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The Ultimate Guide to Physical Therapy CPT Codes

Understanding Physical Therapy CPT Codes can seem like deciphering an intricate puzzle. With their unique combinations of numbers and letters, they play a critical role in the physical therapy (PT) landscape, particularly in billing and documentation. In this comprehensive guide, we'll unravel the complexities of these codes, helping you become well-versed in their usage, significance, and intricacies.

Thumbnail CPT Codes

What are CPT Codes?

Current Procedural Terminology (CPT) codes serve as a universal language in the healthcare industry. Created and maintained by the American Medical Association, these codes are used to classify various medical, surgical, and diagnostic services and procedures. In the world of PT, CPT codes provide a standardized method of documenting and billing for services rendered during patient care.

CPT Code fields on CMS-1500 form
CMS-1500 form location of CPT Codes

The Most Common Physical Therapy CPT Codes

While there are hundreds of CPT codes, only a select few are frequently used in the realm of physical therapy. These codes, which range from evaluations to specific therapeutic procedures, are essential for PTs to accurately document patient care and receive appropriate reimbursement.

Evaluation Codes

Physical therapy begins with an evaluation, which sets the stage for the treatment plan. The complexity of the evaluation determines which of the following codes is used:

  • 97161: Physical therapy evaluation, low complexity

  • 97162: Physical therapy evaluation, moderate complexity

  • 97163: Physical therapy evaluation, high complexity

  • 97164: Physical therapy re-evaluation

When should I bill for an evaluation vs. a re-evaluation?

A common question among PTs is when to bill for an evaluation versus a re-evaluation. An evaluation is typically billed at the onset of care or when a new diagnosis is identified. A re-evaluation, on the other hand, is billed when there's a significant improvement, decline, or change in the patient's condition or treatment plan.

Should I bill for a re-evaluation each time I complete a progress note?

No. While progress notes are important for tracking a patient's progress, billing for a re-evaluation should only be done when there's a substantial change in the patient's status or treatment plan.

Treatment Codes

Following the evaluation, the PT will perform a variety of services or treatments, each with its corresponding CPT code. Here are some of the most commonly used codes:

97110: Therapeutic Exercise

CPT Code 97110 is any type of exercise that develops strength and endurance in one or more areas. The exercises also help with range of motion and flexibility. They get billed in 15-minute increments following the 8-minute rule. A physical therapist cannot bill for this physical therapy cpt code until the service lasts for at least 8 minutes. They can only bill for a single unit unless they provide the service through 22 minutes.

This cpt code for physical therapy requires direct contact time with the patient. This code often gets confused with therapeutic activity, but there is a significant difference between the two on the billing side. Therapeutic activity receives a higher average reimbursement rate from insurance companies compared to therapeutic exercise. The reimbursement difference is due to skill. Therapeutic exercise usually requires less skill compared to therapeutic activities or neuromuscular re-education. Insurance companies view therapeutic exercise as requiring less effort and skill, so it deserves less compensation.

97112: Neuromuscular Re-Education

Neuromuscular re-education involves exercises aimed at restoring function by retraining the brain in muscle control. These activities essentially facilitate communication between the brain and muscles, guiding them on how to function and move effectively. Billing for these activities is typically done in 15-minute units, following the 8-minute rule. The primary goal of neuromuscular re-education is to enhance posture, movement, balance, coordination, and kinesthetic sense, and it also encompasses proprioception for both sitting and standing activities.

Time spent on the following also counts as relevant activities for this code…

  • Kinesiotaping

  • Performing stabilization exercises

  • Ergonomic training

  • Facilitation or inhibition

  • Desensitizing the muscles

  • Improving motor control

  • Plyometrics

97116: Gait Training

Gait training encompasses a series of exercises specifically crafted to assist a patient in standing and walking. The primary objective is to fortify the muscles and joints in the individual's legs, enhance their balance and posture, and bolster their stamina. Additionally, the aim is to refine muscle memory and recondition leg movements through repetitive actions.Common reasons people need gait training include…

  • Broken leg

  • Broken pelvis

  • Joint replacement

  • Stroke

  • Neurological disorders

  • Musculoskeletal disorders

  • Spinal cord injuries

These types of exercises often use machines that specifically help the person walk safely. The machines help support body weight, provide stability, and other forms of assistance while someone learns to develop strength and balance. Physical therapists also have their patients use strength-building machines, ellipticals, and treadmills to target this kind of training. They may also use a harness to help with balance while the patient relearns movements of walking. Walking over objects, lifting legs, sitting down/getting back up, or other activities can all help train the muscles to increase mobility.

97140: Manual Therapy

Manual therapy is described as "hands-on mobilization involving direct interaction with the patient, carried out by a licensed physical therapist (PT) or supervised assistant." The primary goal is to improve joint and soft tissue mobility, decrease joint contracture, and enhance muscle energy. Therapists achieve this by administering resistance and pressure. Consequently, the scope encompasses activities categorized as "manual resistance exercise," aimed at enhancing muscle strength and endurance to boost overall muscle energy.

97150: Group Therapy

The term "group" pertains to providing therapy to two or more patients concurrently, excluding individual sessions. The patients may or may not engage in the same exercises simultaneously. These sessions can take place in diverse environments, such as a gym or a pool. Due to the involvement of multiple patients, this form of treatment necessitates continuous supervision from the physical therapist or their assistant.

97530: Therapeutic Activities

The code provided in this section includes services that involve direct contact with the patient. These activities aim to enhance the functional performance of muscles, ligaments, and other body tissues. The exercises are referred to as "dynamic" because they require the patient to practice movements that involve strength, balance, and flexibility. The repetitive nature of these movements aids in muscle memory, ensuring that patients can safely perform the exercises outside of therapy.

These training exercises necessitate the expertise of a highly skilled physical therapist. The therapist must be capable of correcting and guiding the patient's movements to prevent injuries and help them master the proper techniques.

97016: Vasopneumatic Devices

Vasopneumatic devices are a type of therapeutic equipment used in physical therapy. These devices apply pressure to the limbs, helping to improve circulation and reduce swelling. They are commonly used in the treatment of conditions such as lymphedema and venous insufficiency. The pressure can be adjusted based on the patient's needs, and the therapy can be administered in conjunction with other treatments to maximize the benefits.

97032: Electrical Stimulation

Electrical stimulation is a widely used modality in physical therapy. It involves the application of electrical currents to stimulate nerves and muscles, promoting pain relief, muscle contraction, and tissue healing. This non-invasive technique can be used to treat various conditions, such as muscle weakness, nerve damage, and chronic pain. The intensity and frequency of the electrical currents can be adjusted based on the patient's needs and response to treatment.

Timed vs. Untimed Codes

In the world of PT billing, codes can be classified as timed or untimed. Timed codes correspond to services that are billed based on the amount of time spent with the patient, typically in 15-minute increments. Untimed codes, on the other hand, denote services that can be billed only once per session, regardless of the length of time spent on the service.

Physical Therapy Modifiers

Modifiers play an essential role in PT CPT coding. They provide additional information about the service or procedure performed, allowing for more accurate billing. For example, Modifier 59 indicates that a service or procedure was distinct or separate from other services performed during the same session.

Modifier fields on CMS-1500 form
CMS-1500 form modifier fields

Modifier 59

Modifier 59 signifies that a distinct service or procedure was performed separately from another non-evaluation and management service. It's vital in ensuring that both services comply with the National Correct Coding Initiative.

GP Modifier

The GP modifier is used to indicate that a PT's services were provided, often used in inpatient and outpatient multidisciplinary settings.

KX Modifier

The KX modifier is used when services provided to a patient exceed Medicare’s $2,010 threshold. This modifier ensures that continued treatment is justified with appropriate documentation in the patient's medical record.

XE Modifier

Modifier XE indicates a service was distinct because it occurred during a separate encounter.

XP Modifier

This modifier indicates a service was distinct because it was performed by a different practitioner.

RTM Codes

Remote Therapeutic Monitoring (RTM) codes are a new addition to the PT CPT coding landscape. These codes enable PTs to bill for remote patient monitoring services, reflecting the evolving nature of patient care in the digital age.

98975 - Initial Setup and Patient Education

Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment. Billing Frequency: Billed once at the start of an episode

98976 - Monthly Data Transmission and Supply of Device for Monitoring– Respiratory System

Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days. Billing Frequency: Can be billed once every 30 days

98977 - Monthly Data Transmission and Supply of Device for Monitoring— Musculoskeletal System

Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days. Billing Frequency: Can be billed once every 30 days

98980 - Monitoring/Treatment Management Services, First 20 Minutes

Remote therapeutic monitoring treatment management services, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes. Billing Frequency: Can be billed every calendar month

Reimbursement for Physical Therapy CPT Codes

Based on the 2024 Medicare fee schedule for outpatient physical therapy services the following represents the 2024 Physical Therapy Reimbursement Rates.

Reimbursement for CPT Code 97110: Therapeutic Exercises

Therapeutic exercises $28.82 (2024)

Reimbursement for CPT Code 97112: Neuromuscular Reeducation

Neuromuscular reeducation $33.07 (2024)

Reimbursement for CPT Code 97140: Manual Therapy

Manual therapy $28.82 (2024)

Reimbursement for CPT Code 97530: Therapeutic Activities

Therapeutic activities $36.02 (2024)

Reimbursement for CPT Code 97116: Gait Training

Gait training $28.82 (2024)

Reimbursement for CPT Code 97150: Group Therapeutic Procedures

Group therapeutic $17.68 (2024)

Reimbursement for CPT Code 97161: PT Eval Low Complexity

PT eval low complex $98.56 (2024)

Reimbursement for CPT Code 971612: PT Eval Moderate Complexity

PT eval moderate complex $98.56 (2024)

Reimbursement for CPT Code 97163: PT Eval High Complexity

PT eval high complex $98.56 (2024)

Reimbursement for CPT Code 97164: PT Re-eval Establish Plan of Care

PT re-eval $68.44 (2024)


Mastering Physical Therapy CPT Codes is crucial for PTs to ensure accurate documentation and appropriate reimbursement. While it may seem daunting at first, a solid understanding of these codes can streamline the billing process, improve communication with insurance providers, and ultimately lead to more efficient and effective patient care. Remember, the key to successful PT billing lies in the details – accurate coding, thorough documentation, and consistent tracking of services rendered.

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