Physical therapy CPT codes
Physical therapy CPT codes are probably ‘not’ what drew you to PT. The opportunity to help people and a love for the resilience of the human body were probably motivators for you to practice in the profession. While treating may be your favorite part of being a PT, whether you are a solo practice owner, an employee of a physical therapy practice or a manager at a multi-therapist clinic, at some point you must learn the ins and outs of physical therapy CPT codes if you expect to bill insurance and get paid.
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CPT stands for current procedural terminology codes. Physical therapy CPT codes are utilized to describe the services rendered when submitting a claim to a third-party payer. A therapist will select physical therapy CPT codes based on the type of interventions they used and for the amount of time they administered that intervention. These codes provide healthcare providers a uniform language of coding for medical services and procedures.
Common physical therapy CPT codes
CPT Code | Name | Descriptor |
|---|---|---|
Therapeutic exercise | Timed code. Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength, ROM, endurance, and flexibility and must be direct contact time with the patient. | |
Neuromuscular re-education | Timed code. Therapeutic procedure, one or more areas, each 15 minutes; activities that facilitate movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities. Therapeutic taping or other inhibition/facilitation techniques fit in this category. | |
Gait training | Skilled improvement of gait, including stair training. Focuses on the biomechanics of gait. Walking exercises to improve endurance or cardiovascular health would not go in this category. | |
Manual therapy | Timed code. Skilled hand movements and passive movements of the joints and soft tissue intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling. Includes soft tissue mobilization, joint mobilization, manipulation, manual traction, muscle energy techniques (performed using resistance applied by PT), and manual lymphatic drainage. PROM is not manual therapy. | |
Therapeutic activity | Timed code. Dynamic activities used to promote improved function. Typically utilize multiple parameters such as strength, range of motion, motor control, balance, endurance, etc. Sit to stands, transfers, bed mobility or sport-specific training may fall in this category. | |
Self-care/Home management training | Instruction on compensatory training and in use of adaptive equipment, on ADLs, meal prep and safety procedures. Can also include instruction on wound care, use of a home TENS or electrical stimulation unit, strategies for edema control, advice on sleeping positions, and even transfer training. As long as you are addressing basic ADLs in your plan of care (eating, bathing, dressing, toileting, transferring and continence) you can bill this code. Instruction in a home exercise program should be billed under Therapeutic Exercise. | |
97750 | Physical performance test or measurement | Used to bill for functional capacity exams, isokinetic testing and some specific tests and measures related to balance like the Timed Up and Go. This is a timed code and it is not medically reasonable and necessary to bill this service as part of a routine assessment/evaluation of rehabilitation services |
PT history includes no comorbidities or personal factors impacting the plan of care. Plan of care addresses 1-2 elements of body structure/function, activity and/or participation restrictions. The clinical presentation is stable. Untimed Code. | ||
PT history includes 1-2 comorbidities or personal factors impacting the plan of care. Plan of care addresses 3 or more elements of body structure/function, activity and/or participation restrictions. The clinical presentation is evolving. Untimed Code. | ||
PT history includes 3 or more comorbidities or personal factors impacting the plan of care. Plan of care addresses 4 or more elements of body structure/function, activity and/or participation restrictions. The clinical presentation is unstable. Untimed Code. | ||
97164 | Physical therapy re-evaluation | Requires an examination and a revised plan of care. |
Most physical therapy billing codes are described in terms of 15-minute units of service. It is critical to review your payer policy to determine how to bill for timed units. If they utilize the 8-Minute Rule for billing outlined by Medicare then at least at least 8 minutes of a single intervention must be administered to bill for one CPT unit, 23 minutes for 2 units of that service, 38 minutes for 3 units and 53 minutes for 4 units of that service.
Alternatively, on page XVII of the 2021 CPT manual under the section entitled time, guidance is provided for billing a single unit of timed service once you have passed the midpoint of a 15-minute block. In other words if 7 minutes and 30 seconds of service has been provided then you can bill for one timed unit and it does not stipulate that you must add a certain number of minutes to bill more than one unit.
All physical therapy CPT codes are five digits and are either numeric or alphanumeric. Most of the physical therapy CPT coding falls into the 97000 series called Physical Medicine and Rehabilitation. It is important, however, to be familiar with relevant codes outside of this series because a provider can use any of the physical therapy CPT codes as long as it accurately describes the services provided and is allowed under their state licensure laws.
Physical therapy CPT codes are often undergoing revisions both on the editorial side and the value side so it is important to reference timely physical therapy CPT codes resources such as the American Medical Association, which actually owns the copyright of the physical therapy CPT codes. Additionally, it is important to understand that while a provider may be allowed to utilize certain physical therapy CPT codes, it may or may not be reimbursed by a given payer depending on their individual payment policy.
Physical therapy CPT code billing
Physical therapy CPT codes are an important part of the billing process. After providing a service, documenting and signing the treatment note, and selecting the appropriate physical therapy CPT codes, a bill will be submitted to the patient, a third party payer or to a claims clearinghouse that will act as a middleman between the therapist or business and the payer.
When submitting physical therapy CPT codes for billing, it is important to be aware of several modifier codes that may be necessary to include.
- Modifier 59: According to the CMS website, the CPT manual defines Modifier 59 as follows: “Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances … Modifier 59 is used appropriately for two services described by timed codes provided during the same encounter only when they are performed sequentially. There is an appropriate use for Modifier 59 that is applicable only to codes for which the unit of service is a measure of time (e.g., per 15 minutes, per hour). If two timed services are provided in blocks of time that are separate and distinct (i.e., the same time block is not used to determine the unit of service for both codes), Modifier 59 may be used to identify the services.”
Examples:
- 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.”
- Modifiers XE, XS, XP, XU: Effective January 1, 2015, these modifiers were developed to provide greater reporting specificity in situations where Modifier 59 was previously reported and may be utilized in lieu of Modifier 59 whenever possible. These codes are used to indicate a separate encounter (XE), separate structure (XS), separate practitioner (XP), and unusual, non-overlapping service (XU).
- Modifier GP: When submitting an outpatient physical therapy claim it must include the modifier GP which indicates that these services were provided under a physical therapy plan of care.
- KX Modifier: As of 2018 the Medicare physical therapy cap acts as a threshold after which a physical therapist continuing to provide service to a patient must attach a KX Modifier to their billing to indicate medically necessary services. Documentation must justify that continued services are medically necessary. As of 2021, a KX modifier must be applied as soon as incurred expenses exceed $2,110 for physical therapy and speech therapy services combined.
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While paper claims are still available and in use, most providers are moving toward electronic claims forms. The Universal Claim form CMS-1500 is the most common but payers may also provide their own forms.
Electronic claims are submitted to the payer or to the claims clearinghouse. These claims are covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and are required to meet certain standards. When submitting a claim it is important to review the information to ensure it is “clean.” A clean claim, whether paper or electronic means that it is accurate, complete, and legible (if a paper claim).
While this information has hopefully helped make you feel more comfortable with physical therapy CPT codes and billing for your practice, there is still a lot to learn and a lot on the line if coding and billing are done incorrectly.
How EHR and practice management software can save you time with insurance billing for therapists
EHR with integrated billing software and a clearing house, such as TheraPlatform offers significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to creating, sending and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform a series of tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again or skip this all together by enabling auto credit card charge.
- Automated claim creation and submission: Batch multiple claims with one click of a button or turn auto claim creation and submission on.
- Live claim validation: The system goes over each claim to catch any human errors before submitting, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA all the payments from them will be automatically posted on TheraPlatform’s EHR.
- Tracking: Track payment and profits including aging invoices, overdue invoices, transactions, billed services, service providers.
Utilizing billing software integrated with an EHR and practice management software can make the storage and sharing of billing and insurance an easy decision and can save providers time when it comes to insurance billing for therapists.
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Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including physical therapists in group and solo practices.
More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Insurance billing 101
- Practice management tools
