Procedure Code Description

97012 Application of modality to one or more areas traction mechanical
97010 – Application of a modality to 1 or more areas; hot or cold packs – average fee amount – $10 – $20

Traction is used to treat a variety of musculoskeletal disorders of the neck and back, including muscle spasm, radiculopathy, discogenic pain and degenerative changes. Although most insurance plans do cover traction (Saunders cervical is a Medicare covered benefit),clinicians can increase the likelihood of reimbursement by ensuring that the patient’s medical record contain items such as a description of the condition(s) that justify medical necessity for a traction device. Many payors request that a Letter of Medical Necessity be completed by the treating physician. An Empi Representative will contact you directly if documentation for claim submission is required.

The following documentation is recommended:

• Diagnosis that describes the patient’s condition(s) (examples include: radiculopathy, neck/back pain, muscle spasm)
• Evidence of treatments that have been attempted and failed (i.e. medications, physical therapy)
• Evidence that treatment with supine traction of at least 20# has been beneficial
• Description of an underlying TMJ condition which may be aggravated by halter type (over the door) traction.
• Follow-up visit notes documenting patient benefit from the device (i.e improved range of motion, decreased pain, decreased medication or improved sleeping/ working patterns)

97002 PT reevaluation

Procedure Coding Modalities Supervised
• 97010 hot or cold packs
• 97012 traction, mechanical

97012 traction, mechanical
• Typically cervical or lumbar spine
• Good for radiculopathy, disc herniation, and sciatica (724.3)
• Mutually exclusive to 97140 according to NCCI, but may be billable with -59
• Roller tables and VAX-D not covered
• 3-4 visits maximum
Supervised – 97012 traction, mechanical
• Documentation should include:
• Body part
• Force applied and angle
• Time
• Response of patient
• Functional progress

The provider performs 10 minutes of the percussion “thumper”. What is the correct code?

97012 Traction, mechanical (supervised)

RVU = 0.44

  • Force applied to separate joint surfaces
  • Specify whether traction is:
    • Static
    • Intermittent
    • Auto traction (using body’s own weight)
    • Roller tables are not considered true mechanical traction by some payers.
    • Some payers require FDA cleared devices
    • Should be done in conjunction with therapeutic procedures
    • 97140 needs the 59 modifier if billed at the same encounter (NCCI edits)
    • Flexion-distraction should be billed as CMT
    • VAX-D should be billed as S9090
    • 3-4 visits max in office, then teach home care
    • cervicalgia (M54.2)
    • lumbago (M54.5)
    • radiculopathy (M54.1-)
    • disc herniation (M50-, M51-)
    • sciatica (M54.3-)
    • consider also adhesions, stiffness, inflexibility, arthritis, compression
  1. As part of care plan:
    • Rationale, part of the body, force applied, angle, time, frequency/duration, goals
  2. At each encounter:
    • Any variation from plan and response of patient
  3. At re-evaluation, show progress towards goals
    • 97140 should have 59 or X{EPSU} modifier attached if billed with 97012 or 97150 or 98940-2

Subject: Application of a Modality to one or more Areas-Traction, Mechanical with Manual Therapy Techniques—Mobilization/Manipulation, Manual Lymphatic Drainage, Manual Traction to one or more Regions

Coverage is subject to the terms, conditions, and limitations of an individual member’s programs or products and the edit criteria listed below. Please compare the claim’s date of adjudication to the range of the edit in question. Prior versions, if any, can be found below.


97012 Separate Reimbursement 97140


Anthem Central Region does not bundle 97012 with 97140. Based on CPT Assistant article: “Code 97140, Manual therapy techniques {e.g., mobilization/manipulation, manual lymphatic drainage, manual tract}, one or more regions, each 15 minutes, is a therapeutic procedure which consists of, but is not limited to, joint mobilization and manipulation, manual traction, soft tissue mobilization and manipulation, and manual lymphatic drainage. As the code descriptor states, in a manual technique, provider use their hand to administer these techniques. Therefore, code 97140 describes hands-on therapy techniques requiring one-on-one patient contact by the

Code 97012, Application of modality to one or more areas; traction, mechanical, would be reported for the mechanical traction to the cervical spine.”

97012 and 97140 are two different type of services—- mechanical versus manual versus mechanical and not one-on-one with the patient versus one-on-one with the patient. Based on the National Correct Coding Initiative Edits, code 97012 is not listed as a component code to 97140. Therefore, if 97012 is submitted with 97140—both reimburse separately.


You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement.

This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy.

This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees.

Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the physician or other provider contracts, the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies.

Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations.

UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication.

Reimbursement Guidelines

This policy addresses the appropriate use of modifiers with individual CPT and the Healthcare Common Procedure Coding System (HCPCS) procedure codes.
UnitedHealthcare Community Plan sources its procedure code to modifier relationships to methodologies used and recognized by third-party authorities. Those methodologies can be definitive or interpretive. A Definitive Source is one that is based on very specific instructions from the given source. An Interpretive Source is one that is based on an interpretation of instructions from the identified source.

Modifiers that have no third-party industry standard source, policies or guidelines to direct development of specific coding relationships or edits, are allowed with all CPT codes and HCPCS codes. Modifiers to which this policy does not apply are found on the “Modifier Bypass” list.

Modifier Bypass List

In accordance with correct coding, UnitedHealthcare Community Plan will consider reimbursement for a procedure code/modifier combination only when the modifier has been used appropriately. Note that any procedure code reported with an appropriate modifier may also be subject to other UnitedHealthcare Community Plan reimbursement policies.

For example, the description for modifier 25 (Significant, Separately Identifiable Evaluation and Management (E/M) Service by the Same Physician on the Same Day of the Procedure or Other Service) specifies that it is to be reported with an (E/M) service. Therefore, a surgical code, e.g., 62263, appended with modifier 25 will not be reimbursed because according to its description it should only be appended to E/M codes.

Effective with dates of service on or after July 1, 2020 UnitedHealthcare Community Plan aligns with CMS and requires HCPCS modifiers GN, GO or GP to be reported with the codes designated by CMS as always therapy services. These codes are considered always therapy services, regardless of who performs them, and require one of the applicable therapy modifiers (GN, GO, or GP) to indicate that they are furnished under a physical therapy, occupational therapy or speech-language pathology plan of care.

For a list of codes requiring a modifier, please see the attachment below.
Refer to the UnitedHealthcare Community Plan “Modifier Reference Policy” for a listing of UnitedHealthcare Community Plan reimbursement policies that discuss specific modifiers and their usage within those reimbursement policies.

State Exceptions

Texas Per Texas State Regulations, the state is excluded from the Always Therapy Modifier requirement.

Per Texas State Regulations, the following codes are exempt from the policy:
• 90901, 90911, 92507, 92508, 92521-92524, 92526, 92610, 97001, 97002, 97003, 97004, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032-97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97530, 97535, 97537, 97542, 97597, 97598, 97750, 97760-97762, 97799, 97802-97804, H0016, H0031, H0047, H0050, H2017, H2035,
J1265, S8990, and S9152 when billed with modifier AT.

MODALITIES General Modality Guidelines

(CPT codes 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, G0281, G0283, and G0329)

CPT codes 97012, 97016, 97018, 97022, 97024, 97026, and 97028 require supervision by the qualified professional/auxiliary personnel of the patient during the intervention.

CPT codes 97032, 97033, 97034, 97035, 97036, and 97039 require direct (one-on-one) contact with the patient by the provider (constant attendance). Coverage for these codes indicates the provider is performing the modality and cannot be performing another procedure at the same time. Only the actual time of the provider’s
direct contact with the patient, providing services requiring the skills of a therapist, is covered for these codes.

Modalities chosen to treat the patient’s symptoms/conditions should be selected based on the most effective and efficient means of achieving the patient’s functional goals. Seldom should a patient require more than one (1) or two (2) modalities to the same body part during the therapy session. Use of more than two (2) modalities on each visit date is unusual and should be carefully justified in the documentation.

The use of modalities as stand-alone treatments is rarely therapeutic, and usually not required or indicated as the sole treatment approach to a patient’s condition. The use of exercise and activities has proven to be an essential part of a therapeutic program. Therefore, a treatment plan should not consist solely of modalities, but should also include therapeutic procedures. (There are exceptions, including wound care or when patient care is focused on modalities because the acute patient is unable to endure therapeutic procedures.) Use of only passive modalities that exceeds 4 visits should be very well supported in the documentation.

Multiple heating modalities should not be used on the same day. Exceptions are rare and usually involve musculoskeletal pathology/injuries in which both superficial and deep structures are impaired. Documentation must support the use of multiple modalities as contributing to the patient’s progress and restoration of function.
For example, it would not be medically necessary to perform both thermal ultrasound and thermal diathermy on the same area, in the same visit, as both are considered deep heat modalities.

When the symptoms that required the use of certain modalities begin to subside and function improves, the medical record should reflect the discontinuation of those modalities, so as to determine the patient’s ability to self-manage any residual symptoms. As the patient improves, the medical record should reflect a progression
of the other procedures of the treatment program (therapeutic exercise, therapeutic activities, etc). In all cases, the patient and/or caregiver should be taught aspects of self-management of his/her condition from the start of therapy.

Based on the CPT descriptors, these modalities apply to one or more areas treated (e.g., paraffin bath used for the left and right hand is billed as one unit).

CPT 97010 – hot or cold packs (to one or more areas)
Hot or cold packs (including ice massage) applied in the absence of associated procedures or modalities, or used alone to reduce discomfort are considered not to require the unique skills of a therapist.
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.
Supportive Documentation Recommendations for 97010
• The area(s) treated
• The type of hot or cold application
CPT 97012 – Traction, Mechanical (to one or more areas)

Traction is generally limited to the cervical or lumbar spine with the expectation of relieving pain in or originating from those areas.

Specific indications for the use of mechanical traction include cervical and/or lumbar radiculopathy and back disorders such as disc herniation, lumbago, and sciatica.

This modality is typically used in conjunction with therapeutic procedures, not as an isolated treatment.

Documentation should support the medical necessity of continued traction treatment in the clinic for greater than 12 visits. For cervical conditions, treatment beyond one month can usually be accomplished by selfadministered mechanical traction in the home. The time devoted to patient education related to the use of home traction should be billed under 97012.
Only 1 unit of CPT code 97012 is generally covered per date of service.

Equipment and tables utilizing roller systems are not considered true mechanical traction. Services using this type of equipment are non-covered.

Vertebral Axial Decompression (VAX-D)

Vertebral axial decompression is performed for symptomatic relief of pain associated with lumbar disk problems. The treatment combines pelvic and/or cervical traction connected to a special table that permits the traction application. There is insufficient scientific data to support the benefits of this technique. Therefore,
VAX-D is not covered by Medicare (CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual: §160.16).

Supportive Documentation Recommendations for 97012

• Type of traction and part of the body to which it is applied

For most revenue codes, Outpatient Prospective Payment System (OPPS) requirements mandate CPT/HCPCS coding on the claim. When the revenue code you are reporting requires CPT/HCPCS coding, the appropriate code(s) may be chosen from the list below when submitting your claim to Medicare.
This list represents common physical and occupational therapy services and is not all-inclusive.


Utilization Guidelines and Maximum Billable Units per Date of Service
Rarely, except during an evaluation, should therapy session length generally be greater than 30-60 minutes. If longer sessions are required, documentation must support as medically necessary the duration of the session and the amount of interventions performed. The following interventions should generally be reported no more than one unit per code per day per discipline; 97001, 97002, 97003, 97004, 97012, 97016, 97018, 97022, 97024, 97028, 97150, 97597, 97598, 97605, 97606, G0281, G0283, G0329.

Utilization Guidelines and Maximum Billable Units per Date of Service

Added the word “generally” to the following sentence: Rarely, except during an evaluation, should therapy session length generally be greater than 30-60 minutes. If longer sessions are required, documentation must support as medically necessary the duration of the session and the amount of interventions performed.

Added the word “generally” and deleted the language “additional units will be denied” from the following statement:The following interventions should generally be reported no more than one unit per code per day per discipline; 97001, 97002, 97003, 97004, 97012, 97016, 97018, 97022, 97024, 97028, 97150, 97597, 97598,
97605, 97606, G0281, G0283, G0329.

Added the word “generally” and deleted the language “additional units will be denied” from the following statement:The following timed modalities should generally be reported no more than 2 (two) units per code per day per discipline: 97033, 97034, 97035, 97036.

Added the words “or benefit” to the following statement under the medical necessity section: There must be an expectation that the patient’s condition will improve or benefit significantly in a reasonable (and generally predictable) period of time.