Medical coding and billing are essential for physical therapists to ensure timely and accurate reimbursements for their rendered services. Inaccuracies and inconsistencies in coding can result in claim denials, negatively impacting the healthcare provider’s ability to keep their practice up and running.
Sometimes errors in medical claims can land the therapist in hot waters on account of fraudulent activities, such as upcoding and downcoding.
Thus, we will discuss the most widely used physical therapy CPT codes to save you from becoming a victim and losing your reputation. So, without further ado, let’s get started!
Common CPT Codes for Physical Therapy
Discussed below are the widely used CPT codes for physical therapy billing:
CPT Codes for Physical Therapy – Evaluation
Before exploring the CPT codes for physical therapy billing, you must first understand that therapists cannot initiate the treatment without evaluation. Thus, below are the evaluation codes that decide the complexity of the patient’s ailment and the treatment plan to cure it.
- 97161 – PT evaluation, low complexity
- 97162 – PT evaluation, moderate complexity
- 97163 – PT evaluation, high complexity
- 97164 – PT re-evaluation
You can bill for an evaluation when a new diagnosis is performed, while a re-evaluation is required when the patient’s condition changes (declines or improves).
Physical Therapy CPT Codes – Management and Treatment
CPT Code 97032 – Electrical Stimulation
You can bill this physical therapy CPT code for 15 minutes of electrical stimulation. This procedure involves applying electrical current to stimulate muscles and nerves, promoting tissue healing, muscle contraction, and pain relief.
Physical therapists (PTs) often use this technique for conditions, such as chronic pain, nerve damage, and muscle weakness, that prevent individuals from moving freely. Besides, the frequency and intensity of electrical currents depend on the patient’s specific condition and response to the treatment.
CPT Code 97110 – Therapeutic Exercise
It is a physical therapy type that utilizes specially tailored activities and exercises to develop endurance and strength, helping patients gain fitness levels and mobility.
97110 is also a timed physical therapy CPT code that you can bill in 15-minute increments. Besides, therapists can only report this code if they spend direct contact time. You can easily confuse this code with therapeutic activity, but both have significant differences in reimbursement. Therapeutic activity pays you more than therapeutic exercise because the skill levels required by the former are on the higher side.
CPT Code 97112 – Neuromuscular Re-education
It is another common CPT code for physical therapy that you can report for neuromuscular re-education. It involves stimulating activities to help restore functions and reduce impairments through the retraining of the brain to control muscles. It includes carefully tailored exercises stimulating the brain to move the muscles for better functioning. It is a timed CPT code that therapists can bill for a 15-minute session following the Medicare 8-minute rule.
Besides, these activities assist patients to improve their balance, kinesthetic sense, movement, posture, and coordination. Listed below are the activities covered in this CPT code:
- Desensitizing the muscles
- Ergonomic training
- Inhibition or facilitation
- Improving motor control
- Kinesiotaping
- Performing stabilization exercises
- Plyometrics
CPT Code 97116 – Gait Training
97116 CPT code for physical therapy is related to gait training. It includes exercises, lasting 15 minutes, to help a patient walk and stand by strengthening the joints and muscles in the legs. It aims to improve posture and balance. Besides, these exercises (e.g., stairs climbing) help develop endurance, retain leg movements, and enhance muscle memory through repetitive motions.
The goal of this session should be to reduce patient’s risk of falls and enhance their mobility. Individuals may require gait training for any of the following reasons:
- Brain injuries
- Broken pelvis
- Injured leg
- Joint replacement
- Neurological disorders
- Musculoskeletal disorders
- Spinal cord injuries
- Stroke
Therapists may use machines during these sessions to help individuals walk safely, providing stability and supporting their body weight. The harness is another piece of equipment commonly used in gait training to help patients relearn walking movements.
CPT Code 97140 – Manual Therapy
97140 physical therapy CPT code is related to manual therapy. It is a type of therapy in which a licensed physical therapist utilizes controlled pressure and movement of hands to treat different conditions, such as chronic back pain, etc. Each session lasts 15 minutes and helps improve lymphatic drainage, joint mobility, tissue repair, and alignment.
Anything that qualifies as a manual resistance exercise is covered under this CPT code for physical therapy. Besides, these exercises help increase muscle energy by improving endurance and strength. However, unlike other codes, this billing code will result in low reimbursements because physical therapists are not qualified massage therapists, and they may use this procedure with other exercises to bring out the desired outcome.
CPT Code 97150 – Group Therapy
You may use this CPT code for physical therapy billing when the therapist provides therapy to a group of individuals, i.e., two or more participants in the same session. This session does not necessarily include one-on-one contact with each patient, and everyone may not perform the same exercises simultaneously.
Besides, the exercises may take place at various locations, including the pool or gym. However, constant supervision by the therapist or the assistant is required due to the participation of multiple patients in the group session.
CPT Code 97530 – Therapeutic Activities
Therapeutic activities can help improve the functions of ligaments, muscles, and other tissues. This CPT code for physical therapy involves dynamic exercises for 15 minutes, requiring direct contact with the patient, such as:
- Bed mobility exercises to help patient get in and out of bed safely
- Ball throwing practice to help strengthen muscles, improve arm mobility, and muscle memory
- Hip-hinge training
- Lifting heavy objects using the proper form
- Practicing going down and upstairs
- Practicing getting in and out of a vehicle
- Sitting, standing, then sitting back down
- Squatting to enhance balance
- Swinging a bat or golf club
These exercises require a highly skilled therapist who can assist patients in correcting movements and prevent them from injuring themselves.
CPT Code 97535 – Self Care & Home Management Training
Self-care and home management training are provided by physical therapists when an injury affects an individual’s ability to live their routine permanently or temporarily. The injuries may vary. Maybe the patient has a prosthetic limb or underwent knee replacement/ surgery for broken arms.
The 97535 physical therapy CPT code covers 15 minutes of instructions to help people enhance their ability to live independently by enhancing endurance, strengthening muscles, and improving balance and flexibility.
Apart from the exercises, the provider gives instructions on meal preparation, safety protocols, and the appropriate use of assistive technology/devices. It enables individuals to perform routine tasks such as eating, bathing, getting dressed, moving to and from a wheelchair, etc.
CPT Code 97750 – Physical Performance Test or Measurement
You can report this CPT code when the therapist evaluates the patient’s physical performance for 15 minutes before deciding on their treatment plan. It includes determining the patient’s functional and musculoskeletal capacity via activities and tests, such as:
- Cybex testing
- Exertional testing
- Functional assessments
- Functional capacity evaluations
- Grip tests
- Pinch tests
- Running, throwing, gait video analysis
- Sensory tests
You may also use this physical therapy CPT code to report the evaluation of joint range as it entails the patient’s functionality. However, many therapists will reserve its billing under administering functional assessments at any point after an initial evaluation.
CPT Code 97761 – Prosthetic Training
This physical therapy CPT code is related to prosthetic management and treatment. It involves training patients with a new prosthetic limb. The training enables the patient to balance bodyweight, walk, stand, run, and sit with the new leg. Contrarily, if it is a prosthetic arm, it requires training the patient to properly hold an object, grip, write, and wave.
Besides, this CPT code includes a prosthetic assessment, and how to fit or remove it. It is a time-based code and reports every 15 minutes of the initial encounter.
Physical Therapy Modifiers
Modifiers play a significant role in PT billing. They provide additional details about a rendered procedure, enabling coding accuracy and specificity.
In this section, we will discuss the modifiers that are commonly used with physical therapy CPT codes.
Modifier 59
It identifies that the performed physical therapy procedure is distinct from other management and non-evaluation care services.
GP Modifier
This modifier indicates that the performed physical therapy services are typically rendered in outpatient and inpatient multidisciplinary settings.
KX Modifier
Use this modifier code to ensure treatment continuity if the PT services provided to the patient exceed Medicare’s $2,330 threshold (for calendar year 2024). However, you must supply the payer with additional documentation justifying the medical necessity and appropriateness of treatment.
XE Modifier
It is used to indicate a distinct PT service that was rendered in a separate encounter.
XP Modifier
Indicates a PT service that is distinct as it was performed by a different healthcare provider.
Bottom Line
Some widely used physical therapy CPT codes include 97032 for electrical stimulation, 97150 for group therapy, 97530 for therapeutic activities, 97140 for manual therapy, and 97116 for gait training.
These physical therapy CPT codes can be used with modifiers to ensure coding accuracy. For example, modifiers 59, XP, XE, KX, and GP explain if the procedure was performed by a licensed physical therapist, in an in-patient or outpatient setting, was distinct from other services offered the same day, or was medically necessary even though it exceeded Medicare’s threshold.
However, if you still have trouble handling medical billing and coding in-house, you can get our professional physical therapy billing services.
