CPT 97035: Therapeutic Modalities for Muscle Strengthening and Relaxation
Medicare pays $15 and commercial payers pay $39 on average nationally for this procedure.
CPT code 97035 describes therapeutic modalities administered by physical therapists to strengthen, relax, and promote healing of strained or injured muscles; this service is a physical therapy modality typically delivered as part of a clinic-based outpatient rehabilitation visit or in other ambulatory therapy settings to address musculoskeletal pain and dysfunction.
For related coverage guidance, see recent payer policy updates: Radiofrequency Facet and Sacroiliac Joint Ablation/ Denervation, Facet Joint Injections/ Medial Branch Blocks, Lysis of Epidural Adhesions (Epidural Adhesiolysis).
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National Reimbursement Benchmarks
Commercial averages sit well above Medicare for CPT 97035: Blue Cross Blue Shield and Cigna show mean rates around $47.7 and $45.1 respectively, while BUCA’s mean is $38.7, compared with Medicare’s mean of $14.8. This places Medicare roughly $23.9–$32.9 below several large commercial payers on average, highlighting a substantial gap between government and commercial reimbursement for the code.
Dispersion varies notably by payer. Blue Cross Blue Shield has one of the widest interquartile spreads at $33.0 (P75 $59.1 minus P25 $28.2), and Cigna’s spread is also wide at $58.0 (P75 $72.8 minus P25 $14.8), indicating greater variability in allowed amounts. UnitedHealth Group and Aetna are much tighter with spreads of $5.0 (P75 $17.6 minus P25 $12.6) and $12.0 (P75 $21.6 minus P25 $10.0) respectively, suggesting more consistency in negotiated rates.