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Insurance Coding and Billing

IMPORTANT NOTE: While all attempts are made to keep this information current, we strongly suggest that you consult with experts in coding and reimbursement to determine specifics regarding your practice. Please review our disclaimer concerning the content of this page. (REV 1/2015)

Coding and Reimbursement Guidelines For TheraBand, Biofreeze and Cramer Products

Payors require specific documentation for reimbursement of rehabilitation services and supplies. Clinicians may legally bill for services and supplies based on their state's practice acts. You should contact payors to determine approved provider types, coverage & benefits, authorization requirements, as well as codes allowed and forms necessary to submit a claim.

For coding and reimbursement information specific to clinical and kinesiology taping, click here


Codes refer to specific numbers assigned to individual treatments or supplies. These include CPT codes for procedures, and HCPCS Level II codes for supplies. "Local Codes" may also be used in your area, particularly with Workers Compensation. Remember that coding is specific to the payor; therefore, it is important to know which codes are applicable. Be aware that code "modifiers" may be required as well. The Resource-Based Relative Value System (RBRVS)is used to determine the reimbursement rate for Medicare. These rates are generally limited to "usual, reasonable, and customary" charges.

CPT Code Title Description
97110* Therapeutic exercise, one or more areas, each 15 min. Therapeutic exercises to develop strength and endurance, range of motion and flexibility.
97112 Neuromuscular Re-education, one or more areas, each 15 min. Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception (such as stabilization or balance training)
97113** Aquatic Therapy, one or more areas, each 15 min. Aquatic therapy with therapeutic exercises.
97150 Group Therapeutic Exercise (2 or more individuals). Therapeutic exercises to develop strength and endurance, range of motion and flexibility for 2 or more individuals.
97530* Therapeutic Activities, direct hands-on, each 15 minutes. Use of dynamic activities to improve functional performance with direct contact by the provider.
97140 Manual Therapy techniques, one or more regions, each 15 minutes. Mobilization/manipulation, manual lymphatic drainage, manual traction, and soft tissue mobilization
97124 Therapeutic Massage, one or more areas, each 15 minutes. Includes effleurage, petrissage, and/or tapotement
97018 Paraffin Bath, each 15 minutes. Application of paraffin bath to one or more areas
97535 Self-care / Home Management Training. Instruction in self care at home
98960-2 Education and Training for Patient Self-Management Education and training performed by a non-physician using a standardized curriculum

*NOTE: Therapeutic exercise (97110) and therapeutic activities (97530) both require direct one-on-one provision of service according to Medicare guidelines. Therapeutic Exercise includes activities related to strengthening, endurance training, range of motion, and flexibility. Therapeutic Activities utilize dynamic activities to improve functional performance; these are also referred to as the "-ing" codes, for example, "lifting," "pulling," "pushing," "running," and "jumping."

**Aquatic therapy may require extra documentation. Aquatic therapy has suffered poor reimbursement because of confusion between therapy and exercise. Patients should be appropriately selected for aquatic interventions. Aquatic therapy should be differentiated from aquatic exercise as a skilled intervention by a licensed therapist to improve function. Document a timely plan for transition from water to land and integrate functional land components. Provide specific reasons that aquatic therapy is required, including the special properties of water. The therapist must be present, providing one-on-one contact with the patient, but does not have to be physically in the pool.

Reimbursement for Self-Care Products at Home

Home exercise programs are commonly prescribed in addition to in-clinic rehabilitation. There is no specific CPT code for home exercise instruction. The time spent in educating the patient in a home exercise program for strengthening & stretching activities should be designated as therapeutic exercise, 97110. Training for home exercises involving functional activities should use 97530. Remember that these codes are subject to the 'time' rule.

Medicare and most other insurers do not reimburse for exercise equipment used by the patient at home. The products used to deliver the service in the clinic, such as elastic bands, are considered "bundled" in the fee for service and cannot be billed separately. However, patients using these products for home exercise programs under the supervision of a healthcare professional may be billed for the cost of the items. In the unlikely event that an insurer reimburses for these products, check with the payor for specific coding requirements. Provide a full explanation of the supplies and equipment provided, being as specific as possible in regards to the patients limitations and needs. Letters of medical necessity are particularly helpful.

Product CPT Supply Code HCPCS II Codes
Elastic Bands & Tubing 99070 A9300
Rehab Kits 99070 A9300
Exercise Ball / MiniBall 99070 A9300
Stability Trainers and Discs 99070 A9300
Balance Boards 99070 A9300
FootBar 99070 A9300
FlexBar 99070 A9300
Ankle & Wrist Cuff Weights 99070 A9300
Progressive Hand Trainer 99070 A9300
Hand Exercisers 99070 A9300
Soft Weight 99070 A9300
Exercise Mat 99070 A9300
Aquatic Exercise Equipment 99070 A9300
Accessories/Refills 99070 A9300
Paraffin Bath Unit* 99070 E0235
Paraffin Bath Refills (per pound) 99070 A4265
BIOFREEZE® Gel/Spray/Rollon 99070 A9270
Educational Materials 99071

*Portable paraffin bath units and supplies may be covered when the patient has undergone a successful trial period of paraffin therapy ordered by a provider and the patient's condition is expected to be relieved by long-term use of this modality.

Thera-Band and Biofreeze products are not sold by the Hygenic Corporation direct to consumers; they are only sold through professionals. Since few insurers reimburse the cost of home-based exercise products, it's best to direct-bill patients for the cost of the products. This can easily be done by collecting cash payment for the product at the time of service. Medicare providers should have the patient complete a Notice of Exclusions from Medicare Benefits (NEMB) and an Advanced Beneficiary Notice (ABN) to bill patients for non-covered services. Be sure to provide a receipt and a letter of medical necessity to the patient (download an example here) . Many patients have Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA) that can reimburse patients for out-of-pocket medical expenses.

The amount charged by the professional varies, depending on their cost to inventory the products, as well as the market area. Please remember that most states require clinics to charge a sales tax when selling products to patients. You should check with your local state tax authority about the rules in your particular state before selling products to your patients.