CPT 97610Physical Therapy

Low frequency non-thermal us

CPT code 97610 covers low frequency, non-thermal ultrasound therapy used to promote wound healing through acoustic pressure waves rather than heat. This specialized ultrasound treatment stimulates tissue repair at the cellular level without raising tissue temperature.

Showing rates for

National Average

Base Medicare rate

$397.22

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

0.4

PE RVU (NF)

11.87

MP RVU

0.01

Total RVU

12.28

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

NCCI bundling edits

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Billing tips

Verify place of service coding carefully—POS 11 (office) yields $397.22 while POS 22 (outpatient hospital) yields only $17.14
Impact: $380.08 difference per treatment based on POS designation; incorrect coding can result in massive underpayment
Ensure the wound has failed standard wound care for at least 30 days before initiating LFNTU; document all previous treatment modalities attempted
Impact: Medical necessity denials account for 40-60% of rejected claims; proper documentation of failed conventional therapy is essential for payment
Bill only one unit per session regardless of treatment duration or number of wounds treated during a single application
Impact: Multiple unit billing results in automatic denial and potential fraud investigation; this is a per-session code, not time-based
Document baseline wound measurements (length, width, depth), percentage of granulation tissue, and weekly progress photos to support medical necessity
Impact: Audits focus heavily on objective wound progression; lack of measurable improvement after 4 weeks often triggers denial of subsequent treatments
Check LCD coverage policies for your MAC—some require specific wound types, sizes, or ICD-10 codes for coverage
Impact: NGS, CGS, and Novitas have varying coverage criteria; non-compliant claims face 100% denial with difficult appeal process
Do not bill 97610 on the same date as certain debridement codes (11042-11047) without modifier 59 and separate documentation
Impact: NCCI edits may bundle services; improper modifier use can trigger $300-400 denial per session

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 97610 in 2025?

The 2025 Medicare national average reimbursement for CPT 97610 is $397.22 in non-facility settings (such as private offices and outpatient wound care centers) and $17.14 in facility settings (such as hospital outpatient departments). This substantial difference reflects the practice expense variation between settings.

How many times can you bill CPT 97610 per day?

CPT 97610 should be billed only once per session regardless of treatment duration or the number of wounds treated during that session. It is a per-session code, not a time-based code. Billing multiple units on the same date will result in denial and potential fraud investigation.

What is the difference between CPT 97610 and regular ultrasound therapy?

CPT 97610 is specifically for low frequency (20-100 kHz) non-thermal ultrasound used exclusively for wound healing, while standard therapeutic ultrasound (CPT 97035) operates at higher frequencies (1-3 MHz) and generates heat for musculoskeletal conditions. The mechanisms of action, clinical applications, and reimbursement rates are entirely different.

Does Medicare cover CPT 97610 for all types of wounds?

No, Medicare coverage for CPT 97610 varies by MAC and Local Coverage Determination. Most MACs require the wound to be chronic (typically present for 30+ days), non-healing despite standard wound care, and meet specific diagnosis code criteria. Common covered conditions include diabetic ulcers, venous stasis ulcers, and pressure ulcers, but acute wounds and surgical incisions are generally excluded.

Can CPT 97610 be billed with wound debridement codes?

Yes, but careful documentation and modifier use are required. CPT 97610 can be billed with debridement codes (11042-11047, 97597-97598) on the same date if both services are medically necessary and distinct. Modifier 59 or an X-modifier may be required to bypass NCCI edits, and documentation must clearly show both procedures were performed and were separate services.

What documentation is needed to support medical necessity for CPT 97610?

Required documentation includes: wound chronicity with specific onset date, baseline and serial wound measurements, photographic evidence, comprehensive history of failed conventional treatments with dates and duration, wound bed assessment, patient comorbidities affecting healing, and measurable improvement (or clinical justification for continued treatment if improvement plateaus). Most MACs require reassessment every 30 days.

How long can you continue billing CPT 97610 for the same wound?

Duration depends on documented wound improvement and LCD requirements. Most MACs expect measurable wound progression within 4-6 weeks of initiating LFNTU. If the wound shows less than 30% reduction in area after 4 weeks, continued treatment requires strong clinical justification. Treatment extending beyond 8-12 weeks without significant healing triggers high audit risk and may require peer-to-peer review or medical director approval.