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Official Description

Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Low frequency, non-contact, non-thermal ultrasound is a therapeutic procedure designed to enhance the healing process of various types of wounds. This innovative modality is particularly effective for chronic wounds, including pressure ulcers, diabetic foot ulcers, vascular ulcers, and surgical wound dehiscence. The procedure utilizes an ultrasound system that comprises an ultrasonic generator and a disposable sterile applicator. During the treatment, continuous low-frequency acoustic and sound energy is employed to atomize saline, which is delivered as a fine mist directly to the wound bed. This method facilitates cavitation and acoustic mainstreaming, both of which are critical in promoting wound healing by stimulating tissue granulation and enhancing cellular repair mechanisms. The procedure is performed on a per day basis and encompasses several components, including a thorough wound assessment, the application of topical treatments when necessary, and the provision of instructions for ongoing care to ensure optimal recovery and management of the wound.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure is indicated for the treatment of various chronic wounds, which may include the following conditions:

  • Pressure Ulcers These are localized injuries to the skin and underlying tissue, typically over bony prominences, due to prolonged pressure.
  • Diabetic Foot Ulcers These are wounds that occur on the feet of individuals with diabetes, often resulting from neuropathy and poor circulation.
  • Vascular Ulcers These ulcers are associated with inadequate blood flow, often due to venous insufficiency or arterial disease.
  • Surgical Wound Dehiscence This refers to the reopening of a surgical wound, which can occur due to various factors, including infection or inadequate healing.

2. Procedure

The procedure involves several detailed steps to ensure effective treatment of the wound:

  • Wound Assessment Initially, the wound is thoroughly assessed and measured to determine its size, depth, and overall condition. Photographs may be taken to document the wound's status for future reference.
  • Cleansing the Wound The wound and the surrounding tissue are cleansed to remove any debris or exudate, ensuring a clean environment for treatment.
  • Preparation of the Applicator A disposable applicator is attached to the transducer of the ultrasound device. Treatment parameters are selected based on the specific needs of the wound.
  • Saline Application A saline source is inserted into the applicator, which will be used to deliver the mist to the wound bed during treatment.
  • Ultrasound Treatment The applicator is moved in a serpentine fashion over the entire wound bed, maintaining a distance of 5-10 mm above the wound surface. This ensures that the low frequency, non-contact, non-thermal ultrasound effectively reaches the wound.
  • Post-Treatment Cleanup After the treatment is completed, the applicator and saline source are discarded. Other components of the device are disinfected to maintain hygiene standards.
  • Dressing Application Finally, the wound bed is wiped with sterile gauze, and a dressing is applied to protect the wound and promote healing.

3. Post-Procedure

Following the procedure, it is essential to monitor the wound for signs of healing or any complications. Patients should receive instructions for ongoing care, which may include keeping the wound clean and dry, changing dressings as directed, and reporting any changes in the wound's appearance or symptoms. Regular follow-up assessments may be necessary to evaluate the progress of healing and to determine if additional treatments are required.

Short Descr LOW FREQUENCY NON-THERMAL US
Medium Descr LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY
Long Descr Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day
Status Code Active Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator STV-Packaged Codes
Type of Service (TOS) 1 - Medical Care
Berenson-Eggers TOS (BETOS) T2D - Other tests - other
MUE 1
GW Service not related to the hospice patient's terminal condition
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GP Services delivered under an outpatient physical therapy plan of care
KX Requirements specified in the medical policy have been met
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
CQ Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
GO Services delivered under an outpatient occupational therapy plan of care
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
T5 Right foot, great toe
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
TA Left foot, great toe
T6 Right foot, second digit
25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59.
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
95 Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
97 Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled.
A1 Dressing for one wound
CO Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
CR Catastrophe/disaster related
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
GN Services delivered under an outpatient speech language pathology plan of care
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GZ Item or service expected to be denied as not reasonable and necessary
JZ Zero drug amount discarded/not administered to any patient
T1 Left foot, second digit
T2 Left foot, third digit
T3 Left foot, fourth digit
T4 Left foot, fifth digit
T7 Right foot, third digit
T8 Right foot, fourth digit
T9 Right foot, fifth digit
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
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2014-01-01 Added Added
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