[This post was originally published on 3rd June 2024. It has been updated on 6th January 2026.]

Mechanical traction is a commonly used therapeutic modality in , particularly for patients with disc-related conditions and nerve compression. However, CPT 97012 is also one of the most frequently misused and misunderstood therapy codes, leading to claim denials, audits, and reimbursement delays.

Many billing issues arise not because traction is ineffective or unnecessary, but because the service provided does not meet the payer’s definition of mechanical traction. Understanding what qualifies, what does not, and where practices commonly go wrong is critical for compliant billing and optimal 97012 CPT code reimbursement.

This guide explains how 97012 CPT code should be used, outlines frequent billing errors, and provides clarity on services that are often incorrectly reported under this code.

What 97012 CPT Code Represents

97012 procedure code describes mechanical traction, a supervised physical medicine modality in which a mechanical device applies controlled traction forces to one or more areas of the body.

97012 CPT code description as maintained by American Academy of Professional Coders, is a medical procedural code under the range – Supervised Physical Medicine and Rehabilitation Modalities. Techniques applied in mechanical traction are dependent on the patient’s condition, disorder, tolerance level, and the spinal level to be treated.

Key characteristics of CPT 97012:

• It is a supervised modality, not requiring one-to-one continuous attendance
• It involves mechanical force generated by a device
• It applies to one or more body regions
• Only one unit per visit is typically billable

Chiropractic CPT Code – 97012 – is used for mechanical traction. 

What is Mechanical Traction

Mechanical traction is a supervised physical medicine modality that does not require one-to-one, constant patient contact. Using a mechanical or electromechanical device, controlled traction forces are applied to the spine to create separation of vertebral segments and reduce pressure on spinal structures.

“It is the position of the American Chiropractic Association that modalities such as mechanical traction are not included in the work of the CMT codes. Code 97012 should be used to describe these services, subject to documented medical necessity.”

Source

The purpose of mechanical traction is to:

• Decrease nerve root compression
• Reduce disc pressure
• Increase intervertebral space (foraminal opening)
• Alleviate pain and improve patient function

Depending on the patient’s condition, spinal region treated, and tolerance level, traction may be applied as:

• Intermittent traction, or
• Continuous (static) traction, using a mechanical system

Mechanical traction is commonly used for patients with conditions such as:

• Herniated or bulging discs
• Cervical or lumbar radiculopathy
• Neck, arm, leg, and low back pain
• Degenerative disc or joint disease

Clinical effectiveness and appropriateness must always be supported by medical necessity and documentation.

Who Can Perform Mechanical Traction in a Chiropractic Office?

In most chiropractic practices, licensed chiropractors perform mechanical traction. However, state scope-of-practice laws may allow trained Chiropractic Assistants (CAs) to assist with or apply mechanical traction under supervision.

Key supervision requirements include:

• The provider must be present in the office suite when a Chiropractic Assistant performs mechanical traction
• The provider does not need to be in the same treatment room
• Proper training and delegation must comply with state regulations and payer policies

Practices should always verify:

• State chiropractic board rules
• Scope-of-practice laws
• Payer-specific supervision requirements

Failure to meet supervision standards can result in claim denials or compliance issues, even if the service itself is otherwise billable.

Services Commonly Mistaken for Mechanical Traction

One of the most significant challenges with CPT 97012 is that many chiropractic therapies look like traction but do not meet the CPT or payer definition of mechanical traction. These misunderstandings are a leading cause of denials and compliance findings during audits and post-payment reviews.

Below are the most common services that are frequently misreported as CPT 97012, along with explanations of why they do not qualify and how they should be handled from a billing perspective.

Frequent Billing Errors with CPT 97012

Roller Table Traction Billed as Mechanical Traction

A common billing error occurs when practices report CPT 97012 for roller table therapy. Although roller tables may provide spinal movement or decompression-like effects, they rely primarily on gravity, patient positioning, and body weight, not on a mechanical device that applies a controlled pulling force.

Most insurance payers, including Medicare and many commercial carriers, do not recognize roller table therapy as mechanical traction. As a result, these services are often classified as experimental, investigational, or not medically necessary when billed under CPT 97012.

To remain compliant, roller table therapy should not be reported using CPT 97012. In some cases, an unlisted modality code such as CPT 97039 may be appropriate, but only if the payer allows it and documentation clearly supports the service. Always verify payer policy before submitting a claim.

Source

Use of Static Traction Blocks or Positioning Wedges

Another frequent error is reporting CPT 97012 when static traction blocks or positioning wedges are used. While these tools may assist with spinal positioning or patient comfort, they do not generate mechanical traction force.

Static traction blocks do not involve:

• A mechanical traction device
• Controlled pulling force
• Active separation of joint surfaces

Instead, they are considered positional or supportive therapies, which do not meet the CPT definition of mechanical traction. Because CPT 97012 specifically requires a mechanical modality, billing this code for static block therapy is inappropriate and commonly results in denials.

Practices should avoid billing CPT 97012 in these cases and only consider alternative coding if explicitly supported by payer guidelines and clinical documentation.

Flexion-Distraction Reported Separately as Mechanical Traction

Flexion-distraction technique is another service frequently mistaken for mechanical traction. Although it involves movement and decompression of the spine, flexion-distraction is a manual, provider-performed technique, not a supervised mechanical modality.

Most payers consider flexion-distraction to be:

• A manual procedure
• Part of the chiropractic adjustment
• Included in the work of spinal manipulation codes

As a result, reporting CPT 97012 in addition to chiropractic manipulation codes (98940–98942) is typically viewed as unbundling. This practice increases audit risk and may result in recoupments or claim denials.

The correct approach is to bill only the appropriate chiropractic manipulation code and not separately report mechanical traction when flexion-distraction is performed.

How Medicare/CMS Views 97012 procedure code

Medicare’s official outpatient therapy guidance confirms several key points:

Covered Use

• Mechanical traction is accepted as a therapy modality when documented as medically necessary and part of a therapy plan for spinal pain or radiculopathy.
• Only 1 unit of 97012 is generally payable per date of service, even if multiple body areas are treated. 

Documentation Requirements

To be reimbursed, documentation must clearly include:

1. Medical necessity and rationale for traction
2. Diagnosis and etiology
3. Device type and body area treated
4. Start and end times or duration where applicable
5. Progress notes and patient response
6. Educational time related to home traction, when included, can be billed under 97012.

Medicare Limits

• CMS does not recognize spinal decompression devices (e.g., DRX, VAX-D systems) as covered therapy, these are excluded by Medicare National Coverage policy and generally require unlisted codes and accompanying denial/billing to patient. 

Traction equipment as durable medical equipment (DME) (for home use) is separately billable under Part B if prescribed and justified, but that is outside the therapy CPT code.

Correct Use & Billing Tips

1. Define the Modality

You must use mechanical traction devices that provide controlled pull. Manual traction or body-weight/manual techniques are not billable with 97012.

2. Supervision vs. Constant Contact

97012 is a supervised modality, meaning hands-off after setup, but the clinician must ensure the patient is safe and properly positioned.

3. Document Medical Necessity

Insurance, especially Medicare, will require that traction be clearly justified as part of treatment, ideally tied to functional goals.

4. Modifier Use (to avoid denials)

Use appropriate 97012 CPT code modifiers based on payer:

• Modifier 59 / XU / XE / XS – when mechanical traction is distinct from other services on the same day
• Modifier GP – shows therapeutic plan of care for outpatient therapy (some payers require this). For instance, when billing 97012 to BCBSNC and NC State Health Plan (SHP), you must append 97012 with modifier GP. 
• Modifier GY / GA – when the service is expected to be not covered (Medicare) with or without signed ABN
• Exact modifier rules vary by carrier, always verify payer requirements.

Correct Use & Billing Tips

1. Define the Modality

You must use mechanical traction devices that provide controlled pull. Manual traction or body-weight/manual techniques are not billable with 97012. 

2. Supervision vs. Constant Contact

97012 is a supervised modality, meaning hands-off after setup, but the clinician must ensure the patient is safe and properly positioned. 

3. Document Medical Necessity

Insurance, especially Medicare, will require that traction be clearly justified as part of treatment, ideally tied to functional goals. 

4. Modifier Use (to avoid denials)

Use appropriate 97012 CPT code modifiers based on payer:

• Modifier 59 / XU / XE / XS – when mechanical traction is distinct from other services on the same day
• Modifier GP – shows therapeutic plan of care for outpatient therapy (some payers require this). For instance, when billing 97012 to BCBSNC and NC State Health Plan (SHP), you must append 97012 with modifier GP. 

• Modifier GY / GA – when the service is expected to be not covered (Medicare) with or without signed ABN

• Exact modifier rules vary by carrier, always verify payer requirements.

Coding & Payer Differences

Insurance Variation

Commercial payers often have their own definitions for what they’ll cover as “medical necessity” for traction. Verifying benefits before treatment greatly reduces denials. 

Documentation Best Practices

To strengthen claims:

• Record diagnosis codes tied to functional limitation
• Detail device settings and patient tolerance
• Track treatment response and progress
• Include education time if applicable, as per Medicare guidanc

Quick Summary: What CPT 97012 Represents

Coding & Payer Differences

Insurance Variation

Commercial payers often have their own definitions for what they’ll cover as “medical necessity” for traction. Verifying benefits before treatment greatly reduces denials. 

Documentation Best Practices

To strengthen claims:

• Record diagnosis codes tied to functional limitation

• Detail device settings and patient tolerance
• Track treatment response and progress
• Include education time if applicable, as per Medicare guidanc

Quick Summary: What CPT 97012 Represents

Conclusion

CPT code 97012 (Mechanical Traction) is one of the more nuanced and frequently misapplied codes in chiropractic billing. Misunderstanding payer definitions, documentation requirements, or coding policies can quickly lead to denials, audits, and lost revenue.

By gaining a clear understanding of when mechanical traction is appropriate, how it must be documented, and what services do not qualify, chiropractors and billing teams can significantly reduce errors and improve claim outcomes. Accurate use of CPT 97012 not only supports compliant billing but also ensures that patients receive care that is properly justified and reimbursed.

When applied correctly and supported by thorough documentation, mechanical traction can remain a valuable part of a compliant, financially sustainable chiropractic practice.

A Smarter Way to Handle 97012 Billing Challenges

Navigating the complexities of chiropractic billing doesn’t have to fall entirely on your shoulders. zHealth’s managed billing services are designed to eliminate the confusion and risk associated with codes like CPT 97012.

Our experienced billing specialists:

• Review and validate chiropractic billing codes
• Submit clean, compliant claims
• Handle denials and appeals
• Manage accounts receivable efficiently

This allows you to spend less time worrying about 97012 CPT code reimbursement issues and more time focusing on patient care. With zHealth, clinics don’t just bill smarter, they get paid faster and with greater confidence.

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