Physical ‎Therapy Billing CPT Codes | StrataPT (2023)

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Article Contents

What are CPT Codes?

CPT is short for Current Procedural Terminology and the codes published by the American Medical Association. CPT codes are used to classify medical, surgical and diagnostic services and procedures, and range from 00100 to 99499. CPT, ICD-9 and ICD-10 are numeric representations of data that allow for more efficient data retrieval. Each classifies data much like a zip code identifies a specific area and makes it easier for the Post Office to sort the mail and deliver it quickly.

(Video) Physical Therapy Billing Codes

The Most Common Physical Therapy CPT codes:

Please note: CPT codes are copyrighted (1995-2019) by the American Medical Association. All rights reserved.

97110Therapeutic Exercise
97140Manual Therapy
97112Neuromuscular Re-Education
97530Therapeutic Activities
97010Hot/Cold Packs
97014Electrical Stimulation (Unattended)
G0283Electrical Stimulation, Medicare Non-Wound (Unattended)
97035Ultrasound/Phonophoresis
97161PT Evaluation: Low Complexity
97116Gait Training
97162PT Evaluation: Moderate Complexity
97535Self Care/Home Management Training
97016Vasopneumatic Device
97032Electrical Stimulation (Manual)
97012Mechanical Traction
97164PT Re-Evaluation
97113Aquatic Exercise
97150Group Therapy
97124Massage
97018Paraffin Bath
NC001No Charges This Visit
97163PT Evaluation: High Complexity
98941Spinal, Three or Four Regions
97022Whirlpool
97033Iontophoresis
98940Chiropractic Manipulative Treatment (CMT); Spinal, One or Two Regions
97039Laser/Other
97026Infrared Light
97750FCE/Performance Test
98943CMT, Extraspinal, One or More Regions

CPT, ICD-9 and ICD-10

While Physical Therapists use CPT codes to regiment the treatment of diagnoses, ICD coding is the standard international system for recording diagnoses and classifying mortality and morbidity statistics. The World Health Organization (WHO) created the ICD and still watches over it. ICD-9 was the ninth version of the ICD coding system, connecting the health issues of patients by using 3 to 5 digit alphanumeric codes. However, in 2015, ICD-10 (the 10th revision) was introduced, using 4 to 7 digit alphanumeric code. ICD-10 is now the standard of ICD coding.

In Physical Therapists’ offices, ICD-10 codes are used in combination with CPT codes, which identify the Physical Therapy service provided during the patient’s visit. Both codes are submitted to a payer for the Physical Therapist to be reimbursed. Ideally, the CPT code (treatment, service, procedure) matches up logically with the ICD-10 code (the symptom, injury, etc.). Reimbursement problems can arise when the CPT code doesn’t support the ICD-10 code.

Modifier 59

Modifiers are added to CPT codes when they are required to more accurately describe a procedure performed or service rendered. A modifier should never be used in order to receive a higher reimbursement or to get paid for a procedure that should be bundled with another code.

Let’s look at the CPT Manual definition of Modifier 59:

(Video) Overview of PT CPT Codes and BIlling

Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures [and/or] services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

This language can be a bit confusing, and the definition leans toward surgical procedures, however Modifier 59 does have its place in a Physical Therapy setting. It is also a potential red flag for the US Centers for Medicare and Medicaid Services (CMS) and commercial payers. When Modifier 59 is used incorrectly, it can lead to claim denial.

Modifier 59 is used to represent a service that is separate and distinct from another service it’s paired with. For therapists, Medicare uses the following example to explain the proper use of Modifier 59:

Column 1 Code / Column 2 Code - 97140/97530

(Video) 3 Common CPT Codes for Physical Therapy

>CPT Code 97140 – Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes >CPT Code 97530 – Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
Modifier 59 may be reported if the two procedures are performed in distinctly different 15 minute time blocks. For example, one service may be performed during the initial 15 minutes of therapy and the other service performed during the second 15 minutes of therapy. Alternatively, the therapy time blocks may be split. For example, manual therapy might be performed for 10 minutes, followed by 15 minutes of therapeutic activities, followed by another 5 minutes of manual therapy. CPT code 97530 should not be reported and modifier 59 should not be used if the two procedures are performed during the same time block.

When is Modifier 59 Acceptable?

While the CPT Manual may give guidelines for the use of Modifier 59, the language is rather confusing and many Physical Therapists struggle with its use. Keep in mind the following:

  • Submitting a claim containing both codes in an NCCI edit pair (also called linked services) will result in the payment of only one of the procedures. This happens because the payer will automatically assume that one of the procedures or services was built in to the other.
  • If you didn’t actually perform the services together, then you can use Modifier 59 to let the payer know that each service in the edit pair was performed separate and independently of the other, and each service requires its own payment.
  • Make sure you have the appropriate documentation that supports your billing decision. The final decision will come down to the details, and the more you can accurately document, the better off you will be. Never mislead or fake your documentation. Likewise, you shouldn’t get in the habit of using Modifier 59 with re-evaluation codes.
  • Modifier 59 should be used as a last resort. If there’s a better option, use it instead. Frequently, a more descriptive modifier can be applied. Modifier 59 should only be initiated when it best fits the circumstances at hand.

Please be aware that in 2015, CMS created a new set of modifiers for use instead of Modifier 59 (in certain cases). These modifiers, such as XE, XP, XS and XU, are intended to bypass a National Correct Coding initiative edit by denoting a distinct encounter, anatomical structure, practitioner or unusual service. While the APTA has issued a statement that therapists do not need to use these new modifiers in place of Modifier 59, it’s probably just a matter of time before they are required to do so.

We will provide you with an update if we hear any changes on this policy.

Please note: New codes (as of April 2019) are shown in bold.

(Video) Physical Therapy 97530 and 97110 - Medical Coding

CPT CodeDescriptionTimed?Column 2
y = use 59 modifier
n = do not bill the code in combination with code in column 1
90911Biofeedback for IncontinenceN90901n; 97032y; 97110y; 97112y; 97530y; 97535y; 97550y
G0451Developmental TestingN96125y; 96127n; 96146y; 96160y; 96161y
92507Treatment of Speech and Language, IndividualN0373Tn; 36591n; 36592n; 69209n; 69210n; 96523n; 97110y; 97112y; 97127y; 97150y; 97153n; 97154n; 97155n; 97156n; 97157n; 97530y; 97532y; 97533y; G0515y
92508Speech GroupN36591n; 36592n; 69209n; 69210n; 92507y; 96523n; 97110y; 97112y; 97127y; 97150y; 97154n; 97155n; 97156n; 97157n; 97158n; 97530y; 97532y; 97533y; G0515y
92521Evaluation of Speech FluencyN36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92522Evaluation of Speech ProductionN36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92523Evaluation of Speech Production with Evaluation of Language Comprehension and ExpressionN36591n; 36592n; 69209n; 69210n; 92522n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92524Behavioral and Qualitative Analysis of Voice and ResonanceN36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92526Treatment of Swallowing DysfunctionN36591n; 36592n; 92511y; 92520y; 96523n; 97032n; 97110y; 97112y; 97127y; 97150y; 97530y; 97532y; G0270n; G0271n; G0283n; G0515y
92597Evaluation of Voice ProstheticN36591n; 36592n; 96523n; 97755n
92607Evaluation of Speech Generating Device (SGD); First HourY36591n; 36592n; 92507y; 92508y; 92521y; 92522y; 92523y; 92524y; 92597n; 92609y; 96523n; 97755n
92608Evaluation of Speech Device (Each Additional 30 Minutes)Y36591n; 36592n; 96523n; 97755n
92609Programming and Training for Speech Generating DeviceN36591n; 36592n; 92507y; 92508y; 92521y; 92522y; 92523y; 92524y; 96523n; 97755n
92610Evaluation of SwallowingN35691n; 35692n; 92511y; 96523n
92611Modified Swallow StudyN36591n; 36592n; 70370y; 70371n; 76120n; 76125n; 92511y; 92610y; 96523n
92612Flexible Endoscopic Evaluation of SwallowingN31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 92614n; 96523n
92614Flexible Endoscopic Evaluation; Laryngeal Sensory Testing by Cine or Video RecordingN31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 96523n
92616Flexible Endoscopic Evaluation of Swallowing and Laryngeal Sensory Testing by Cine or Video RecordingN31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 92612n; 92614n; 96523n
95831Muscle Testing, Extremity (Excluding Hand) or TrunkN36591n; 36592n; 95851n; 97140y
95832Muscle Testing, HandN36591n; 36592n; 95852n; 97140y
95833Muscle Testing, Total Eval Body, Excluding HandsN36591n; 36592n; 95831n; 95832n; 95851n; 97140y
95834Muscle Testing, Total Eval Body, Including HandsN36591n; 36592n; 95831n; 95832n; 95833n; 95851n; 95852n; 97140y
95992Canalith RepositioningN36591n; 36592n; 92531n; 92532n; 97110y; 97112y; 97140y; 97530y
96105Assessment of AphasiaY36591n; 36592n; 96110y; 96125y; 96127n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; ; G0451y; G0505y
96110Developmental Testing, LimitedN36591n; 36592n;; 96125y; 96146n; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n
96112Developmental Test Administration; First HourY0362Tn; 0373Tn; 36591n; 36592n; 90791y; 90792y; 90832y; 90833y; 90834y; 90836y; 90837y; 90838y; 90839y; 90845y; 90846y; 90847y; 90849y; 90853y; 90865y; 90870y; 90880y; 92002y; 92004y; 92012y; 92014y; 96105y; 96110n; 96125y; 96127n; 96130y; 96131y; 96132n; 96133n; 96136n; 96137n; 96138n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97161y; 97162y; 97163y; 97164y; 97165y; 97166y; 97167y; 97168y; G0380y; G0381y; G0382y; G0383y; G0384y; G0406y; G0407y; G0408y; G0410y; G0411y; G0425y; G0426y; G0427y; G0451n; G0459n; G0463y; G0508y; G0509y; Check E&M Codes as well (99201 - 99497)
96113Developmental Test Administration; Each Additional 30 MinutesY0362Tn; 0373Tn; 36591n; 36592n; 90791y; 90792y; 90832y; 90833y; 90834y; 90836y; 90837y; 90838y; 90839y; 90845y; 90846y; 90847y; 90849y; 90853y; 90865y; 90870y; 90880y; 92002y; 92004y; 92012y; 92014y; 96110n; 96125y; 96127n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97161y; 97162y; 97163y; 97164y; 97165y; 97166y; 97167y; 97168y; G0380y; G0381y; G0382y; G0383y; G0384y; G0406y; G0407y; G0408y; G0410y; G0411y; G0425y; G0426y; G0427y; G0451n; G0459n; G0463y; G0508y; G0509y; Check E&M Codes as well (99201 - 99497)
96125Standardized Cognitive Performance TestingY36591n; 36592n;; 96127n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154; 97155n; 97156n; 97157n; 97158n
29581Multi-Layer Compression System - Below KneeN29540y; 29550y; 29580y; 97140y; 97535y
29584Multi-Layer Compression System - Entire ArmN29125y; 29126y; 29130y; 29131y; 97140y; 97535y
97012Mechanical TractionN96523n; 97018y; 97140y; 97164y; 97168y
G0281Electrical Stimulation - Stage 3-4 WoundsN96523n; 97032y; G0283y; 97164y; 97168y
G0283Electrical Stimulation - Other Than Wound CareN96523n; 97032y; 97164y; 97168y
97016Vasopneumatic DeviceN96523n; 97018y; 97026y; 97164y; 97168y
97018Paraffin BathN96523n; 97022y; 97164y; 97168y
97022WhirlpoolN96523n; 97164y; 97168y
97024DiathermyN96523n; 97018y; 97026y; 97164y; 97168y
97026InfraredN96523n; 97018y; 97022y; 97164y; 97168y
97028UltravioletN96523n; 97018y; 97022y; 97026y; 97164y; 97168y
97032Electrical Stimulation, ManualY96523n; 97164y; 97168y
97033IontophoresisY96523n; 97164y; 97168y
97034Contrast BathY96523n; 97164y; 97168y
97035UltrasoundY96523n; 97164y; 97168y
97036Hubbard TankY96523n; 97164y; 97168y
97039Unlisted ModalityY96523n; 97164y; 97168y
97110Therapeutic ExercisesY96523n; 97164y; 97168y
97112Neuromuscular Re-educationY96523n; 97022y; 97036y; 97164y; 97168y
97113Aquatic Therapy/ExercisesY96523n; 97022y; 97036n; 97110y; 97164y; 97168y
97116Gait TrainingY96523n; 97164y; 97168y
97124MassageY96523n; 97164y; 97168y
97127Therapeutic Interventions for Cognitive FunctionN96523n; 97155n; 97164y; 97168y; 0373n
97139Physical Medicine ProcedureY96523n; 97164y; 97168y
97140Manual TherapyY96523n; 95851y; 95852y; 97018y; 97124n; 97164y; 97168y; 97530y; 97750y
97150Group Therapeutic ProceduresN96523n; 97110y; 97112y; 97113y; 97116y; 97124y; 97127y; 97140y; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97164y; 97168y; 97530y; 97532y; 97533y; 97535y; 97537y; 97542y; 97760y; 97761y; 97763y; G0515y; 0373Tn
97151Behavior Identification AssessmentY0403Tn; 0488Tn; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96160y; 96161y; 96523n
97152Behavior Identification - Supporting AssessmentY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90889n; 96160y; 96161y; 96523n
97153Adaptive Behavior Treatment by ProtocolY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 92508n; 96523n; 97127n
97154Group Adaptive Behavior Treatment by ProtocolY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n; 97127n
97155Adaptive Behavior Treatment by Protocol ModificationY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n
97156Family Adaptive Behavior Treatment GuidanceY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n; 97127n
97157Multiple-Family Group Adaptive Behavior Treatment GuidanceY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n; 97127n
97158Group Adaptive Behavior Treatment by Protocol ModificationY0403Ty; 0488Ty; 36591n; 36592n; 90785y; 90791n; 90792n; 90832n; 90833y; 90834n; 90836y; 90837n; 90838y; 90839n; 90840y; 90845n; 90846n; 90847n; 90849n; 90853n; 90863y; 90865n; 90867; 90868n; 90869n; 90870n; 90875y; 90876y; 90880n; 90882n; 90885n; 90887n; 90889n; 92507n; 96523n; 97127n; 97150y
97161Physical Therapy Evaluation - Low ComplexityN95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97164n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97162Physical Therapy Evaluation - Moderate ComplexityN95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97161n; 97164n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97163Physical Therapy Evaluation - High ComplexityN95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96150n; 96130y; 96132y; 96136y; 96138y; 96146y; 96151n; 96152; 96153n; 96154n; 97161n; 97162n; 97164n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97164Physical Therapy Re-evaluationN95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97165Occupational Therapy Evaluation - Low ComplexityN95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97151n; 97152n; 97168n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97166Occupational Therapy Evaluation - Moderate ComplexityN95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97151n; 97152n; 97168n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97167Occupational Therapy Evaluation - High ComplexityN95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97151n; 97152n; 97168n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97168Occupational Therapy Re-evaluationN95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97151n; 97152n; 97168n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97530Therapeutic ActivitiesY95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96523n; 97113y; 97116y; 97127y; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97164y; 97168y; 97533y; 97535y; 97537y; 97542y; 97750y; G0515y; 0373Tn
97533Sensory IntegrationY96523n; 97164y; 97168y
97535Self Care/Home Management TrainingY96523n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97164y; 97168y; 0373Tn
97537Community/Work ReintegrationY96523n; 97164y; 97168y
97542Wheelchair Management - Assessment and TrainingY96523n; 97164y; 97168y
97545Work Hardening; First 2 HoursY96523n; 97140n; 97164y; 97168y
97597Wound Care Selective First 20 Square CentimetersN17250y; 29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280y; 29305y; 29325y; 29345y; 29355y; 29358y; 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29582y; 29583y; 29584y; 96523n; 97022y; 97164y; 97602n; 97605y; 97606y; 97607y; 97608y; 97610y, 99451n; 99452n; G0471y
97598Wound Care Selective; Each additional 20 Square Centimeters or Any Part ThereofN29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280y; 29305y; 29325y; 29345y; 29355y; 29358y; 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29582y; 29583y; 29584y; 96523n; 97022y; 97164y; 97602n; 97605y; 97606y; 97607y; 97608y; 97610y, G0471y
97602Wound Care Non-SelectiveN29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280y; 29305y; 29325y; 29345y; 29355y; 29358y; 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29582y; 29583y; 29584y; 96523n; 97164y; 97607n; 97608n
97605Negative Pressure Wound Therapy ≤ to 50 Square CentimetersN96523n; 97164y; 97607y; 97608n
97606Negative Pressure Wound Therapy ﹥50 Square CentimetersN96523n; 97164y; 97607n; 97608y
97610Low Frequency, Non-Contact, Non-Thermal UltrasoundN96523n; 97035y; 97602n; 97607y; 97608y
97750Physical Performance Test or MeasurementY95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96523n; 97150n
97755Assistive Technology AssessmentY96523n; 97035y; 97110y; 97112y; 97127y; 97140y; 97530y; 97532y; 97533y; 97535y; 97537y; 97542y; 97545y; 97750n; 97760y; 97761y; 97762n; 97763y;
97760Orthotic Management & Training, Initial Orthotic(s) EncounterY0213Ty; 0216Ty; 0228Ty; 0229Ty; 0230Ty; 0231Ty; 29044y; 29046y; 29049y; 29055y; 29058y; 29065y; 29075y; 29085y; 29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29582y; 29583y; 29584y; 96523n; 97016y; 97110y; 97112y; 97116y; 97124y; 97140y; 97164y; 97168y; 97762y; 97763n
97761Prosthetic Management & Training, Initial Prosthetic(s) EncounterY0213Ty; 0216Ty; 0228Ty; 0229Ty; 0230Ty; 96523n; 97016y; 97110y; 97112y; 97116y; 97124y; 97140y; 97164y; 97168y; 97760y; 97762y; 97763n
97763Orthotic/Prosthetic Management and/or Training, Subsequent Orthotic/Prosthetic Encounter(s)Y0213Ty; o216Ty; 0228Ty; 0229Ty; 0230Ty; 0231Ty; 29044y; 29046y; 29049y; 29055y; 29058y; 29065y; 29075y; 29085y; 29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280; 29305y; 29325y; 29345y; 29355y' 29358y; 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29584y; 96523n; 97016y; 97110y; 97112; 97116y; 97124y; 97140y
G0515Development of Cognitive SkillsY96523n; 97164y; 97168y

CPT Updates

Due to CPT changes on January 1, 2017, PTs and OTs can no longer use the following CPT codes when billing for initial evaluation and re-evaluation:

97001, 97002, 97003, and 97004

These four codes have been replaced by a set of eight evaluative codes – two for re-evaluation and six for evaluations.

The new codes for initial evaluation are tiered to designate the complexity of the evaluation.

Replacement CPT Codes for 97001

97161Physical therapy evaluation: low complexity
97162Physical therapy evaluation: moderate complexity
97163Physical therapy evaluation: high complexity

Replacement CPT Codes for 97003

97165Occupational therapy evaluation: low complexity
97166Occupational therapy evaluation: moderate complexity
97167Occupational therapy evaluation: high complexity

Replacement CPT Codes for 97002 and 97004

97164

Re-evaluation of physical therapy established plan of care requiring:

  1. An examination (including a review of history and use of standardized tests and measures)
  2. A revised plan of care (based on use of a standardized patient assessment instrument and/or measurable assessment of functional outcome)
97168

Re-evaluation of occupational therapy established plan of care requiring:

  1. An assessment of changes in patient functional or medical status, along with a revised plan of care
  2. An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals
  3. A revised plan of care (a formal re-evaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required)

If you need further explanation of the evaluation and re-evaluation codes, do not hesitate to contact your StrataPT account manager.

(Video) Physical Therapy Billing: The Rule of Eights

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FAQs

Is there a CPT code for physical therapy? ›

What is a CPT® code? The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency.

What CPT code is 97150? ›

CPT 97150 consists of all therapeutic services provided to a group of 2 or more people at the same time. These techniques may include water therapy, conditioning therapy, or exercise therapy with the constant presence of a doctor or licensed therapist, but not in individual contact with an individual patient.

What CPT codes Cannot be billed together? ›

The following CPT® codes may not be reported with 99439 in the same calendar month: 90951-90970, 99339, 99340, 99374, 99375, 99377, 99378, 99379, 99380, 99487, 99489, 99491, 99605, 99606, 99607.

Is 97110 a billable code? ›

CPT 97110: Therapeutic Procedure

Like many CPTs, it's billed in units of 15 minutes, using the eight-minute rule when necessary1. The eight-minute rule helps you count how many units of a time-based service you can bill for Medicare.

What is CPT code 90837 used for? ›

CPT® code 90837: Psychotherapy, 1 | American Medical Association.

Where can I get a list of CPT codes? ›

The Centers for Medicare & Medicaid Services offer a free search (CPT code lookup) for RVU for every CPT code. Users can also request a CPT/RVU Data File license from the AMA to easily import codes and descriptions into existing claims and medical billing systems.

Is CPT code 97140 physical therapy? ›

CPT® code 97140: Manual therapy techniques, 1 or more regions, each 15 minutes (Mobilization/manipulation, manual lymphatic drainage, manual traction)

What is the CPT code 97151? ›

Behavior identification assessment (97151) is used to report. initial assessments or reassessments and preparation of a plan. of care or report by the physician/other QHP. Code 97151 may. be reported for assessments required for treatment plans that.

What is CPT code G0283? ›

Most non-wound care electrical stimulation treatment provided as part of a therapy plan of care should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/assistive personnel) without constant, direct contact required throughout the treatment.

How do you maximize physical therapy billing? ›

6 Steps to Improve Your Physical Therapy Billing in 2022
  1. Step One: Pre-Collect Data. ...
  2. Step Two: Verify Details & Document. ...
  3. Step 3: Talk Benefits With Your Patient. ...
  4. Step 4: Have a Check In Process. ...
  5. Step 5: Make Following Up on Rejections a Priority. ...
  6. Step 6: Use a Trusted Billing Partner.
2 Nov 2021

What is a 59 modifier physical therapy? ›

Modifiers 59 or –XS are for surgical procedures, non-surgical therapeutic procedures, or diagnostic. procedures that: • Are performed at different anatomic sites, • Aren't ordinarily performed or encountered on the same day, and.

What modifiers do physical therapists use? ›

For physical therapists, use -GP, occupational therapists, use -GO, and speech language pathologists, use -GN. KX Modifier- Patients with Medicare insurance have a threshold for therapy services, and once the patient exceeds that threshold, Medicare does not usually reimburse for provided services.

Can you bill 3 units of 97110? ›

The Codes. Per Medicare rules, you could bill one of two ways: three units of 97110 (therapeutic exercise) and one unit of 97112 (neuromuscular reeducation), or. two units of 97110 and two units of 97112.

How do I bill CPT 97140? ›

For the timed manual therapy CPT code, the service has to be performed for a minimum of 8 minutes to bill one unit. Modifier 59 should be appended to 97140 to indicate that it is a distinct procedure and is performed at a different anatomic region than the chiropractic adjustment that day.

What is the difference between CPT 97530 and 97110? ›

Therapeutic exercise is billed as 97110 and Therapeutic activity is billed as 97530. Both are CPT codes that are commonly used in occupational and physical therapy billing. These codes are very similar and are often confused.

What is the difference between 90837 and 90834? ›

Both 90834 and 90837 are designed to bill for the same service – psychotherapy. The primary distinguishing factor between the two codes is time; 90834 is defined as 45 minutes of psychotherapy, while 90837 is defined as 60 minutes.

Who can bill CPT 90834? ›

CPT code 90834 doesn't have to be billed by a licensed medical doctor. It's mainly used by licensed mental health professionals. Typically, Licensed Clinical Social Workers, Licensed Professional Clinical Counselors, Licensed Marriage and Family Therapists, and Clinical Psychologists will bill CPT code 90834.

What does CPT code 90834 mean? ›

CPT® code 90834: Psychotherapy, 45 minutes | American Medical Association.

How do I choose a CPT code? ›

When choosing the correct CPT code, it must be backed up by medical necessity based on insurance guidelines. Use the Professional Edition of CPT coding book supplied by the American Medical Association for guidance. For instance, choosing the correct CPT code for an office visit is based on the complexity of the visit.

What CPT codes are most frequently used? ›

Category I is the most common and widely used set of codes within CPT. It describes most of the procedures performed by healthcare providers in inpatient and outpatient offices and hospitals. Category II codes are supplemental tracking codes used primarily for performance management.

What are the most common CPT codes? ›

Routine office visits (CPT codes 99213 & 99214) are the most common and heavily reimbursed of all physician procedures, numbering over 288 million with total Medicare payments of over $53.8 billion in 2021, according to Definitive Healthcare.

What is the difference between 97140 and 97124? ›

97124: Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion). 97140: Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.

Can 97162 and 97140 be billed together? ›

Yes. It's possible to bypass the edit by using the 59 modifier/X modifier when billing 97140 with the physical therapy evaluation codes (97161, 97162, or 97163). If you don't use the modifier for this combination of codes, CMS will deny the manual therapy code.

What can be billed under 97110? ›

CPT® code 97110: Therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes.

What is CPT code 0373T? ›

0373T. Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: • administered by the physician or other qualified health care professional who is on site, •

What is CPT code H0032? ›

2022 HCPCS Code H0032 : Mental health service plan development by non-physician. 2021/2022 Codes.

What does CPT code 95165 mean? ›

CPT procedure code 95165 is used to report multiple dose vials of non-venom antigens. Effective January 1, 2001, for CPT code 95165, a dose is now defined as a one- (1) cc aliquot from a single multidose vial.

What is CPT code S8948? ›

S8948: Application of a modality (requiring constant provider attendance) to one or more areas; low- level laser; each 15 minutes.

Is 97014 a physical therapy code? ›

CPT® 97014, Under Supervised Physical Medicine and Rehabilitation Modalities. The Current Procedural Terminology (CPT®) code 97014 as maintained by American Medical Association, is a medical procedural code under the range - Supervised Physical Medicine and Rehabilitation Modalities.

What is CPT code G2083? ›

HCPCS code G2083 for Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration ...

How does PT billing work? ›

How Does Therapy Billing Work?
  • A bill is submitted to the patient, third-party payer directly, or a 'claims clearinghouse' that prepares the bill.
  • The claims clearinghouse will submit the bill to the payer. ...
  • Copayments are collected at the time of service.
9 Mar 2015

How many therapy units is 40 minutes? ›

40 minutes total treatment time. The 40 total treatment time falls within the range for 3 units (see chart). In this instance, you would bill 2 units of 97110 and 1 unit of 97140. You count the first 30 minutes of 97110 as 2 full units.

How often can physical therapy evaluation be billed? ›

State PT/OT Acts

If a physical therapist assistant or physical therapy aide is involved in the patient care plan, a physical therapist shall reassess a patient every 60 days or 13 visits, whichever occurs first.

What modifier do I use for 97140? ›

The 97140 CPT code is appended with the modifier -59 or the appropriate -X modifier.

Can 97012 and 97140 be billed together? ›

True Blue. when I looked these up I get: 97012 is a manual traction code and 97140 is a manual therapy code. They consider these to be two modalities that are not possible for the same area in the same session. That is the mutually exclusive part.

Which modifier goes first 26 or 59? ›

Always add 26 before any other modifier. If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position.

Is PT modifier only for Medicare? ›

For Medicare only, the ASA code will change from 00812 to 00811, but the modifier PT is appended for all payors when a screening becomes diagnostic resulting in a procedure.

What is GY modifier? ›

The GY HCPCS modifier indicated that an item or service is statutorily non-covered or in not a Medicare benefit.

Does 97110 need a GP modifier? ›

Published by Sam on 04/16/2021 04/16/2021

Anthem has updated its professional reimbursement policy. This policy change requires that claims with physical medicine services 97010-97799 will require modifier GP. The modifier is required for dates of service after April 1, 2021.

Can you bill 97110 for 10 minutes? ›

You can bill 2 units of 97110 and 1 unit of 97140. You count the first 30 minutes of 97110 as 2 full units then add the additional 3 minutes of 97110 (33 minutes - 30 minutes) to code 97140 so you have 10 minutes of treatment time and can bill for 1 unit of 97140.

How many minutes is 4 units PT? ›

Guidelines for Medicare's 8-Minute Rule

8 to 22 minutes of treatment = 1 unit. 23 to 37 minutes of treatment = 2 units. 38 to 52 minutes of treatment = 3 units. 53 to 67 minutes of treatment = 4 units.

What is the 8-minute rule in physical therapy? ›

8-Minute Rule Basics

Basically, a therapist must provide direct, one-on-one therapy for at least eight minutes to receive reimbursement for one unit of a time-based treatment code.

What can be billed under manual therapy? ›

97140 Manual Therapy

Sessions that can be billed under this physical therapy CPT code can cover joint mobilization, soft tissue mobilization, muscle energy techniques, manual traction, and manual lymphatic drainage.

What does CPT code 97112 mean? ›

The definition of 97112: Therapeutic procedure, one or more areas, each 15 minutes – Neuromuscular Reeducation of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting and/or standing activities.

Can CPT 97110 and 97530 be billed together? ›

You will not be able to use a 59 modifier to charge 97530 with an initial evaluation. Note that you can continue to bill other timed codes, such as 97110, 97112 and 97140 with an initial evaluation. However, you will now be required to use a 59 modifier if you bill 97140 (manual therapy) with an initial evaluation.

Is CPT code 97530 physical therapy? ›

The CPT code 97530 is a therapeutic activity that covers a broad range of rehabilitative techniques involving movement of the entire body which may include such activities as bending, lifting, carrying, reaching, catching, transfers and overhead activities to improve functional performance in a progressive manner.

Is 97110 a PT or OT? ›

The 97110 CPT code describes therapeutic exercises that a patient participates in during an OT therapy session.

Can 97110 and 97112 be billed together? ›

You would need the mod-59 on 97112 so that they know it is a different 15-minute time period than the 97110, otherwise they will bundle the codes.

Is 97140 a physical therapy code? ›

CPT® code 97140: Manual therapy techniques, 1 or more regions, each 15 minutes (Mobilization/manipulation, manual lymphatic drainage, manual traction) As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care.

Is CPT code 97530 physical therapy? ›

The CPT code 97530 is a therapeutic activity that covers a broad range of rehabilitative techniques involving movement of the entire body which may include such activities as bending, lifting, carrying, reaching, catching, transfers and overhead activities to improve functional performance in a progressive manner.

What is the difference between 97140 and 97124? ›

97124: Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion). 97140: Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.

What is the ICD 10 code for physical therapy? ›

Z51. 89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2023 edition of ICD-10-CM Z51. 89 became effective on October 1, 2022.

How do I bill CPT 97140? ›

Medicare covers multiple manual therapy techniques with proper documentation. Manual therapy is reported using CPT code 97140. CPT code 97140 – Manual Therapy Techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, every 15 minutes.

Can 97162 and 97140 be billed together? ›

Yes. It's possible to bypass the edit by using the 59 modifier/X modifier when billing 97140 with the physical therapy evaluation codes (97161, 97162, or 97163). If you don't use the modifier for this combination of codes, CMS will deny the manual therapy code.

What modifier do you use for 97140? ›

The 97140 CPT code is appended with the modifier -59 or the appropriate -X modifier.

What is the difference between CPT 97110 and 97530? ›

Therapeutic exercise is billed as 97110 and Therapeutic activity is billed as 97530. Both are CPT codes that are commonly used in occupational and physical therapy billing. These codes are very similar and are often confused.

Is CPT code 97110 a physical therapist? ›

CPT® code 97110: Therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes.

Can CPT 97110 and 97530 be billed together? ›

You will not be able to use a 59 modifier to charge 97530 with an initial evaluation. Note that you can continue to bill other timed codes, such as 97110, 97112 and 97140 with an initial evaluation. However, you will now be required to use a 59 modifier if you bill 97140 (manual therapy) with an initial evaluation.

Can a physical therapist Bill 97124? ›

Therapeutic Massage

It's always important to check your state practice act, but in most cases, physical therapists can bill CPT code 97124 (massage therapy) when they provide therapeutic massage.

Can CPT code 97124 and 97140 be billed together? ›

It's important to note that you can never bill 96523 or 97124 with 97140, because these codes represent mutually exclusive procedures.

Is 97124 a physical therapy code? ›

CPT® 97124, Under Physical Medicine and Rehabilitation Therapeutic Procedures. The Current Procedural Terminology (CPT®) code 97124 as maintained by American Medical Association, is a medical procedural code under the range - Physical Medicine and Rehabilitation Therapeutic Procedures.

Can physical therapists assign ICD-10 codes? ›

The International Classification of Disease, 10th Revision (ICD-10) is a set of diagnosis, symptom, and procedure codes that physical therapists use daily in their practice.

Can physical therapist use Z codes? ›

However, if you're providing surgical aftercare, Z-codes are perfectly appropriate. For example, you could use Z51. 89, encounter for other specified aftercare, or Z47. 1, aftercare following joint replacement surgery.

What does CPT code 97162 mean? ›

97162 - Physical therapy evaluation: moderate complexity, requiring these components: • A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of. care; • An examination of body systems using standardized tests and measures in addressing a total of 3 or.

Videos

1. Appropriate Use of CPT code 97164 - Physical Therapy Re-Evaluation
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2. How to Bill for Physical Therapy After An Auto Vehicle Accident / Personal Injury
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3. Physical Therapy Medicare Overpayment CPT Codes CERT
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4. Physical Therapy Evaluation plus 4 Units of Direct 1 to 1 Treatment in 60 minutes
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5. CPT Codes for Physical Therapy Billing - 24/7 Medical Billing Services
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6. Medicare Guidelines for Billing Therapeutic Exercise 97110 PT, OT in 2020
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