CPT 97035
Global XXX ActiveApp mdlty 1+ultrasound ea 15
CPT 97035 Billing & Documentation Guide
CPT code 97035 (App mdlty 1+ultrasound ea 15) is classified under Physical Medicine with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.21, a non-facility practice expense RVU of 0.21, and a malpractice RVU of 0.01, a total non-facility RVU of 0.43 and facility RVU of 0.43. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $14.76, though rates vary from $13.21 to $18.18 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 97035, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 97035 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 97035 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 97035
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.21 | 0.21 |
| Practice Expense RVU | 0.21 | 0.21 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.43 | 0.43 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 97035
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $15.75 | $15.75 | $15 - $18.08 | 29 |
| Florida | $14.7 | $14.7 | $14.22 - $15.16 | 3 |
| Georgia | $14.12 | $14.12 | $13.67 - $14.56 | 2 |
| Illinois | $14.46 | $14.46 | $13.94 - $14.88 | 4 |
| Michigan | $14.08 | $14.08 | $13.8 - $14.35 | 2 |
| North Carolina | $13.77 | $13.77 | $13.77 - $13.77 | 1 |
| New York | $15.62 | $15.62 | $13.91 - $16.42 | 5 |
| Ohio | $13.75 | $13.75 | $13.75 - $13.75 | 1 |
| Pennsylvania | $14.31 | $14.31 | $13.77 - $14.84 | 2 |
| Texas | $14.27 | $14.27 | $13.71 - $14.75 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 97035
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 97035 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0183T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0229T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0230T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0231T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 62310 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 97035
What does CPT code 97035 mean? +
CPT code 97035 represents: App mdlty 1+ultrasound ea 15. It's in the Physical Medicine category with a global period of XXX.
What is the Medicare reimbursement for CPT 97035? +
The 2026 Medicare national average non-facility payment for CPT 97035 is $14.76. Rates range from $13.21 to $18.18 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 97035? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 97035? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team