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Understanding the 90935 CPT Code & 97035 - Real Billing Insights

Name: Cures Medical Billing Services Company
Address: 3811 Ditmars Blvd# 1124, Astoria, NY 11105, Astoria, NY, 11105, USA
Telephone: +1 (917) 994-9941

Accurate CPT coding is the backbone of clean claims and timely reimbursements. Two codes that often trip up providers are CPT Code 90935 (hemodialysis with physician evaluation) and CPT Code 97035 (ultrasound therapy). While both are crucial in their respective specialties, nephrology and physical therapy/chiropractic care, they come with unique documentation and modifier requirements.

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.

This code is most often used in outpatient dialysis centers or hospitals when:

The dialysis is performed with physician evaluation
Only one dialysis session occurs per day

Documentation Requirements

To support CPT 90935 billing, documentation must include:

Physician evaluation notes on the dialysis date
Confirmation of single-day treatment
Associated ICD-10 diagnosis codes such as:
- N18.6 – End-stage renal disease
- Z99.2 – Dependence on renal dialysis

Pro Tip: Claims often deny when documentation does not clearly reflect the physician’s evaluation. Always include signed progress notes.

What Is CPT Code 97035?

CPT Code 97035 is widely used in physical therapy and chiropractic offices for ultrasound therapy.

Application of ultrasound to one or more targeted areas, billed per 15-minute interval.

This is a timed code, so therapists must document the actual time spent in direct contact with the patient.

Billing Guidelines for 97035

8–22 minutes = 1 unit
23–37 minutes = 2 units
38–52 minutes = 3 units

Failure to document start and stop times can trigger audits or denials.

Reimbursement for CPT Code 97035

Reimbursement depends on payer, region, and therapy plan inclusion. On average in 2025:

Medicare → $8–$10 per unit
Private payers → $15–$25 per unit

ICD-10 codes commonly paired include:

M54.5 – Low back pain
M25.561 – Pain in right knee

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Modifier Use with 97035

Correct modifiers are critical for reimbursement:

GP → Required for services under a therapy plan of care
59 → Used when billed with other timed procedures to show distinct services
XS → To separate the service from non-therapy procedures

Denials in chiropractic settings often occur when the GP modifier is missing.

90935 vs. 97035 – Specialty Use Cases

Code	Specialty	Definition	Key Billing Factor
90935	Nephrology	Hemodialysis with physician evaluation	Document physician involvement
97035	Physical therapy/Chiropractic	Ultrasound therapy (per 15 min)	Timed documentation & modifiers

Common Billing Challenges & Fixes

For 90935 (Hemodialysis):

Denied for “no physician evaluation”
Fix: Attach physician note.
Duplicate billing in one day
Fix: Bill once per day only.

For 97035 (Ultrasound Therapy):

Missing GP modifier
Fix: Always apply GP when under therapy plan.
No time documentation
Fix: Record exact start and stop times.

Conclusion

Both CPT 90935 and CPT 97035 are highly specific but frequently mishandled in billing. While 90935 requires clear documentation of physician evaluation for dialysis, 97035 demands accurate time-tracking and proper modifier usage.

At Cures Medical Billing Services, we specialize in coding accuracy, denial prevention, and maximizing reimbursements. Whether you’re a nephrology practice, physical therapy clinic, or chiropractic office, our team ensures your claims are clean, compliant, and paid faster.

Frequently Asked Questions (FAQs)

What is CPT Code 90935?

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.

Who can bill CPT Code 90935?

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

Is 90935 a time-based code?

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.

What documentation is required for 97035?

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.

What modifiers are used with 97035?

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

Can CPT 97035 be billed with other therapy codes?

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.

Are CPT 90935 and 97035 covered by Medicare?

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.

How much is reimbursement for 90935 and 97035?

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.

Tips to prevent denials for 90935 and 97035?

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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