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Understanding the 90935 CPT Code & 97035 - Real Billing Insights

A women write something on clipboard about the CPT Codes 90935 & 97035 for billing purpose.

The 90935 CPT code represents a hemodialysis procedure performed on a single day without a physician’s evaluation. It’s a crucial code for nephrology billing, often used in outpatient settings. Based on real-world billing experience, many clinics face denials due to documentation gaps, incorrect modifiers, or payer-specific policies.

Pairing this with the 97035 CPT codes used for ultrasound therapy brings unique physical or chiropractic billing challenges. This article shares first-hand insights, definitions, reimbursement details, and answers common queries to help practices avoid costly mistakes.

What Is CPT Code 90935?

CPT code 90935 is defined as:

Hemodialysis procedure with single physician or qualified healthcare professional evaluation, per day.

When to use 90935:

  • Outpatient dialysis services
  • Performed with evaluation
  • Single session per day

From a compliance standpoint, clinical documentation must support the dialysis session and the physician’s involvement for that date.

CPT Code 97035 - Description & Definition

The 97035 CPT code is used for ultrasound therapy, typically applied in physical therapy or chiropractic offices.

Definition of 97035 CPT Code:

Use of ultrasound modality on one or more targeted areas, billed per 15-minute interval.

This is a timed code, meaning documentation must show actual treatment duration in 15-minute units. Therapists must be actively engaged throughout the session to justify billing.

Reimbursement for CPT 97035

Reimbursement varies based on payer policies, geographical location, and whether it’s part of a therapy plan. On average:

  • Medicare pays around $8–$10 per unit of CPT code 97035.
  • Private insurers may reimburse $15–$25, depending on contracts.

To maximize payments, clinics should submit accurate units and link the service to ICD-10 codes like M54.5 (low back pain) or M25.561 (pain in right knee), as medically necessary.

Does CPT Code 97035 Need a Modifier?

Yes, depending on the situation:

  • GP, modifier is mandatory for medical services under a therapy plan of care.
  • Modifier 59 may be necessary if billed with other timed services to show separate procedures.
  • Use modifier -XS when separating the procedure from other non-therapy services.

Pro tip: Always refer to your MAC (Medicare Administrative Contractor) for regional modifier rules.

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Timed Billing Rules for 97035

Since 97035 is a time-based code, follow these rules:

Time Spent (Min) Units Billed

  • 8–22 mins 1 unit
  • 23–37 mins 2 units

Document start and stop times in progress notes. Failing to fix so can generate audits or denials.

CPT 97035 in Chiropractic Care

In chiropractic practices, ultrasound therapy (97035) helps reduce inflammation, improve soft tissue healing, and support mobility. Chiropractors must:

  • Show medical necessity
  • Must be part of a comprehensive, physician-supervised rehabilitation plan.
  • Avoid using 97035 as a standalone service unless justified

Real experience tip: Chiropractic claims are often denied when the GP modifier or documentation of direct patient contact is missing.

90935 CPT Code - Documentation Best Practices

To avoid denials:

  • Include physician evaluation notes for the dialysis date
  • Specify single-day treatment
  • Note some existing conditions that justify the procedure

Common ICD-10 codes:

  • N18.6 (End-stage renal disease)
  • Z99.2 (Dependence on renal dialysis)

Conclusion

Using 90935 CPT codes and 97035 CPT codes correctly is critical for timely reimbursements. From understanding modifiers to following timed code documentation rules, every step counts. Don’t leave money on the table. Review your claims for accuracy, compliance, and efficiency. Need Help With CPT Code Billing?

Partner with Cures Medical Billing Services for reliable, accurate claims handling. From CPT 90935 to ultrasound therapy billing (97035), we make sure maximum approvals and fewer denials. Call us at +1 (917) 994-9941, visit our website for tailored billing solutions.

Frequently Asked Questions (FAQs)

CPT 90935 is used for hemodialysis procedures performed as a single evaluation session. It includes all physician services related to one dialysis treatment, whether performed in a hospital, dialysis center, or other setting.

Only physicians or qualified healthcare providers managing the dialysis care plan may bill 90935. It’s typically used by nephrologists for outpatient dialysis visits.

No, CPT 90935 is not time-based. It is billed once per dialysis session and includes all related E/M services performed during that visit.

  • Treatment goal (e.g., reduce inflammation)
  • Body part treated
  • Total treatment time
  • Patient’s response to therapy
    appropriate documentation supports medical necessity and helps reduce denials.
  • Use the appropriate therapy plan modifier:

    • GP – Physical therapy
    • GO – Occupational therapy
    • 59 – When ultrasound is provided along with other timed codes to indicate distinct services
  • Yes, but make sure there is no duplicate of services. Common pairings include:

    • 97110 – Therapeutic exercises
    • 97140 – Manual therapy
    • 97530 – Therapeutic activities
      Use modifier 59 to separate services when needed.
  • 90935 is widely reimbursed by Medicare and commercial payers. It necessity be medically necessary and sustained by appropriate documentation.
  • 97035 is often denied by Medicare, as many carriers consider it experimental or not medically necessary unless specific criteria are met.
  • 90935: Typically reimbursed at around $100–$150 depending on the location and setting.
  • 97035: Reimbursement may range from $10–$20 per 15-minute session, but check with payer-specific fee schedules for accuracy.
  • Match services with correct ICD-10 codes (e.g., N18.6 for ESRD, M79.1 for myalgia)
  • Use accurate modifiers
  • Document medical necessity clearly
  • Stay updated with payer guidelines for each code

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