97139 CPT Code: Know Your Codes
97139 CPT Code: Unlisted Therapeutic Procedure (specify)
If an existing CPT code does not describe the service performed, an unlisted CPT code may be used. When an existing HCPCS/CPT code does not accurately describe the services performed, the provider submits information, for the payer’s review, to describe the ‘unspecified’ modality(s) or therapeutic procedure(s) performed. The use of unlisted codes like 97139 CPT code should be rare. If unlisted codes are billed, the medical record must clearly state what modality or procedure is billed as an unlisted code. If not, the unlisted code billed will be subject to denial for insufficient information.
For CPT code 97139, unlisted therapeutic procedure, the information supplied to the contractor must specify the procedure furnished and also meet the other requirements for therapeutic procedures, i.e., the process of effecting change, through the application of clinical skills or services that attempt to improve function. CPT code 97139 remain designated as always therapy and require the use of the GP or GO modifier, as appropriate.
When reporting such a service, the appropriate unlisted code may be used to indicate the service, identifying it by ‘special report’. When unlisted codes are used, the provider/supplier must submit information, for the payer’s review, to describe the ‘unspecified’ modality(s) or therapeutic procedure(s) performed. The ‘special report’ is used to assist in determining the medical appropriateness of the treatment and the appropriateness of the unlisted code billed.
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