CPT Codes 97039, 97139, and 97799: What’s the Difference?

August 7, 2017
Rick Gawenda

I often receive questions of what is the difference between CPT codes 97039, 97139 and 97799 and can I give an example of when a provider of therapy services would use these CPT codes. Lets first begin by defining the 3 CPT codes. According to the American Medical Association (AMA), CPT 2017 Professional, the codes are as follows:

  • 97039 – Unlisted modality (specify type and time if constant attendance)
  • 97139 – Unlisted therapeutic procedure (specify)
  • 97799 – Unlisted physical medicine/rehabilitation service or procedure

So, what are some examples of interventions that would be included in each of these codes?

Examples of CPT code 97039 could include, but is not limited to,

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  1. What would be the standard fee for 97039, 97139 and 97799? What can I expect for reimbursement? If I am manipulating tissue at the same time as I am using a class 4 laser, what is the best way to code that? If I am just using the laser is 97039 the best code?

    1. Each insurance carrier would determine if they will pay for any of those 3 CPT codes and if yes, they will determine the price they will pay. Laser is an example of CPT code 97039.

  2. Our billing dept is suggesting we bill dry needling under 20999, and not 97799. Can therapists bill under the code 20999 or is this for physicians only?

    1. You would need to determine the cost to provide the service. This would include staff costs, practice expenses and a profit margin.

  3. What would be the most accurate coding for instrument assisted soft tissue mobilization (Graston instruments)? Thank you.

    1. You would need to check with the specific insurance carrier as some may include it under manual therapy while others may say it should be billed under either 97139 or 97799.

  4. Do you think 97139 or 97799 could be charged if a PT is screening the patient in the acute environment? I would lean toward 97799, as an acute PT screen for mobility (not evaluation, no order) would be an unlisted PMR service. Looking for options in acute to screen patients and capture charge (mainly for productivity, not necessarily reimbursement due to DRG)

  5. What CPT code should be used for ( reimbursement claim submission) purchase of a hydrotherapy table (by patient) to “restore physical function” due to stenosis?

    1. If . they are purchasing a hydrotherapy table, not of the CPT codes used by physical and occupational therapists would be appropriate.

  6. Would use of RTUS/Real Time Ultrasound during treatment be billed with CPT 97039 or would you use 97112 neuromuscular re-education?

    1. Due to liability reasons, I can’t provide an answer to your question in this forum. If interested in consulting services, please email me at info@gawendaseminars.com and provide me with the name and address of your organization and the name and title of the person who would sign the contract and I will email you a contract proposal.

    1. Those are CPT codes and not ICD-10 diagnosis codes. Each insurance carrier and Medicare Administrative Contractor would price those 2 codes.