Hydrotherapy Guidelines

January 4th, 2018 - Find-A-Code
Categories:   CPT® Coding   HCPCS Coding   Physical Medicine|Physical Therapy   Billing   Documentation Guidelines  
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According to CGS Administrators, hydrotherapy involves the patient’s immersion in a tank of agitated water in order to relieve muscle spasm, improve circulation, or cleanse wounds, ulcers, or exfoliative skin conditions.

Qualified professional/auxiliary personnel one-on-one supervision of the patient is required. If the level of care does not require the skills of a therapist, then the service is not covered.
Hubbard tank treatments more than 12 visits require clear documentation supporting the medical necessity of continued use of this modality.

It is not medically necessary to have more than one form of hydrotherapy during a visit (CPT codes 97022, 97036).

Supportive Documentation Recommendations for 97036

  • Rationale requiring the unique skills of a therapist to apply, including the complicating factors
  • Area(s) being treated

CPT 97039 - Physical therapy treatment (Specify type and time if constant attendance)
If an existing CPT code does not describe the service performed, an unlisted CPT code may be used. The use of unlisted codes should be rare. If unlisted codes are billed, the claim and medical record must clearly state what modality or procedure is billed as an unlisted code. If not, the unlisted code billed will be subject to denial for insufficient information.

Note: Low level/cold laser light therapy (LLLT) is considered not reasonable and necessary under SSA 1862(a)(1)(A) and is not payable by Medicare. This procedure is considered non-covered billed under any HCPCS/CPT codes, including S8948 and 97039.

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