CPT code 97535 for self care/home management is often considered a component of
the more comprehensive code, therapeutic activities (CPT code 97530). Many
therapists incorrectly assume that these two activities cannot be billed on the
same day. Both interventions may be provided on the same date of
service and can be billed to your Medicare contractor. To be reimbursed for CPT
code 97535, you would have to append modifier-59 to CPT code 97535 on the claim
form. As always, your documentation must support the medical necessity of
both interventions and that the interventions were provided at separate
and distinct times from each other.
For modifier 59 please remember that two therapy interventions may not
be reported in the same 15 minute period (except for supervised modalities
97010-97028) with other services rendered. Also recall that:
Two timed procedures (i.e. group and individual) performed in
separate time increments, apply Modifier 59. The time calculation rules apply.
Modifier 59 is not appropriate for re-evaluation (97002, 97004) and
planned therapy during the same day/encounter.
- Apply Modifier 59 for a change in the patient’s condition causing
Provide and use Modifier 59 for separate time periods only. Take extra
precautions to document the time period that each service was provided. For
example, 9:00AM-9:30AM theapeutic exercises of (list exercises),
followed by 9:45AM-10:15AM, aquatic therapeutic exercises (list the
exercises). The words "followed by" informs the Medicare contractor
that you provided land-based exercises followed by aquatic therapy.
Do not assume that the Medicare contractor will know or ''Figure things out."
Make it easy for them to pay you by elininating their judgement, and or creating
extra work for the contractor.
Tom Kane, PT