97010 CPT code

97010 CPT code is used for hot and cold packs modalities found in almost all physical therapy clinics and most people’s homes. Physical therapists know that choosing one over the other is not as simple as patient preference. Each of these modalities has a unique physiologic effect which should impact your selection in most cases.

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Summary

• CPT code 97010 is used to document hot and cold pack therapy, but it is a bundled code and not reimbursed separately by Medicare and most insurers.

• Cold packs reduce swelling and pain through vasoconstriction, while hot packs increase blood flow and tissue elasticity, making them useful for different therapeutic needs.

• Therapists must document the use of heat or ice along with other skilled interventions to justify medical necessity and avoid claim denials.

In this article, we will briefly review the physiologic effects, indications and contraindications of cold and hot packs and then outline best practices for billing these services using the 97010 CPT code.

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How are cold packs and hot packs different?

Cold pack benefits and limitations

Cold packs fall under the category of cryotherapy or cold therapy. As you probably recall, when you apply ice or cold packs to the body, the cooling effect reduces swelling, slows the arrival of inflammatory mediators and can have an anesthetic effect of reducing pain.

Professionals continue to debate the benefits and drawbacks of using ice or cold packs on an acute injury. The increase in blood flow and inflammation that ice combats, some argue, slows the influx of immune cells and inflammatory mediators whose roles are essential in cleaning up injured tissue and laying the foundation for healing.

Those who eschew the use of ice often feel its use is disruptive to the healing process while others believe it is facilitatory. Regardless of which side of the debate you land, cryotherapy remains one of our most effective non-pharmacologic pain relievers which is an important consideration nonetheless.

Below is a quick review of considerations for cold packs (Seidel et al., 2021, Malanga et al., 2014). Note, this is not an exhaustive list and you should do your due diligence and review the contraindications and precautions in depth before using heat or ice.

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Tips for using cold packs

• It should be used with caution in those with hypertension, mental or cognitive impairment, or decreased sensation.

• Frostbite, skin burns and neuropathy of superficial nerves can occur if ice or cold therapy is applied for too long.

• Avoid in those with cold hypersensitivity, cold intolerance, Raynaud’s disease or over areas of vascular compromise or open wounds.

• Short-term changes in joint position sense, muscle strength and neuromuscular control can occur post-cooling.

Hot pack benefits and limitations

Hot packs belong in the category of thermotherapy or heat therapy. Unlike cold packs which constrict blood vessels, thermotherapy causes vasodilation which brings more blood to the area and may promote healing by bringing more nutrients and oxygen to the injured area. It also has a pain-relieving effect, increases the elasticity of connective tissue and can reduce feelings of stiffness (Malanga et al., 2014).

Similar to cold packs, there are best practices on how to use hot packs. (Seidel et al., 2021, Malanga et al., 2014).

Tips for using hot packs

• Heat therapy can cause skin burns or ulcerations when applied incorrectly and without proper protection.

• Use is contraindicated in patients with peripheral vascular disease, bleeding disorders, local malignancy, acute inflammation or trauma, edema, infection, open wounds, over large scars, those with impaired sensation (neuropathy) or impaired ability to communicate/cognitive impairments.

• Use with caution in those with diabetes and multiple sclerosis.

In many cases, especially when pain relief is the primary goal, patient preference can be the primary decider of cold vs hot packs. Though these modalities can be purchased easily over the counter at a drugstore or ordered online, it is important that you educate your patients on the risks, precautions and contraindications of heat and cold therapy. Despite their ready availability, both of these treatments can cause injury.

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CPT code basics

Many therapists use hot and cold packs regularly but how many of you feel confident that you are billing correctly for these services? PT students get an introduction to CPT codes in school, but few clinicians learn about them in depth.

Before we jump into the details of billing for hot and cold packs, it can be helpful to review the basics of CPT codes. If you already know this information, skip ahead and dive right into CPT code 97010.

The term CPT stands for Current Procedural Terminology. These codes were developed to provide a uniform language of coding for medical services and procedures that can be used across all medical providers.

As physical therapists, you utilize CPT codes to describe the services rendered during a patient encounter. Codes are then submitted via a claim to a third-party payer who will use this information to approve or deny payment for said claim.

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What does the CPT code 97010 mean?

All CPT codes are five digits and are either numeric or alphanumeric. In general, most of the codes used by physical therapists fall under the 9700 series called Physical Medicine and Rehabilitation, however, a PT can use any CPT code as long as the service described falls under the physical therapy scope of practice defined by your state licensure laws.

Some of the 97000 codes commonly utilized by physical therapists include:

Billing for hot and cold packs is not as simple as it may sound. The Centers for Medicare and Medicaid Services (CMS) has created rules for this code which most commercial insurances follow. As with all CPT codes though, it is your responsibility or your clinic manager’s responsibility to understand the specific coverage of all in-network plans.

Is the CPT code 97010 billable?

CPT code 97010 is an untimed code. This means that you will bill one untimed unit regardless of how much time the patient spends using heat or ice. Similarly, this code covers hot or cold packs applied to one or more areas. You can only bill this code once even if you use cryo or thermotherapy on more than one body area.

Supportive documentation is required to avoid claim denial for 97010. CMS mandates that you detail the area(s) where you applied the therapy and the type of cryotherapy or thermotherapy used. This should be in addition to your other documentation such as the patient’s medical condition, physical therapy diagnosis, objective and subjective information and your assessment, all of which support the medical necessity of skilled physical therapy services.

According to the CMS website, CPT code 97010:

is bundled. It may be bundled with any therapy code. Regardless of whether code 97010 is billed alone or in conjunction with another therapy code, this code is never paid separately. If billed alone, this code will be denied.

So what does this mean? Essentially, hot and cold packs are not reimbursable. If you bill CPT code 97010 by itself, Medicare will automatically deny this code.

Instead, this is a bundled code–you must bill this code with another therapy code like therapeutic exercise to avoid automatic denial. In this case, when bundled with another code, 97010 likely will not be denied but you will also not receive payment for it.

So, you may be asking yourself if you should even be giving patients hot or cold packs if insurance will not pay for this service. Payment for services is indeed the thing that keeps physical therapy clinics open, but the patient’s clinical indications should be the first thing you consider.

In light of this information, here are questions to ask yourself next time you decide to use hot or cold packs with your patients:

• Are hot or cold packs medically and clinically indicated for my patient? Will the quality or effectiveness of their therapy decrease if I forgo this modality during their treatment session?

• Could they safely apply this therapy at home instead of in the clinic?

• Could you or a well-trained PT tech safely monitor the patient during this treatment after their prescribed 1:1 time with you so you can maximize billable units during your treatment time?

Although insurance may not pay for this service, it is still important to submit the code for hot and cold packs if you use them. Many clinics utilize these codes to keep track of hot and cold pack use and to track and justify their expenditure for purchases of hot and cold packs, maintenance of fridges or hydrocollators and so forth.

Though fewer physical therapists use these modalities than in the past, hot and cold packs continue to have a role in the treatment of many conditions seen by physical therapists.

When using these tools it is important to understand their physiologic effect, indications, precautions and contraindications. CPT code 97010 is a bundled code and cannot be billed alone.

Despite the bundling, you will not receive payment specifically for time using heat and ice. Instead, use your clinical reasoning to determine when to use these treatments and you will ensure you are using best practices in both a clinical and billing sense.

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How EHR and practice management software can save you time with insurance billing for therapists

EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.

What are automation and batching?

• Automation refers to setting up software to perform tasks with limited human interaction.

• Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.

Which billing and medical claim tasks can be automated and batched through billing software?

• Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
• Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
• Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
• Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
• Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
• Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
• Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.

Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.

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Resources

TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including physical therapists in group and solo practices.

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References

Article - Billing and Coding: Outpatient Physical and Occupational Therapy Services (A56566). (n.d.). http://www.cms.gov https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56566

Chen, P. (2016). Therapeutic Modalities – PM&R KnowledgeNow. https://Aapmr.org https://now.aapmr.org/therapeutic-modalities

Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine, 127(1), 57–65. https://doi.org/10.1080/00325481.2015.992719