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.
CPT code 90935 is defined as:
Hemodialysis procedure with single physician or qualified healthcare professional evaluation, per day.
When to use 90935:
From a compliance standpoint, clinical documentation must support the dialysis session and the physician’s involvement for that date.
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 varies based on payer policies, geographical location, and whether it’s part of a therapy plan. On average:
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.
Yes, depending on the situation:
Pro tip: Always refer to your MAC (Medicare Administrative Contractor) for regional modifier rules.
Since 97035 is a time-based code, follow these rules:
Time Spent (Min) Units Billed
Document start and stop times in progress notes. Failing to fix so can generate audits or denials.
In chiropractic practices, ultrasound therapy (97035) helps reduce inflammation, improve soft tissue healing, and support mobility. Chiropractors must:
Real experience tip: Chiropractic claims are often denied when the GP modifier or documentation of direct patient contact is missing.
To avoid denials:
Common ICD-10 codes:
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.
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.
Use the appropriate therapy plan modifier:
Yes, but make sure there is no duplicate of services. Common pairings include:
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