Guide to 97140 CPT Code in Wound Care & Therapy

When therapists talk about "hands-on" treatment, CPT code 97140 is often what they mean. It's the billing code for skilled manual therapy techniques—things like joint and soft tissue mobilization, manual lymphatic drainage, and manual traction. These aren't just generic procedures; they're specific, skilled interventions aimed at improving function, knocking down pain, or reducing swelling. This comprehensive guide will walk you through everything from the code's core definition to the nuances of documentation, modifiers, and denial prevention, ensuring your practice can bill for this essential service with confidence and accuracy. Understanding and correctly applying the 97140 CPT code is crucial for financial stability and regulatory compliance in any therapy-focused practice.

What CPT Code 97140 Actually Means for Your Practice

Think of 97140 as the code that captures the value of your specialized, hands-on skills. It’s a world away from simple massage. This code is for targeted treatments addressing distinct musculoskeletal or soft tissue problems that are holding a patient back. The application of these techniques requires significant clinical reasoning and skill, differentiating it from more general therapeutic procedures. It signifies a one-on-one intervention where the therapist's hands are the primary tool for enacting therapeutic change.

For instance, a physical therapist might use soft tissue mobilization to work on scar tissue around a postsurgical knee, helping the patient regain their full range of motion. Or, in a wound care setting, a therapist could apply manual lymphatic drainage to get stubborn edema out of a patient's leg, which is absolutely critical for healing and comfort. Each time you use these techniques, you're making a clinical judgment and applying a specific skill—and that's what 97140 is all about. The ability to correctly bill for these interventions ensures that the high value of this skilled care is recognized and reimbursed by payers.

Core Components of 97140

The American Medical Association (AMA) defines CPT code 97140 as "Manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes." Since it was first introduced, it has become a staple in physical and occupational therapy. Getting the hang of its core components is the first real step to billing it correctly and confidently. The code is designed to be time-based, meaning reimbursement is directly tied to the duration of direct, one-on-one patient contact.

For a deeper dive into the code's history and various applications, this detailed CPT code 97140 overview is a great resource. Mastering this code is non-negotiable for practices that rely on manual therapy, allowing you to get paid appropriately for the high-value, one-on-one care your patients receive. A thorough understanding not only prevents claim denials but also ensures ethical billing practices that stand up to scrutiny during an audit.

Key Takeaway: CPT 97140 is a timed code, billed in 15-minute increments, and requires direct, one-on-one patient contact. Your documentation must paint a clear picture of why your skilled manual intervention was medically necessary to hit specific, functional goals.

To make things even clearer, here’s a quick-glance table breaking down the essential pieces of CPT code 97140. It's a handy reference to keep clinicians and billing staff on the same page.

CPT Code 97140 At a Glance

Having this breakdown in mind helps ensure every time you bill 97140, it's for the right reasons and backed by the right documentation. Consistency in applying these principles across your practice is fundamental to a healthy revenue cycle.

Calculating Billable Units with the 8-Minute Rule

When you're billing for hands-on, time-based services like manual therapy (CPT 97140), every minute counts. But how you count those minutes is what really matters. That’s where the 8-Minute Rule comes in—a standard from Medicare that has essentially become the law of the land for physical therapy billing. While it originated with Medicare, most commercial payers have adopted this rule or a similar standard, making it a critical concept for all therapy providers.

Think of it as the minimum time investment needed to justify a billable unit. You have to provide at least 8 minutes of a direct, one-on-one, time-based service to bill for even a single unit. If you spend 7 minutes, you can't bill for it. This rule is the bedrock of compliant billing for timed codes. It prevents billing for very short, incidental services and ensures that a meaningful amount of treatment was provided for each unit claimed.

How the 8-Minute Rule Works for 97140

At its core, the rule is built on 15-minute increments. Once you clear that initial 8-minute hurdle, you're on your way to billing for one unit. To bill for a second unit, you need to provide another 15 minutes of care, and so on. It sounds simple, but the real-world application can be tricky, especially when your total time doesn't fit neatly into 15-minute blocks. The key is to sum the total time spent on all timed services before determining the number of units.

Here’s a quick-glance chart that breaks down how total time converts to billable units for a single timed service like 97140:

See the pattern? A 20-minute manual therapy session gets you one unit, but push that to 25 minutes, and you've crossed the threshold into two-unit territory. Knowing these cutoffs is absolutely essential for billing accurately and ethically. Miscalculating can lead to either underbilling, which hurts your revenue, or overbilling, which can trigger audits and penalties.

What Happens When You Mix Timed Services?

This is where things can get complicated and where a lot of clinics make mistakes. What if you provide both manual therapy (97140) and therapeutic exercise (97110) in the same visit? You don't get to apply the 8-Minute Rule to each service separately. Instead, you have to aggregate the total time you spent on all timed services combined. This is a crucial point that is often misunderstood, leading to significant compliance issues.

You simply add up the minutes for every one-on-one, time-based procedure you performed. Then, you use that grand total to figure out how many units you can bill for the entire visit. For a deeper dive into this, check out our guide on how to calculate Medicare billing units and sidestep common pitfalls.

Let’s walk through a common scenario to make this crystal clear:

• Manual Therapy (97140): 12 minutes
• Therapeutic Exercise (97110): 10 minutes

Looking at them individually, you might think you can bill one unit for the 10 minutes of exercise and one unit for the 12 minutes of manual therapy. That’s a major compliance red flag. CMS rules require you to combine them.

Total Timed Treatment: 12 minutes + 10 minutes = 22 minutes
According to the rule chart, a total of 22 minutes only supports one billable unit. You then have to assign that single unit to the service you spent the most time on—in this case, CPT 97140.

This aggregation rule is a notorious source of billing errors that can lead to denied claims and even audits. Getting this calculation wrong can look like overbilling, which payers take very seriously. Mastering the 8-Minute Rule isn't just good practice; it's a non-negotiable for protecting your revenue and staying compliant. Regularly training your clinical and billing staff on these calculations is a vital investment in your practice's health.

Creating Audit-Proof Documentation for 97140

When it comes to the 97140 CPT code, your clinical notes are your first and last line of defense. In the eyes of an auditor, if you didn’t write it down, it simply didn’t happen. Solid documentation isn't about just checking boxes; it’s about painting a clear, compelling clinical picture that proves medical necessity and justifies every single unit you bill. It must tell a coherent story that connects the patient's diagnosis to your intervention and the resulting outcome.

Think of your notes as the bridge connecting your patient's problem to your skilled solution. Each manual therapy technique you use must tie directly back to a specific functional limitation and a measurable goal. That direct line is what separates a paid claim from a painful denial. Auditors are trained to spot inconsistencies and gaps, so your documentation must be thorough and logical from start to finish.

The Anatomy of a Strong Progress Note

To make your documentation truly bulletproof, you have to get specific. Vague notes like "performed manual therapy to back" are a massive red flag for payers and practically invite a review. What you need to do is show, not just tell. Your notes should provide enough detail that another therapist could read them and understand precisely what was done, why it was done, and how the patient responded.

Your documentation should answer a few key questions for anyone reading the chart:

• What exactly did you do? Name the specific manual technique you used.
• Where did you do it? Pinpoint the anatomical location with precision.
• Why did you do it? Link the technique to a documented impairment and the patient's functional goals.
• How did the patient respond? Note their immediate feedback and any objective, measurable changes you observed.

Key Takeaway: Audit-proof documentation for 97140 is detailed, objective, and laser-focused on function. It proves that a skilled professional delivered a specific, necessary intervention to fix a documented problem.

For example, just saying you performed "soft tissue work" won't cut it. A much stronger entry would be: "soft tissue mobilization and myofascial release to the left gastrocnemius to reduce adhesions and improve ankle dorsiflexion." That level of detail leaves no room for doubt and showcases your clinical reasoning.

Strong vs. Weak Documentation Examples

Seeing good and bad examples side-by-side often makes the difference crystal clear. A weak note leaves an auditor guessing and forced to assume the worst. A strong note provides an undeniable record of care.

Let's look at two notes for the same patient: someone recovering from a knee replacement who has significant scar tissue limiting their range of motion.

Weak Documentation:

• Technique: Manual therapy
• Location: Knee
• Time: 15 minutes
• Patient Response: Patient tolerated well.

This is far too generic. It doesn’t name the technique, specify the treatment area, or provide any measurable outcome. It gives the payer no real reason to approve the 97140 CPT code.

Strong Documentation:

• Technique: Performed deep transverse friction massage and scar tissue mobilization.
• Location: Directly over the 4-inch surgical scar on the anterior aspect of the left knee.
• Rationale: To reduce scar tissue adherence restricting patellar mobility and knee flexion.
• Patient Response: Patient reported decreased pulling sensation. Post-treatment, passive knee flexion improved from 90 to 105 degrees.

Now that is an audit-proof note. It nails the what, where, and why, then backs it up with a measurable, functional improvement. This is the gold standard payers are looking for. For clinicians in wound care, mastering these details is a game-changer. You can find more practical guidance in this excellent resource for improving your wound care documentation templates.

Essential Elements to Include Every Time

To stay consistent and compliant, build your charting habits around a core checklist. Every single note for a 97140 service should have these components.

• Specific Technique: Name the method you used (e.g., myofascial release, joint mobilization Grade III, manual lymphatic drainage).
• Precise Anatomical Region: Get specific (e.g., "right upper trapezius," not just "neck"; "lumbar paraspinals L3-L5," not "low back").
• Connection to Functional Goals: State exactly how the manual therapy helps the patient achieve a goal from their plan of care (e.g., "…to increase shoulder abduction for overhead reaching").
• Objective, Measurable Changes: Use numbers whenever possible to show progress (e.g., ROM in degrees, pain scale reduction from 7/10 to 4/10).
• Patient's Subjective Response: Add a brief note on the patient's immediate feedback during or right after the technique.

By baking these elements into every note, you create a rock-solid clinical record that not only gets you paid but also improves continuity of care and proves the immense value of your hands-on skills.

Using Modifiers and Navigating Bundling Rules

Let’s be honest: billing for CPT code 97140 is rarely simple, especially when you perform it alongside other therapeutic services. This is where you run into the tricky world of billing modifiers and bundling rules—specifically, the National Correct Coding Initiative (NCCI) edits. These edits are automated checks within payer systems designed to prevent improper payments.

Think of NCCI edits as a set of traffic rules for your claims. They’re designed to prevent you from billing for two services that auditors consider part of the same "trip." Many payers automatically bundle manual therapy (97140) into other procedures like therapeutic exercise (97110), assuming the hands-on work is just a small part of the main service. To get paid fairly for both, you have to prove they were separate and distinct. This is where modifiers become your best friend.

The Power of Modifier 59 and the X-Subset

The key to getting paid for distinct, correctly billed services is Modifier 59. This little addition to your claim tells the payer, "Hey, I know these two codes often get bundled, but in this case, the service was truly separate and medically necessary." It’s your way of signaling a Distinct Procedural Service, which is essential for getting past those NCCI roadblocks.

But just slapping Modifier 59 on a claim won't cut it. Your documentation has to tell the same story. The services must be performed on different anatomical locations or during entirely separate patient encounters on the same day.

To add even more clarity, CMS introduced the more specific "X" modifiers. These help you tell a more precise story:

• XE (Separate Encounter): The service was distinct because it happened in a separate session.
• XS (Separate Structure): The service was distinct because it was done on a separate organ or structure. This one is hugely important for 97140.
• XP (Separate Practitioner): The service was distinct because a different clinician performed it.
• XU (Unusual Non-Overlapping Service): The service was distinct because it doesn’t overlap with the usual parts of the main service.

For manual therapy, the XS modifier is often the perfect fit. Say you perform manual therapy on a patient's shoulder and then guide them through therapeutic exercises for their lumbar spine. The shoulder is a completely separate anatomical structure from the spine, which perfectly justifies unbundling the codes.

Common Bundling Pitfalls with 97140

The most common conflict by far is billing 97140 with therapeutic exercise (97110). Payers just assume the manual therapy was a quick warm-up for the exercises. Without a modifier and crystal-clear documentation spelling out the difference, this combination is almost guaranteed to be denied.

The denial statistics paint a clear picture. Claims with incomplete documentation—lacking functional goals or specific techniques—see a 14% denial rate. That number skyrockets to 30% when Modifier 59 is missing on claims with adjunctive codes like 97110. You can dig deeper into these occupational therapy CPT code trends on otpotential.com.

Let’s walk through a wound care scenario to see how this plays out in the real world.

Clinical Example: Justifying the Modifier
A patient has a venous leg ulcer and is dealing with significant ankle stiffness from chronic edema. During the visit, the therapist performs:

• 15 minutes of manual therapy (97140): This includes soft tissue mobilization around the ankle and foot, specifically to break down adhesions and improve dorsiflexion.
• 15 minutes of therapeutic exercise (97110): This involves guided calf pumps and ankle circles to activate the calf muscle pump and boost circulation to the lower leg.

In this case, the manual therapy targeted a specific joint and tissue restriction (a separate goal), while the exercises focused on improving circulation and muscle activation. The intent and techniques are clearly distinct. Billing 97140-59 (or the more precise 97140-XS) alongside 97110 is completely appropriate and defensible here. Your documentation just needs to clearly separate the rationale, time, and goals for each intervention.

As you navigate these rules, you might also find our guide that helps explain what the KX modifier is useful for showing that services are medically necessary.

Common CPT 97140 Code Pairings and Modifier 59 Guidance

To make this easier, here’s a quick-reference table for the most common code pairings you’ll encounter with 97140. It highlights when you’ll likely need to use Modifier 59 to avoid an automatic denial.

Remember, this table is a guide. Your clinical judgment and, most importantly, your detailed documentation are what ultimately support the medical necessity of using a modifier.

Mastering these modifier rules isn’t just about ticking boxes for compliance. It’s about making sure your practice gets paid for all the skilled, necessary work you do. Getting it right is what transforms a likely denial into a clean, paid claim.

How to Proactively Avoid Common Claim Denials

Let’s be honest, claim denials for CPT code 97140 are more than just an administrative headache. They’re a direct hit to your practice’s revenue, and they eat up valuable time that should be spent on patient care. By getting a handle on why payers are rejecting these claims, you can stop playing defense with appeals and start preventing the denials from ever happening. A proactive approach to billing is always more effective and less costly than a reactive one.

Most of the time, denials for 97140 boil down to a few common—and completely avoidable—mistakes. We see it all the time: weak proof of medical necessity, improper modifier use, and notes that don't clearly paint a picture of skilled, one-on-one service. The trick is to build a process that catches these issues before the claim even goes out the door. Implementing internal audits and regular staff training can be a powerful preventative measure.

The Medical Necessity Blind Spot

If there's one single reason a 97140 CPT code claim gets denied, it’s a failure to demonstrate medical necessity. When a reviewer reads your notes, they need to see a crystal-clear link between the manual therapy you provided and a specific, functional problem the patient has. Vague documentation is basically an open invitation for a denial. Medical necessity is not just about the diagnosis; it's about connecting the treatment to a functional deficit that the treatment is expected to improve.

Your documentation has to be your best line of defense. Every single note should tell a story, connecting the dots between the patient's diagnosis, their functional limitations, and the specific manual technique you chose to use.

• Weak Rationale: "Performed manual therapy on the patient's shoulder."
• Strong Rationale: "Performed soft tissue mobilization to the right infraspinatus to reduce trigger points causing pain at end-range external rotation, limiting the patient's ability to reach into a cabinet."

By explicitly stating the "why" behind the "what," you're handing the payer the clinical reasoning they need. It changes the service from just another procedure into a necessary, skilled intervention aimed at a clear functional outcome.

This approach doesn't just justify the service; it shows your clinical decision-making is solid, which is exactly what payers are looking for when they scrutinize claims involving the 97140 CPT code.

Mismatched Modifiers and Bundling Errors

Here’s another big one: incorrect modifier usage. This happens a lot when you bill 97140 alongside another code, like therapeutic exercise (97110). Payer systems are automatically set up to bundle these, assuming your manual work was just a small part of the exercise session. Without the right modifier, a denial is almost a sure thing.

Using Modifier 59 or the more specific XS modifier (Separate Structure) is absolutely essential. But—and this is a big but—just slapping the modifier on isn't enough. Your documentation has to back it up by clearly separating the two services.

Proactive Prevention Checklist:

1. Separate Anatomical Sites: Did your notes clearly state that manual therapy was for one area (like the cervical spine) while the other service was for a totally different area (like the shoulder)?
2. Separate Clinical Goals: Did you document a unique objective for each intervention? For instance, was the manual therapy meant to improve joint mobility, while the exercise was focused on building muscle strength?
3. Separate Time Documentation: Did you record the exact number of minutes you spent on each distinct service? This is key to justifying the billable units for each code.

Putting together a simple internal checklist for your billing team can be a game-changer. Before they submit a claim with 97140 and a paired code, a quick check can confirm the documentation supports the modifier. This one step can dramatically cut down on those automatic NCCI edit denials.

Staying Ahead of Payer-Specific Policies

Finally, it's crucial to remember that what works for Medicare might not fly with a commercial payer like Aetna or UnitedHealthcare. Every payer has its own Local Coverage Determinations (LCDs) and internal policies for the 97140 CPT code. If you ignore these rules, you're just setting yourself up for a cycle of denials. These policies can dictate acceptable diagnoses, frequency of treatment, and specific documentation requirements.

Your practice needs a system for keeping track of these payer-specific guidelines. It could be a simple shared document or something built into your practice management software that flags specific requirements.

Actionable Strategies:

• Create a Payer "Cheat Sheet": Put together a quick-reference guide that summarizes the rules for 97140 from your top 3-5 commercial payers. Include their preferred modifiers and key documentation points.
• Regularly Review LCDs: Assign someone on your team to check for updates to Medicare and major commercial payer policies at least once a quarter. Things change.
• Analyze Your Denials: Start tracking your 97140 denials by payer. If you see a pattern with one insurance company, that’s your cue to dig into their policies and figure out what you need to adjust.

By focusing on these three core areas—medical necessity, modifier use, and payer policies—you can build a much more resilient billing workflow. This proactive approach doesn't just boost your clean claim rate; it fosters a culture of documentation excellence that helps your patients and your practice’s financial health.

Putting It All Together with Ekagra Health AI

Let's be honest—juggling the complex documentation and billing rules for CPT code 97140 is a heavy lift. It eats up valuable time and demands a level of precision that's tough to maintain back-to-back with patients. This administrative grind doesn't just bog down your workflow; it takes your focus away from patient care and opens the door to frustrating, costly denials. The real challenge is bridging the gap between providing skilled, hands-on therapy and actually getting paid for it. This is where the right technology can make a world of difference.

Ekagra Health AI was designed specifically for this problem, especially in busy settings like wound care. It uses a "voice-to-claim" approach that automates the most tedious parts of the job. The system uses ambient listening technology to capture the natural dialogue and clinical details during an appointment. In other words, the entire story of the manual therapy session is recorded as it happens, without you ever having to stop, turn to a screen, and type.

From Conversation to Compliant Claims

The magic isn't just in the recording; it's in the translation. The system takes that unstructured conversation and turns it into structured, audit-proof documentation. Think about it: you can describe the manual techniques you're applying, note the patient’s response, and mention objective improvements, all while you work. The AI hears these details and automatically builds a formal progress note right in the EMR.

This ensures all the key pieces for a defensible 97140 claim are locked in:

• Specific Techniques: The AI picks up on and documents terms like "soft tissue mobilization" or "manual lymphatic drainage."
• Anatomical Location: It correctly maps your verbal descriptions to the exact body part treated.
• Medical Necessity: It automatically links your manual therapy back to the patient's functional goals and impairments.
• Patient Response: It logs both subjective feedback ("that feels looser") and objective changes (like a measured gain in range of motion).

This isn't a small tweak to your day. This kind of automation can cut documentation time by as much as 70%. That’s not just about saving a few minutes; it’s about fundamentally changing how you interact with patients, letting you stay fully present instead of being tied to a keyboard.

Smart Coding and Catching Errors in Real-Time

Ekagra Health AI goes beyond just writing notes—it’s also an intelligent coding partner. As it organizes the clinical information from the visit, its engine suggests the right CPT and ICD-10 codes based on the services you actually provided. This takes the guesswork out of the equation and dramatically improves coding accuracy.

Even better, the system is built to spot common billing issues before they turn into denials. For example, if it sees you’ve documented both 97140 and therapeutic exercise (97110) in the same session, it can flag the potential need for a modifier. This kind of real-time feedback helps ensure claims go out clean the first time, avoiding those automatic rejections from NCCI edits.

By capturing the nuances of your clinical work and translating them directly into compliant billing data, a tool like Ekagra Health AI turns a complicated manual chore into a simple, automated workflow. It helps practices get paid accurately for the valuable hands-on care they deliver, all while giving clinicians the freedom to focus on what they do best: helping patients.

Your Top Questions About CPT Code 97140, Answered

When it comes to CPT code 97140, a few common questions pop up time and time again for clinicians and billers. Let's clear up the confusion with straightforward answers to help you code with more confidence. Having clear answers to these frequently asked questions can serve as a quick reference and reinforce best practices within your team.

Can I Bill 97140 and 97110 on the Same Day?

Absolutely, but you have to be very careful with your documentation and use the right modifier. Payers are quick to bundle CPT 97140 (manual therapy) and 97110 (therapeutic exercise) because they often look similar on a claim. Your job is to prove they were separate and essential services. This is one of the most common NCCI edit pairs, so diligence is required.

The key is to append Modifier 59 or, even better, the more specific XS modifier (Separate Structure) to the 97140 code. Your notes must then paint a clear picture showing the manual therapy was performed on a completely different body part than the therapeutic exercises. Another way to justify it is by documenting that each service targeted a distinctly different clinical goal. For example, manual therapy was used to increase passive range of motion in a joint, while therapeutic exercise was used to strengthen the supporting musculature through active movement.

What Is the Difference Between 97140 and 97124?

Both codes are for 15-minute, hands-on techniques, but they serve very different purposes. It’s really about function versus relaxation. Confusing these two codes is a frequent cause of claim denials and audit flags.

• CPT Code 97140 (Manual Therapy): This is your go-to for skilled techniques aimed at fixing a problem. Think joint mobilization to restore movement, myofascial release to break up adhesions, or manual traction to decompress a joint. The goal is always functional—improving range of motion, reducing restrictions, and helping the patient move better. Documentation must reflect these functional goals and outcomes.
• CPT Code 97124 (Massage Therapy): This code covers classic massage techniques like effleurage and petrissage (think stroking, compression, and kneading). The primary purpose here is to relieve muscle tension, boost circulation, and promote relaxation. While it can be medically necessary, its focus is less on correcting a specific biomechanical fault and more on general tissue health and comfort.

Your documentation needs to tell the story of why you chose one over the other. If you're working to restore function, 97140 is your code. If the goal is mainly to ease muscle soreness and improve blood flow, 97124 is the better fit.

Is There a Limit to How Many Units of 97140 I Can Bill?

There’s no universal hard cap on 97140 units, but you can bet that payers have internal red flags. Most insurers, including Medicare, have soft limits or thresholds that will trigger an automatic review if crossed. Billing a high number of units consistently will likely draw payer scrutiny.

Pushing past four units (60 minutes) of manual therapy in a single session is unusual and will almost certainly get a second look. If you do need to provide this much manual therapy, your documentation must be exceptionally detailed and robust.

The real decider is medical necessity. Your notes have to be rock-solid in justifying every minute you bill. Each 15-minute increment must be backed by detailed notes explaining the skilled technique you performed and how it directly helped the patient get closer to their functional goals. You should clearly articulate why a prolonged duration of manual therapy was required for that specific patient on that specific day.

At the end of the day, everything must follow the 8-Minute Rule and be completely defensible. If you need to bill more units than is typical, your documentation has to be exceptionally thorough to prevent a denial.

Stop losing revenue to coding errors and documentation gaps. Ekagra Health AI uses advanced voice-to-claim technology to automatically generate audit-proof notes, suggest accurate CPT/ICD-10 codes, and flag modifier issues in real time. Reduce your denial rate and reclaim up to 70% of your documentation time.

Discover how you can streamline your billing.