A Guide on Physical Therapy CPT Codes for Medical Providers & Billers – Streamline Your Billing Process

Whether you are a physical therapist, assistant, medical biller, or insurance payer (Medicare, Medicaid, or a commercial plan), you should know how to use the CPT codes for physical therapy. It helps PTs get paid on time, allows payers to understand how much to pay PTs, and helps medical billers know where and when to use these CPT codes to speed up reimbursements.

CPT (Current Procedural Terminology) codes are the most important part of the medical billing process, as your payments broadly depend on these codes. However, if you use incorrect or outdated CPT codes, the payer will deny your claim, and you will need to resubmit it after fixing it. It not only made the billing process lengthy and complex but also increased the administrative workload and distracted your focus from patients.

In today’s blog, we guide you on physical therapy CPT codes, how and when to use them to streamline your billing process and help you increase revenue, so you can treat patients well without having stress for your payments. Let’s begin with what you should know first.

What are Current Procedural Terminology Codes?

According to the American Medical Association (AMA), the Current Procedural Terminology (CPT) codes are the primary language used to communicate between providers, payers, and third parties. It helps to understand what services or treatments are delivered to the patient. Moreover, these codes are often five alphanumeric digits used during insurance claim submission to maintain the accuracy and efficiency of the medical billing process.

Additionally, medical billers and providers use these codes in administrative work, enhancing efficiency and precision in every claim submission, reducing the delays and denials for the rendered services, and helping providers receive payments on time.

Common CPT Codes for Physical Therapy

Knowing the Physical therapy CPT codes is as essential to your revenue as it is to your practice. Why? Because you can’t bill for rendered services without adding these codes to your insurance claim.

Here are the most common CPT codes for physical therapy services;

97110 for Therapeutic Exercise

When you deliver therapeutic exercises to help the patient develop strength, use this code. Moreover, when providing stretching or range-of-motion exercises, use this code. It helps the payer understand that the rendered treatment is delivered to the patient to enhance the patient’s physical function in the body parts.

97112 for Neuromuscular Re-education

Use this code when you provide balance and coordination training, postural retraining, proprioceptive exercises, and motor control activities that restore the patient’s normal movement patterns and improve nerve-muscle coordination.

97530 for Therapeutic Activities

If the patient is treated by employing sit-to-stand tasks, reaching, pulling, and pushing activities, and squatting and bending movements, use code 97530 in the clinical notes to ensure on-time payments.

97140 for Manual Therapy

Code 97140 refers to the manual therapy delivered to the patient by using skilled techniques such as joint mobilization, myofascial release, manual stretching, and traction. Make sure to use the accurate code to maintain the medical necessity of documents and avoid claim denials.

97116 for Gait Training

Gait training involves one-on-one therapist involvement and billing for services at 15-minute intervals. It includes weight lifting and balance during ambulation and trains patients to use assistive devices such as a walker/cane, enabling them to walk independently, safely, and efficiently.

97035 for Ultrasound

You should use code 97035 when treating patients with ultrasound waves that strengthen, relax, and heal strained muscle tissues.

97535 for Self-Care/ Home Training Management

If you treat patients to help them work independently at home, and educate them on how to dress, bathe, and groom safely. These often deliver to people with Parkinson’s disease or any past injury or strength limitations. Hence, when a therapist provides home training management, use code 97535 for a quick reimbursement.

97150 for Group Therapy

Use code 97150 for group therapy, which includes two or more patients at a time to improve their strength and social activity involvement within the group, then in other areas.

97550 for Caregiver Training

The codes 97550 to 97552 are used to train caregivers help patients recover from past injuries to help improve their functional deficiency.

Rehabilitation CPT Codes Vs Occupational CPT Vs Speech Therapy CPT Codes: Do They All Fall Under PT CPT Codes?

If you’re a biller or physician who delivers one of the above therapies to patients, you might be thinking that CPT codes are the same for these services.

NO – Not all physical therapy CPT codes can be used for occupational and speech therapies.

Are you still confused? Let’s make it simple together.

First of all, know that Physical, Occupational & Speech Language Pathology services fall under “Rehabilitation Services.” For Speech Therapy, there is a separate CPT code set that ranges from 92500–92700, so there is no further confusion between PT and SLP CPT codes. However, some occupational and physical codes share the same CPT codes, such as (97110). And to distinguish them, the “modifiers” play an important role.

To separate these PT CPT codes by treatment, PTs, OTs, and SLPs must use modifiers to prevent claim rejections and denials.

Here are the modifiers you should use when sharing the same CPT codes;

For Physical Therapy – GP
For Occupational Therapy – GO
For Speech Language Pathology – GN

However, modifiers are not only used when you share the same codes, but also in the case of;

Physical/Occupational Therapy Assistant treats the patient, then applies CQ/CO.
You performed two different therapy treatments in separate 15-minute sessions, so you must apply the modifier (-59) to ensure you are paid for both.
When your patient’s total yearly treatment cost exceeds the annual Medicare Therapy threshold, but your patient still needs treatment, you must apply the (KX modifier) with medical proof. Because, without using this modifier, the insurance company will not pay you.

Want to know more about Rehab documentation and billing?

Physical Therapy Billing Guidelines for Fast & Quick Reimbursements

If you want to get paid quickly for your rendered services, make sure to follow the AMA and CMS physical therapy billing guidelines. Here are some essential therapy coding and billing best practices that help you streamline the billing process while focusing on patient care.

Know the Difference Between Time-Based & Service-Based Codes

Whenever you begin billing for your physical therapy services, make sure you know which codes to use to ensure accurate payments. There are two types of CPT codes, based on time limits: one is time-based & the other is Service-based. Time-based billing codes are only used when you deliver therapy sessions of 15 minutes, while service-based codes can be used only when you evaluate a patient’s condition.

Master the 8-Minute Rule

When you treat a patient with time-based services, make sure to bill the insurance company by using the 8-minute rule. The CMS (Center for Medicare and Medicaid) established the 8-minute rule, based on physical therapy billing units, to ensure that every physical therapist is paid accurately for the time spent delivering patient care.

Understand it as if you deliver a therapy session between 8 and 22 minutes, you can add one billing unit. Similarly;

23 – 37 minutes = 2 billing unit 3
8 – 52 minutes = 3 billing unit
53 – 67 minutes = 4 billing unit

Need more guidance on physical therapy billing units?

Ensure Clean Claim Submission

When you submit claims, make sure that everything is done accurately. It includes medical coding, modifier use, patient demographics, and prior authorization checks, if required. Moreover, the premium RCM companies use advanced technologies such as claim scrubbing, which detects missing information and coding errors before claim submission and helps submit clean claims.

Use Modifiers Correctly

Always ensure to use modifiers correctly, based on your rendered treatment or services, as it plays an important role in physical therapy billing, and a minor mistake in using a modifier can lead to payment delays or loss of revenue.

HIPAA-Compliance Billing

Following the Health Insurance Portability and Accountability Act (HIPAA) is mandatory to prevent data breaches, penalties, and fraud. Hence, ensure that every step of your revenue cycle management strictly follows payer-specific coding rules, policies, and HIPAA requirements to ensure you get paid without delay.

PT Billing Codes List – A Quick Overview

CPT Code	Description	Billing Type
97161	PT Evaluation (Low Complexity)	Service-based
97162	PT Evaluation (Moderate)	Service-based
97163	PT Evaluation (High Complexity)	Service-based
97164	PT Re-evaluation	Service-based
97110	Therapeutic Exercise	Timed (15 min)
97112	Neuromuscular Re-education	Timed (15 min)
97140	Manual Therapy	Timed (15 min)
97530	Therapeutic Activities	Timed (15 min)
97116	Gait Training	Timed (15 min)
97535	Self-Care/Home Management	Timed (15 min)
97010	Hot/Cold Packs	Service-based
97012	Mechanical Traction	Service-based
97035	Ultrasound	Timed (15 min)
97032	E-Stim (Manual)	Timed (15 min)
97550	Caregiver Training (Initial 30m)	Timed (30 min)
97150	Group Therapy	Service-based

Conclusion

In short, CPT codes are the main part of your physical therapy billing services, because without using these codes, you can’t bill to the payer. If you use incorrect codes, the payer rejects the claims, and you need to wait a long time. Hence, always ensure your billing team applies valid CPT codes for physical therapy based on the clinical notes to ensure clean claim submission. Additionally, outsourcing therapy billing services to eClaim Solution can help speed up your reimbursement process. Our team of billing experts has expertise in using CPT codes, ICD-10, and modifiers in accordance with therapy billing guidelines. Moreover, we always ensure to follow payer-specific codes and HIPAA rules to stay compliant, prevent data breaches, and avoid the high cost of penalties.

Frequently Asked Questions

How can we differentiate between rehabilitation therapy and physical therapy billing services?

Rehabilitation therapy billing refers to the patient’s improvement in cognitive, emotional, and physical health, which may include PT, OT, and SLP therapies. In contrast, physical therapy billing involves only treatments for physical impairments, such as exercise, massage, and physical activities.

What is the difference between 97161, 97162, and 97163?

All these codes fall under physical therapy evaluation services. So, use 97161 code for low-complexity, 97162 for moderate-complexity, and 97163 for high-complexity physical therapy solutions.

What CPT code can be used for therapeutic activity in physical therapy?

Use 97530 when you provide therapeutic activities as part of physical therapy services.

Book a Consultation