Correct Coding for Modalities & Therapeutic Procedures

Sep 1, 2025 | ANJC News & Updates, News for Members

By David Klein, CPC, CPMA, CHC, ANJC Coding & Compliance Consultant

Chiropractic Manipulative Therapy (CMT) is the most common service Chiropractors provide to their patients.

However, most Chiropractic offices also utilize different types of adjunct services when caring for patients, for example, traction, ultrasound, stretching, etc. Providers often use the term “therapies” when describing these types of services. “Therapy” is a general term, however; these therapies are distinctly different and understanding the differences is critical to correct coding and reimbursement.

The Physical Medicine and Rehabilitation section of Current Procedural Terminology (CPT) breaks down these “therapies” into two distinct types, as follows:

Modalities
Therapeutic Procedures

Modalities

According to the AMA, modalities are defined as:
“Any physical agent applied to produce therapeutic changes to biologic tissues; includes but not limited to thermal, acoustic, light, mechanical, or electric energy.”

Modalities are passive in nature, meaning the patient is not actively involved in the treatment. The patient often acts as a bystander and simply receives the care. They are designed for symptomatic relief. Modalities are coded based on the method of delivery; there is a “physical agent” used to gain the desired result.

Examples include:

Electrical stimulation
Biofeedback
Cryotherapy
Ultrasound
Laser therapy
Magnetic therapy
Massage
Mechanical traction

To further complicate modalities, they are divided into two categories:

Supervised
Constant Attendance

Supervised modalities (CPT codes 97010–97028) are defined as “the application of a modality that does not require direct (one-on-one) patient contact by the provider.”

Constant Attendance modalities are defined as “the application of a modality that requires direct (one-on-one) patient contact by the provider.”

Supervised modalities are coded only once per encounter, regardless of the number of body areas treated. In other words, time is not a factor in determining the number of units billed and the Provider does not have to have direct one-on-one contact with the patient throughout the procedure.

Example: CPT 97012 – traction, mechanical. When applying mechanical traction, the Provider sets the patient up with the device and does not have to watch the patient throughout the procedure – they “supervise.”

Constant Attendance (CPT codes 97032–97036) modalities require direct (one-on-one) patient contact.

Example: CPT 97035 – ultrasound. When applying ultrasound, it must be manually applied by someone. The Provider must be in constant attendance throughout the procedure, or the patient could be injured. Time is recorded in the record based on constant one-on-one attendance and the appropriate code is used for each 15-minute interval.

Example: If ultrasound is applied to four areas for a total of 30 minutes (one-on-one), CPT code 97035 is billed two times, once for each 15-minute interval.

Therapeutic Procedures

The AMA defines Therapeutic Procedures (CPT codes 97110–97546) as “A manner of effecting change through the application of clinical skills and/or services that attempt to improve function.”

Examples include:

Strengthening exercises
Stretching exercises
Cardiovascular exercise
Balance and coordination
Gait Exercise
Aquatic Therapy
Neuromuscular Re-education

Therapeutic Procedures are coded based on the therapeutic outcome intended by the Provider. They are typically active in nature: the patient is an active participant in the activity, and they are often designed towards long-term outcomes. Therapeutic procedures often include education and/or exercise, and the Provider relies on feedback from the patient when performing these services.

Because these services are outcome-driven, some appear to be similar in nature; however, they require specific circumstances and documentation to code. For example, therapeutic exercise (CPT 97110) and therapeutic activities (CPT 97530).

Choosing CPT 97530 or 97110 depends on the intent/outcome of the service. CPT 97110 focuses on one parameter, such as strength or range of motion. CPT 97530 focuses on activities that may be dependent on multiple parameters.

When using CPT 97530, providers should focus on tasks such as carrying, lifting, handling, reaching, transferring and transporting to improve specific functions – all “ing” tasks. Specific examples include hand assembly activities, transfers (chair to bed, lying to sitting, etc.), swinging, catching, lunging and throwing.

In contrast, therapeutic exercise (97110) uses only one parameter, e.g., strength, range of motion, flexibility.

Example: Wall squats can be used for strengthening and billed under CPT 97110. However, if the patient is squatting for item retrieval from the floor level, it could be coded as CPT 97530.

This is because CPT 97530 encompasses broader functional movements and activities aimed at improving the functional capacity of the patient. CPT 97530 is best suited for addressing specific functional limitations that involve multiple physical skills (e.g., balance, mobility, or coordination). This code is often used for patients with complex conditions.

With the exception of group therapy (CPT 97150), all therapeutic procedures are time-based and require direct one-on-one contact by the physician or therapist (visual, verbal and/or manual contact) during provision of the service.

Coding for these services depends on the therapeutic outcome, time of performance and level of contact provided to the patient. The provider’s direct time requirement (one-on-one) is 15 minutes per unit and time spent must be recorded in the record (either total time spent or beginning and ending time).

As with all procedures, your documentation must substantiate the medical necessity of the service, be dated and signed, and support the diagnosis and services billed. A thorough and well drafted treatment plan in the patient’s record will significantly help and is required by Medicare and most, if not all, Payers and state boards.

Providers should also be aware of Medicare’s Correct Coding Initiative (NCCI). NCCI edits are applied to CPT codes and may prohibit certain codes from being billed together or require that the services are distinct or independent from each other when billed on the same day.

This advisory is designed to serve as an overview of certain coding scenarios. Providers should always be careful to check all applicable state laws and regulations as well as individual Payer policies to ensure proper coding and compliance.

ABOUT THE AUTHOR

David Klein, CPC, CPMA, CHC, is the ANJC’s coding and compliance consultant. He is the co-founder of PayDC, a web-based Electronic Health Records Practice Management system that focuses on compliance and reimbursement. He is a certified professional coder through the American Academy of Professional Coders (AAPC) and is certified in healthcare compliance through the Health Care Compliance Board (HCCB).