Physical therapy plays a key role in rehabilitation, helping patients recover from injuries, surgeries, and other physical health issues. However, it’s crucial for healthcare providers to use the correct CPT (Current Procedural Terminology) codes when billing for services. This ensures accurate claims and timely reimbursements. In this guide, we will go over the most common physical therapy CPT codes, their uses, and important billing information.
What is a CPT Code?
A CPT code is a numerical system used to identify medical procedures and services. These codes, developed and maintained by the American Medical Association (AMA), are used by healthcare providers to document and report the treatments provided to patients. CPT codes help in the billing process by ensuring that insurance companies can clearly understand the services that were provided. Accurate coding also reduces the risk of claim denials and delays.
In physical therapy, CPT codes are assigned to specific treatments, such as exercises, manual therapy, or therapeutic activities. Properly using the right CPT code ensures that the therapist is compensated fairly for their work and helps keep the healthcare system running smoothly.
Most Common Physical Therapy CPT Codes
Below are detailed descriptions of the most commonly used CPT codes for physical therapy. These codes are used to represent the specific services provided to patients. Having a clear understanding of each code is essential for billing accuracy.
| CPT Code | Description | Common Use |
|---|---|---|
| 97110 | Therapeutic Exercises | This code is used for therapeutic exercises that focus on improving strength, flexibility, and range of motion. These exercises might include weight lifting, resistance band exercises, and stretching activities aimed at helping patients regain mobility and muscle strength. Therapeutic exercises are often prescribed for rehabilitation after musculoskeletal injuries, surgeries, or weakness due to other conditions. |
| 97112 | Neuromuscular Re-education | This code applies to exercises designed to improve balance, coordination, and motor control. Neuromuscular re-education is essential for patients who have lost their ability to perform coordinated movements due to neurological or musculoskeletal injuries. Exercises in this category focus on improving movement patterns, muscle control, and posture. This is commonly used for patients recovering from stroke or neurological disorders. |
| 97530 | Therapeutic Activities | This CPT code is used for functional activities that help patients improve their ability to perform daily living tasks. This could include walking, standing, or reaching tasks aimed at improving physical function and restoring independence. Therapeutic activities aim to restore normal physical function, such as carrying groceries, using stairs, or performing simple tasks around the house. |
| 97140 | Manual Therapy | Manual therapy includes hands-on treatments like joint mobilization, manipulation, and soft tissue techniques (such as myofascial release). The goal of manual therapy is to alleviate pain, increase joint mobility, and reduce muscle tension. These techniques are commonly used for musculoskeletal conditions, where hands-on interventions are more effective at relieving discomfort and improving range of motion. |
| 97535 | Self-care/Home Management Training | This code applies when therapists provide patients with education or training on how to manage their condition at home. This may include teaching exercises that can be done at home, how to use assistive devices (like crutches or walkers), or techniques for managing pain independently. It’s crucial for helping patients become more independent and regain confidence in their daily routines. |
| 97035 | Ultrasound Therapy | Ultrasound therapy involves the use of sound waves to treat musculoskeletal pain and inflammation. Therapeutic ultrasound is often used to reduce swelling, increase circulation, and promote tissue healing. This technique can be applied to muscles, tendons, and ligaments, and is commonly used to treat conditions like sprains, strains, or chronic pain issues. The ultrasound machine emits sound waves that penetrate deep into the tissue. |
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Physical Therapy CPT Code Billing Codes with Explanations
Properly billing physical therapy services requires using the correct CPT code that accurately reflects the service performed. Here are detailed explanations of key CPT codes:
CPT 97110 – Therapeutic Exercises
This code is applied when physical therapists use exercises to improve strength, flexibility, and functional range of motion. The exercises can include resistance training, stretching, and joint mobility exercises. It helps restore the physical function needed for daily activities, such as walking, reaching, and lifting. It is used for musculoskeletal conditions where improving muscle strength and joint mobility is a priority. For example, a therapist might use this code for a patient recovering from a knee surgery who needs exercises to strengthen the leg muscles.
CPT 97112 – Neuromuscular Re-education
Neuromuscular re-education focuses on improving motor control, balance, and coordination. It is commonly used for patients recovering from neurological injuries, such as stroke or brain injury, as well as those with musculoskeletal issues that affect coordination. Through exercises and activities, therapists help patients regain proper motor patterns, such as walking or sitting upright. This code is used when therapy involves restoring the normal functioning of the nervous system and muscle control.
CPT 97530 – Therapeutic Activities
This code represents activities designed to improve the patient’s ability to perform tasks of daily living. For example, a physical therapist may guide a patient through exercises that help them improve their ability to walk, carry items, or use stairs. It is commonly used for patients recovering from injury or surgery who need help regaining functional mobility. This can also include training patients on how to use mobility aids or adaptive equipment.
CPT 97140 – Manual Therapy
Manual therapy involves hands-on techniques such as joint mobilization, soft tissue manipulation, and stretching to relieve pain and improve movement. Physical therapists use this code when performing treatments like massage or joint manipulation to help restore mobility and reduce muscle tension. This technique is commonly used for conditions like neck or back pain, tendonitis, or joint stiffness.
CPT 97535 – Self-care/Home Management Training
This code is for teaching patients how to manage their condition outside the clinic. It may include instruction on at-home exercises, the use of assistive devices, or strategies for managing pain and fatigue. It’s often used for patients recovering from surgery, injury, or chronic conditions who need to incorporate self-management techniques into their daily routines.
CPT 97035 – Ultrasound Therapy
Ultrasound therapy uses high-frequency sound waves to target deep tissue and promote healing. It is commonly used to treat pain, inflammation, and soft tissue injuries. This code applies when ultrasound therapy is administered to reduce muscle soreness or aid in healing tissue after injury. It’s particularly effective for treating soft tissue injuries like muscle strains or tendinitis.
Also Read: What is POS 11 in Medical Billing
What is Modifier 59?
Modifier 59 is used to indicate that two separate and distinct procedures were performed on the same day. It informs insurance companies that the procedures should not be considered part of a bundle of services, even though they might normally be grouped together. Modifier 59 helps ensure that each procedure is reimbursed appropriately when multiple services are provided during the same visit.
How Do I Use Modifier 59?
Modifier 59 should be applied when two procedures are distinct and necessary, even though they are typically bundled under the same category. For example, if a patient receives manual therapy (CPT 97140) and therapeutic exercises (CPT 97110) during the same session, Modifier 59 can be added to indicate that the two services were separate. This allows both procedures to be reimbursed individually, without being considered as part of a single service.
When Should I Use Modifier 59?
You should use Modifier 59 when:
- Two procedures are distinct and performed at the same time but are unrelated.
- The procedures are not typically bundled but should be billed separately.
- You want to avoid claim denials due to inappropriate bundling.
Use this modifier carefully, as incorrect application can lead to claim rejections.
Best Practices for Using Physical Therapy CPT Codes
Outsource Billing and Coding for Accuracy
One of the best practices for handling CPT codes in physical therapy billing is outsourcing to a professional medical billing company. These experts ensure that your codes are accurate, reducing the risk of errors, claim denials, and delayed payments. This allows your staff to focus on patient care while billing experts handle the complex task of ensuring reimbursement.
Proper Documentation
It’s essential to document every treatment and procedure accurately. This includes noting the type of therapy provided, the patient’s condition, and the progress made during each session. Proper documentation will support the use of the CPT code and help avoid claim denials.
Stay Up-to-Date with Code Changes
CPT codes are updated annually, and new codes may be added or existing codes may be modified. Staying up-to-date with the latest code updates from the AMA ensures that your practice uses the correct codes. Regularly reviewing the new CPT code updates will help you avoid submitting outdated codes and ensure your claims are processed smoothly.
Use the Right Modifiers
Modifiers like Modifier 59 are useful when billing for separate, unrelated procedures performed on the same day. Use modifiers accurately to prevent claim issues. Misusing modifiers can result in delayed claims or denials, so make sure each modifier is applied correctly.
Conclusion
CPT codes are an essential part of physical therapy billing. By understanding these codes and their proper usage, physical therapists can ensure accurate billing and avoid common claim issues. Always stay informed about code updates, use the right modifiers, and consider outsourcing your billing to experts for better efficiency. With these practices, your practice will be able to navigate the complex world of CPT codes and provide top-notch care to patients.
FAQs
What are the CPT codes for physical therapy?
CPT codes for physical therapy include codes like 97110 (Therapeutic Exercises), 97112 (Neuromuscular Re-education), and 97530 (Therapeutic Activities). Each code corresponds to specific physical therapy services.
Where can I get a list of CPT codes?
You can get a list of CPT codes from the American Medical Association (AMA) website, which provides the most current and comprehensive list. You can also refer to billing software or coding books that include CPT codes.
What is the difference between CPT code 97530 and 97110?
CPT 97530 refers to therapeutic activities that improve functional mobility, such as walking or standing. CPT 97110, on the other hand, refers to therapeutic exercises that help improve muscle strength, range of motion, and flexibility.
What is CPT code 97162 for physical therapy?
CPT 97162 refers to a physical therapy evaluation that includes a comprehensive assessment of a patient’s condition, followed by the development of a treatment plan based on the findings.
