Name of Manual - Blue Cross and Blue Shield of Minnesota

Hot and Cold Pack
Exclusion
TMJ Orthotic
Adjustments
Massage and Manual
Therapy Exclusion
Coding Policies and Guidelines (Rehabilitative Services)
Blue Cross and Blue Shield of Minnesota (Blue Cross) will not
reimburse providers for the physical medicine hot and cold pack
modality, CPT code 97010.
Blue Cross reviewed the utilization of the hot and cold pack
therapy code and determined that this modality is used in
conjunction with and/or to enhance other services performed.
Thus, 97010 will be denied as provider liability, whether billed
alone or with another service.
Adjustments for TMJ orthotics are normally billed under CPT
codes 97760 or 97762. These services are not separately covered
with a TMJ diagnosis. These adjustments are considered an
integral part of the splint therapy and as such will be denied
regardless if billed alone or with another service.
97760 Orthotic(s) management and training (including
assessment and fitting when not otherwise reported), upper
extremity(s), lower extremity(s) and/or trunk, each 15 minutes
97762 Checkout for orthotic/prosthetic use, established patient,
each 15 minutes
Blue Cross will not reimburse providers for massage or manual
therapy services. Massage or manual therapy will deny either as
incidental (provider liability) or subscriber liability.
Massages that are provided as preparation for a physical medicine
therapy are considered an integral part of the therapy. As such, we
will deny it as provider liability. If a massage is billed alone, then
it may be denied as a subscriber contract exclusion.
Codes
97124 Therapeutic procedure, one or more areas, each 15
minutes; massage, including effleurage, petrissage and/or
tapotement (stroking, compression, percussion).
97140 Manual therapy techniques (e.g. mobilization /
manipulation, manual lymphatic drainage, manual traction),
one or more regions, each 15 minutes.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/19/12)
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