App mdlty 1+ultrasound ea 15
CPT 97035 covers therapeutic ultrasound treatment, a physical therapy modality that uses sound waves to reduce pain, inflammation, and promote healing in muscles, tendons, and joints. Each 15-minute session of ultrasound therapy is billed separately.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document exact time on/time off for ultrasound application. Medicare requires 8+ minutes to bill one unit; 23+ minutes for two units (8-minute rule)
Impact: Underdocumented time is the #1 denial reason. Proper time documentation protects $13.91 per unit
Always include specific body area treated, intensity settings (W/cm²), frequency (MHz), and treatment goal in documentation
Impact: Missing technical parameters increase audit risk by 40% and medical necessity denials
Bill 97035 separately from therapeutic exercise (97110) or manual therapy (97140) when performed same day, as they are not bundled
Impact: Proper unbundling can increase revenue by $13.91+ per session when both services provided
Use modifier GP (physical therapy) or GO (occupational therapy) on every claim to ensure proper routing and therapy cap tracking
Impact: Missing therapy modifiers causes processing delays and potential denials; required for payment
Do not bill 97035 for cold/hot packs, electrical stimulation, or other modalities - each has separate codes (97010, 97014, 97032)
Impact: Code confusion causes 100% payment denial; ultrasound is specifically acoustic wave therapy only
Verify medical necessity by linking to appropriate ICD-10 codes (M25.5- joint pain, M79.1 muscle pain, M75.1- rotator cuff) and include functional goals
Impact: Weak medical necessity documentation increases denial rate from 8% to 35% for this code
Common denials
Insufficient time documentation or treatment time below 8-minute threshold per Medicare's 8-minute rule
How to appeal: Submit corrected documentation showing exact start/stop times totaling 8+ minutes. Include therapist attestation and contemporaneous daily notes proving service was rendered for documented duration
Medical necessity not established - ultrasound deemed not reasonable/necessary for diagnosis code submitted
How to appeal: Provide evaluation notes establishing baseline impairments, peer-reviewed literature supporting ultrasound for specific condition, and progress notes showing functional improvement. Request LCD review under local coverage determination
Missing or incorrect therapy modifier (GP, GO, or GN) causing claim rejection or incorrect processing
How to appeal: Resubmit claim with correct modifier attached. Include corrected CMS-1500 and cover letter explaining modifier addition. Most payers allow corrected claim within 1 year
Services deemed maintenance therapy rather than rehabilitative, especially after extended treatment periods
How to appeal: Document ongoing functional improvements using objective measures (ROM, strength, pain scales). Cite Jimmo v. Sebelius settlement clarifying maintenance therapy coverage. Show skilled need for ultrasound parameters adjustment
Frequently asked questions
What is the Medicare reimbursement rate for CPT 97035 in 2025?
The 2025 Medicare national average reimbursement for CPT 97035 is $13.91 for both facility and non-facility settings. This rate is based on 0.43 total RVUs multiplied by the 2025 conversion factor of 32.3465.
How many units of 97035 can I bill per session?
You can bill multiple units of 97035 based on the 8-minute rule: one unit for 8-22 minutes, two units for 23-37 minutes, and so on. Each unit represents 15 minutes of direct ultrasound application time. Document exact start and stop times for each treatment area.
Can CPT 97035 be billed with 97110 on the same day?
Yes, 97035 (ultrasound) and 97110 (therapeutic exercise) can be billed together on the same date of service as they are not bundled codes. Both must meet the 8-minute rule independently, be medically necessary, and be documented separately with distinct time tracking.
What modifiers are required for billing CPT 97035?
Medicare requires therapy discipline modifiers: GP (physical therapy), GO (occupational therapy), or GN (speech therapy). Modifier 59 or XU may be needed when billing with codes that have CCI edits. Always verify payer-specific modifier requirements.
What diagnosis codes support medical necessity for 97035?
Common supporting ICD-10 codes include M25.5- (joint pain), M79.1 (myalgia), M75.1- (rotator cuff syndrome), M77.1- (epicondylitis), S43.4- (shoulder sprain), and M76.- (enthesopathies). Link codes to documented functional limitations and treatment goals.
How do you document ultrasound therapy for billing CPT 97035?
Document: (1) time on/off, (2) exact body area, (3) frequency (1 or 3 MHz), (4) intensity (W/cm²), (5) duty cycle, (6) treatment purpose, (7) patient response. Example: '2:00-2:12 PM, ultrasound right shoulder rotator cuff, 1 MHz, 1.5 W/cm², continuous, to reduce inflammation and pain, patient tolerated well.'
What is the RVU value for CPT code 97035 in 2025?
CPT 97035 has a total RVU of 0.43 in 2025, consisting of 0.21 work RVU, 0.21 practice expense RVU (both facility and non-facility), and 0.01 malpractice RVU. These values are from the CMS Physician Fee Schedule RVU25A.