Summary & Overview
CPT 97035: Therapeutic Ultrasound Application, 15-Minute Increments
CPT 97035 covers the application of therapeutic ultrasound in 15-minute increments, a commonly used physical therapy modality for soft tissue pain and musculoskeletal conditions. Nationally, this code is relevant because ultrasound remains a routine adjunct in outpatient rehabilitation across diverse diagnoses and care pathways. The code’s time-based reporting and frequent pairing with therapeutic exercise and manual therapy make it a focal point for billing, coverage, and utilization discussions. Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, typical billing patterns, and payer coverage considerations. The publication outlines common clinical uses, how CPT 97035 interfaces with related physical therapy CPTs such as 97110 and 97140, and common modifiers used in practice. It also provides benchmarking information for utilization and frequency in outpatient physical therapy, notes on documentation elements that typically accompany time-based modalities, and summaries of payer-specific coverage themes where available. Data gaps are identified where input was not provided. This summary is intended to inform clinicians, billing staff, and policy analysts about the operational and reimbursement landscape surrounding therapeutic ultrasound in outpatient physical therapy.
CPT Code Overview
CPT 97035 describes the application of therapeutic ultrasound as a modality to one or more areas, reported in 15-minute time increments. This service is delivered as part of physical therapy care and is typically provided in an office (POS 11) setting.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient physical therapy clinic with localized musculoskeletal pain (for example, low back pain or unilateral knee pain). After an initial evaluation by a licensed physical therapist, the plan of care includes therapeutic modalities to reduce pain and promote tissue healing. During a treatment visit, therapeutic ultrasound is applied to one or more affected areas in 15-minute increments as part of a supervised physical therapy session. The workflow typically includes patient check-in, brief reassessment, documentation of the modality applied and time spent, concurrent or subsequent active therapeutic exercises or manual therapy as indicated, and documentation of response to the ultrasound intervention.
Coding Specifications
Modifier 59 - Distinct Procedural Service:
- Use when the ultrasound procedure is distinct and independent from other services performed on the same day (for example, when medically necessary and separately identifiable from other therapeutic procedures).
Modifier GP - Services delivered under an outpatient physical therapy plan of care:
- Indicates the service is provided under an outpatient physical therapy plan of care and is commonly reported with outpatient PT services.
Associated provider taxonomies:
-
Physical Therapist (
225100000X) — represents licensed physical therapists who evaluate and manage the PT plan of care and often provide or supervise therapeutic modalities. -
Physical Therapy Assistant (
225200000X) — represents licensed PT assistants who may provide components of the plan of care under the supervision of a physical therapist. -
Rehabilitation Practitioner (
225400000X) — represents other rehabilitation professionals involved in delivering therapeutic services under the plan of care.
Related Diagnoses
-
M54.5— Low back pain- Low back pain is frequently treated with therapeutic modalities such as ultrasound to reduce pain and promote tissue healing in the lumbar region.
-
M25.561— Pain in right knee- Focal knee pain may be treated with ultrasound applied to the affected knee to address soft tissue pain or inflammation before or during physical therapy interventions.
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M25.562— Pain in left knee- As with the right knee, ultrasound can be applied to the left knee to manage localized pain and facilitate subsequent therapeutic activities.
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M79.7— Fibromyalgia- In patients with generalized musculoskeletal pain such as fibromyalgia, ultrasound may be used selectively for localized symptomatic areas as part of a broader physical therapy plan.
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M54.2— Cervicalgia- Neck pain (cervicalgia) is a common indication for localized therapeutic ultrasound to reduce pain and improve tolerance for active rehabilitation exercises.
Related CPT Codes
| CPT Code | Description | Relationship to 97035 |
|---|---|---|
97110 | Therapeutic exercises to develop strength and endurance, range of motion and flexibility | Often provided in the same visit: 97035 may be used to address pain or tissue healing prior to or in conjunction with active therapeutic exercises (97110). These codes can be billed together when each service is distinct and documented. |
97140 | Manual therapy techniques | Manual therapy may be performed before or after ultrasound to improve mobility or reduce pain. 97035 can be provided in the same session when documented as distinct from 97140. |
97012 | Application of a modality to 1 or more areas; traction, mechanical | Alternative modality of the same category; choice between modalities (e.g., ultrasound vs mechanical traction) depends on clinical goals. Documentation should support the selected modality. |
97010 | Application of a modality to 1 or more areas; hot or cold packs | Commonly used adjunctive modalities; 97035 can be used in combination with hot/cold packs in the same session when each service is separately documented. |
Notes:
- Codes listed are commonly used together in a single treatment session when each service is distinct and medically necessary. Documentation must support time, modality, and clinical rationale for combined services.
National Reimbursement Benchmarks
National mean allowed rates for 97035 place Medicare slightly below the BUCA (average commercial) mean: Medicare at $14.83 versus BUCA at $16.82. Blue Cross Blue Shield and Cigna show higher national mean rates overall, with Cigna at $21.07 and Blue Cross Blue Shield at $18.46.
Rate dispersion (P75 − P25) varies across payers. Cigna exhibits the widest spread (24.125 − 12 = 12.13), followed by Blue Cross Blue Shield (19.75 − 11.75 = 8.00). Aetna and UnitedHealth Group show tighter distributions (Aetna: 16 − 9 = 7.00; UnitedHealth Group: 17 − 12.666667 = 4.33). Medicare displays the tightest range (15 − 14 = 1.00). The table and chart below present the full breakdown.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a notable spread in reimbursement rates for CPT code 97035, particularly among commercial payers. Cigna shows the widest rate spread, with a 75th percentile of $47.00 and a 25th percentile of $16.00, resulting in a $31.00 difference. Blue Cross Blue Shield and BUCA also display substantial variability, while Aetna and UnitedHealth Group have tightly clustered rates, indicating less variation among providers. Medicare rates remain consistent with a minimal spread.
Compared to national averages, Alaska's commercial payers consistently offer higher mean reimbursement rates. UnitedHealth Group and Cigna stand out with mean rates well above their national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska.
Key Insights for Alaska
- UnitedHealth Group offers the highest mean reimbursement rate for CPT 97035 in Alaska at $36.11, while Medicare is the lowest at $14.46.
- All commercial payers in Alaska reimburse at rates significantly above their respective national averages, with Cigna and UnitedHealth Group showing the largest deviations.
- The rate spread is widest for Cigna, indicating substantial variability in reimbursement amounts among providers.
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