CPT 97035Physical Therapy

App mdlty 1+ultrasound ea 15

CPT 97035 covers therapeutic ultrasound treatment, a physical therapy modality that uses sound waves to treat pain, reduce inflammation, and promote tissue healing in muscles, tendons, and joints.

Showing rates for

National Average

Base Medicare rate

$13.91

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.21

PE RVU (NF)

0.21

MP RVU

0.01

Total RVU

0.43

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill in exact 15-minute increments only; round down if treatment time is less than 8 minutes (do not bill), bill 1 unit for 8-22 minutes, 2 units for 23-37 minutes following the 8-minute rule
Impact: Overbilling units by rounding up incorrectly can result in $13.91 overpayment per improper unit and triggers high-dollar audit flags
Document the specific body area treated, ultrasound parameters (frequency, intensity, duty cycle), and duration in the daily treatment note; avoid generic template phrases
Impact: Specific documentation reduces denial rate by approximately 40% and strengthens medical necessity in audits and appeals
Never bill 97035 as a standalone service without therapeutic exercise or manual therapy codes; Medicare and commercial payers expect active treatment, not passive modalities alone
Impact: Modality-only visits face 60-80% denial rates for lack of medical necessity; always pair with skilled therapeutic intervention codes
Apply appropriate therapy modifier (GP for PT, GO for OT) on every claim to ensure proper therapy cap tracking and avoid payment delays
Impact: Missing modifiers cause automatic claim rejections requiring resubmission, delaying payment by 14-30 days
For Medicare patients exceeding therapy thresholds ($2,280 in 2025), append modifier KX and ensure medical necessity documentation including functional goals and objective measurements are current
Impact: Missing KX modifier results in automatic denial of all claims above threshold; proper use maintains continuous reimbursement stream
Verify that payer policy allows ultrasound for the specific diagnosis; some payers deny 97035 for chronic conditions beyond 6-8 weeks or limit total units per episode of care

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Frequently asked questions

How much does Medicare pay for CPT code 97035 in 2025?

Medicare pays $13.91 for CPT code 97035 in 2025 (national average non-facility rate). This rate applies to both facility and non-facility settings. The code has a total RVU value of 0.43, calculated using the 2025 conversion factor of 32.3465.

Can you bill CPT 97035 for multiple units in one session?

Yes, you can bill multiple units of CPT 97035 if ultrasound is applied for sufficient time using the 8-minute rule: 1 unit for 8-22 minutes, 2 units for 23-37 minutes, etc. However, most therapeutic ultrasound treatments last 5-15 minutes (1 unit), and billing multiple units requires clear documentation of extended treatment time and medical necessity for prolonged application.

What is the 8-minute rule for billing CPT 97035?

The 8-minute rule requires at least 8 minutes of direct ultrasound application to bill 1 unit of 97035. Treatment lasting 7 minutes or less cannot be billed. For 8-22 minutes, bill 1 unit; 23-37 minutes, bill 2 units; and so on. Always document exact minutes, not ranges, to support your billing.

Can CPT 97035 be billed with other physical therapy codes?

Yes, CPT 97035 is commonly billed with therapeutic exercise (97110), manual therapy (97140), and neuromuscular re-education (97112). However, it should not be the only service provided. Medicare and most payers expect ultrasound to be combined with skilled therapeutic interventions, not billed as a standalone modality-only treatment.

What modifiers are required for CPT 97035?

For Medicare, modifier GP (physical therapy) or GO (occupational therapy) is required to designate the therapy discipline and track therapy caps. Modifier KX is required when exceeding the therapy threshold. Modifier 59 may be needed when billing multiple distinct modalities. Modifiers LT/RT indicate laterality when treating left or right sides.

What diagnosis codes support medical necessity for CPT 97035?

CPT 97035 is medically necessary for diagnoses involving soft tissue inflammation, tendinitis, muscle spasm, joint contracture, or acute injuries where ultrasound promotes tissue healing. Common ICD-10 codes include M75.1 (rotator cuff tendinitis), M76.6 (Achilles tendinitis), M25.56 (knee pain), S93.4 (ankle sprain), and M79.1 (myalgia). Always link diagnosis to functional limitations and treatment goals.

How many times can you bill CPT 97035 per week or per episode?

There is no universal limit, but medical necessity determines frequency. Most payers expect 2-3 treatments per week for acute conditions, tapering as patient improves. Some payers limit total units to 24-36 per episode or 6-12 per month for chronic conditions. Always verify payer-specific policies and document ongoing need based on objective functional improvements.