get paid for — two or more procedures occurring during the same encounter by the same physician that would not normally be paid independently. Use modifier 59 correctly, and you’ll collect every penny of reimbursement for the work you do.
What can be billed under 97530?
What does CPT code 97530 mean?
The CPT code 97530 is a therapeutic activity that covers a broad range of rehabilitative techniques involving movement of the entire body which may include such activities as bending, lifting, carrying, reaching, catching, transfers and overhead activities to improve functional performance in a progressive manner.