Decoding Physical Therapy CPT Codes
Every year, U.S healthcare insurers process over 5 billion claims for payment. Learn how physical therapy CPT codes keep the process of billing simplified, organized, and accurate.
What are Physical Therapy CPT codes?
CPT (Current Procedural Technology) codes, also known as “service codes,” are used to indicate any medical, surgical, or diagnostic treatments or procedures offered by a healthcare provider.
These codes were originally used to codify different types of surgeries, but their use was later expanded to include medical services. They usually consist of five digits, or sometimes, four digits and one letter, creating uniformity in tracking services.
Developed by the American Medical Association (AMA), CPT codes range from from 00100 to 99499, and they are updated annually. These codes are flexible, however, and are often revised, so each number within the aforementioned range does not correspond to a specific code.
Physical therapy CPT codes are often used in tandem with ICD (Internal Classification of Disease) codes to detail what form of treatment will be used based on a patient’s condition or diagnoses. A valid physical therapy CPT code indicating a form of treatment, service, or procedure must be paired with a ICD diagnosis code. There are, however, multiple CPT codes per ICD code. Regardless, if the two codes don’t correspond, therapists will have trouble being reimbursed.
For example, ICD-10 code G56.0, the diagnosis for carpal tunnel syndrome, is used in conjunction with CPT code 80329, meaning the patient is being treated with ibuprofen. Carpal tunnel syndrome can, however, also be treated with nerve-repairing surgery (64721) or stretching (97110).
Physical therapy CPT codes assist in the process of billing by easily classifying and identifying services offered. Depending on payer agreements, this will indicate how much reimbursement a therapist will receive from an insurer and how much a patient has to pay. The reimbursed amount differs depending upon the type of procedure, treatment provided, payer or plan.
CPT codes used by physical therapists also provide valuable data and serve as performance indicators. Government agencies use them to track how often different treatments are administered or the frequency of certain procedures; healthcare providers use them to determine how adept their staff is at providing the correct solution to a broad range of medical conditions.
How Physical Therapy CPT codes are categorized
There are three categories of CPT codes: CPT I, CPT II, and CPT III. Let’s take a look at each category.
These are the most common and widely used CPT codes. CPT I codes consist of five digits and are updated once per year.
Category One codes detail the majority of services procedures performed by healthcare providers in both inpatient and outpatient offices as well as hospitals, ranging anywhere from surgeries and devices to drugs and vaccines.
CPT I codes are divided into 6 sections and are grouped, with the exception of Evaluation and Management, numerically. Here are the different Category One codes:
Evaluation and Management: 99201 – 99499
Anesthesia: 00100 – 01999; 99100 – 99140
Surgery: 10021 – 69990
Radiology: 70010 – 79999
Pathology and Laboratory: 80047 – 89398
Medicine: 90281 – 99199; 99500 – 99607.
There are subgroups within these sections that indicate the type of procedure or what part of the body that procedure relates to. For example, Radiology is categorized by type—ultrasound radiation, bone and joint studies, etc. The largest section, Surgery, is organized according to the body part(s) the surgery is meant to be performed on.
Each section also has guidelines on use. For example, Surgery has a section on how to report extra materials used or how to report follow-up care.
Several CPT codes are arranged by indentation. It’s very likely that you will see one code indented below another, indicating that the indented code represents a variation of the procedure described above it.
For example, in the CPT codebook, code 20200 has the description “biopsy, muscle; superficial.” Indented below it is code 20205, which reads, “biopsy, muscle; deep.” The semicolon serves to distinguish the two similar procedures, formally known as the parent code (20200) and child code (20205).
These are supplemental performance tracking codes; these codes are also optional and not used for billing. Physical therapy CPT II codes have four digits followed by the letter F and are updated three times per year.
Category Two codes reduce administrative tasks by tracking a patient’s health record, such as tobacco use, cholesterol results, or recommended courses of care. Collecting such information allows healthcare providers to improve performance and quality of care and, as a result, provide better outcomes for patients.
There are ten types of CPT II codes, all of which are arranged numerically. Here are the different Category Two Codes:
Composite Measures (0001F – 0015F)
Patient Management (0500F – 0584F)
Patient History (1000F – 1505F)
Physical Examination (2000F – 2060F)
Diagnostic/Screening Processes or Results (3006F – 3776F)
Therapeutic, Preventive, or Other Interventions (4000F – 4563F)
Follow-up or Other Outcomes (5005F – 5250F)
Patient Safety (6005F – 6150F)
Structural Measures (7010F – 7025F)
Non Measure Code Listing (9001F – 9007F)
These codes are temporary codes that describe new and experimental technologies, services, and procedures; these codes can also be used for billing. Physical Therapy CPT III codes consist of four digits followed by the letter T and are updated twice a year.
(For example, 0054T: Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images.)
Category Three codes are primarily used to gather data for FDA approval or indicate widespread usage that would turn the code into a permanent Category One code.
After a period of five years, these codes either become a Category One code, get rejected, or reapply for Category Three status. Services and procedures must receive FDA approval before they can be assigned a Category One Code.
Now that we’ve reviewed what CPT codes are and how they’re categorized, let’s get to the more important question: how do these codes apply to physical therapy?
Physical Therapy CPT codes are necessary for therapists to code treatment in EHRs
Physical Therapy CPT Codes
Physical therapy CPT codes essentially say, “This is what I did to help my patient. Please reimburse me accordingly.” Therapists must make sure that they choose the correct CPT code and that it corresponds with a designated ICD code.
In order to make sure payment is received, documentation supporting the codes billed out should be entered into an evaluation, daily note or flowsheet. This flowsheet should detail four things: services performed, duration of service (how long), extent of service (format, meaning sets or repetition), and other supporting documentation.
There are two types of physical therapy CPT codes:
These codes include pre-treatment, treatment, and post-treatment time. One unit—the number of times a service is performed—is billed for the first 15 minutes of treatment. More units can be billed as the duration of the treatment continues, but treatment may not fit into 15 minutes segments; therefore, therapists must abide by the “8-Minute Rule,” meaning 8 minutes must be spent performing a service before one unit can be billed.
To calculate the total number of units, add up the total amount of time spent and divide by 15. If the remainder is more than 8, you can bill an additional unit; if it’s 7 or less, you can only bill for the minimum number of units.
These codes are usually billed once per day but can be billed more than once if the purpose or area of treatment changes.
If need be, these codes can be modified with two digits to give a more accurate description of the procedure. Some examples of modifiers are Modifiers 59, XE, XP, XS, XU, and KX. A guide on how to use these modifiers can be found here.
Physical therapy evaluation CPT codes—low-complexity (97161), moderate-complexity (97162), and high-complexity (97163)—reflect patient presentation, how a patient displays signs of illness or disease before examination by a medical professional. Developed in 2017, these three codes replaced the old 97001 evaluation code.
Most Common PT CPT Codes
The three most common types of physical therapy CPT codes are therapeutic exercise (97110), neuromuscular re-education (97112), and gait training (97116). Here is a list and description of 10 commonly-used codes:
97110, Therapeutic Exercise: exercises for strengthening, ROM, endurance, and flexibility; must be direct contact time with the patient
97112, Neuromuscular Re-Education: activities that facilitate the re-education of movement, balance, posture, coordination, and kinesthetic sense
97116, Gait Training: sequences and training using a modified weight-bearing status, which employ assistive devices, and completing turns with proper form
97140, Manual Therapy: soft tissue mobilization, joint mobilization, manipulation, manual traction, muscle energy techniques, and manual lymphatic drainage
97150, Group Therapy: the physical therapist provides a therapeutic procedure to two or more patients at the same time in a land or aquatic setting
97530, Therapeutic Activities: any dynamic activities that are designed to improve functional performance
97535, Self-Care/Home Management Training: includes a variety of techniques including ADL training, compensatory training, safety procedures/instructions, meal preparation, use of assistive technology devices or adaptive equipment
97750, Physical Performance Test or Measurement: includes tests determining function of one or more body areas or measuring an aspect of physical performance including a functional capacity evaluation
97761, Prosthetic Training: includes fitting and training in the use of prosthetic devices as well as an assessment of the appropriate device
97762, Checkout for Orthotic/Prosthetic Use: includes evaluation of the effectiveness of an existing orthotic or prosthetic device and recommendation for change
Other Common PT CPT Codes
97010 Hot/Cold Packs
97014 Electrical Stimulation (Unattended)
G0283 Electrical Stimulation, Medicare Non-Wound (Unattended)
97161 PT Evaluation: Low Complexity
97162 PT Evaluation: Moderate Complexity
97016 Vasopneumatic Device
92507 SLP Treatment; Individual
97032 Electrical Stimulation (Manual)
97164 PT Re-Evaluation
97012 Mechanical Traction
97113 Aquatic Therapy/Exercise
97124 Massage Therapy
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