How to Accurately Use Physical Therapy CPT Codes: Tips and Best Practices

Whether you’re fresh out of school or have been practicing for years, understanding physical therapy CPT codes is one of the most important skills you can master. Current procedural terminology (CPT) codes are five-digit numeric codes representing medical procedures or services provided by healthcare professionals, including physical therapists. Developed by the American Medical Association, these codes create a uniform language that accurately describes treatments, making communication with insurance companies efficient.

For physical therapists, the CPT code set includes codes for evaluations, therapeutic exercises, manual therapy, modalities, and other treatment procedures. Each procedure or service you provide during a session is linked to a corresponding CPT code, allowing the payer (e.g., Medicare or private insurance) to understand and reimburse appropriately.

In this guide, we’ll break down the basics, discussing when and how to use these codes, and providing best practices to help you confidently navigate the world of physical therapy billing and reimbursement.

Why accurate CPT coding matters

For a new graduate stepping into practice, the complexity of physical therapy CPT codes can seem overwhelming, but mastering them is essential for maintaining compliance and securing proper reimbursement. For seasoned professionals who have already cracked the code, staying updated on the latest changes and best practices is just as crucial for maximizing reimbursements and avoiding errors.

Regardless of where you are in your career, understanding CPT codes helps ensure that your services are communicated clearly and reimbursed correctly by insurance providers. Using the correct codes will help you with:

• Compliance: Accurate coding is necessary for compliance with federal laws and payer guidelines. Incorrect or fraudulent coding can lead to penalties, audits, or other legal consequences.
• Documentation: CPT codes are part of a broader system that links your documentation to the services you’ve provided, creating a clear and transparent record of the treatment process. This helps establish trust with payers and supports better continuity of care for your patients.
• Billing and reimbursement: The main purpose of CPT codes is to communicate with payers to ensure accurate reimbursement. Coding errors can lead to denied claims or underpayment, affecting your practice’s financial health. Understanding how payers determine the value of CPT codes is essential for ensuring that the services you provide are appropriately compensated. Watch the video below for a brief overview of this process.

How and when to use physical therapy CPT codes

Knowing how and when to use CPT codes is critical to running a compliant and efficient practice. Each treatment or service provided during a physical therapy session should have a corresponding code to ensure proper billing.

Evaluation codes

At the start of a new patient case, you’ll need to choose the correct evaluation code. In physical therapy, evaluation codes are based on the complexity of the patient’s case. The three levels of evaluation are:

• Code 97161: Low complexity evaluation
• Code 97162: Moderate complexity evaluation
• Code 97163: High complexity evaluation

These codes take into account factors such as the patient’s history, clinical presentation, and the number of treatment options considered.

Treatment codes

Once the evaluation is complete, the actual treatment codes come into play. These codes describe the services performed, such as therapeutic exercises, neuromuscular re-education, or manual therapy. Common treatment physical therapy CPT codes include:

• Code 97110: Therapeutic exercise
• Code 97112: Neuromuscular re-education
• Code 97140: Manual therapy
• Code 97035: Ultrasound therapy
• Code 97014: Electrical stimulation

Timed vs. untimed codes

One critical aspect of physical therapy CPT codes is the distinction between timed and untimed codes.

• Timed codes are used for services billed in increments of 15 minutes, such as code 97110 (therapeutic exercise) or code 97112 (neuromuscular re-education). You must track how much time you spend on each service to calculate the appropriate billing. For example, if you spent 25 minutes on therapeutic exercises, you would bill two units for code 97110.
• Untimed codes, such as code 97014 (electrical stimulation), are billed once regardless of how long the service was performed during the session. Whether the treatment lasts 5 minutes or 20 minutes, you only bill for one unit, ensuring simplicity in these cases.

The 8-Minute Rule

Medicare and some other payers follow the 8-Minute Rule for timed CPT codes. This rule allows you to bill for a timed code if you spend at least 8 minutes on the service. The formula for billing units looks like this:

• 8–22 minutes: 1 unit
• 23–37 minutes: 2 units
• 38–52 minutes: 3 units
• 53–67 minutes: 4 units

To comply with this rule, it’s essential to accurately track the time spent on each service to bill the correct number of units. For example, if you perform manual therapy for 15 minutes and ultrasound for 8 minutes, you would bill two units—one for code 97140 and one for code 97035.

Common physical therapy CPT codes

While physical therapy practices may vary, several CPT codes are frequently used across most settings. Here are some of the most common ones you’ll likely encounter:

• Code 97110 – Therapeutic exercise: Use this code when providing exercises aimed at improving strength, range of motion, endurance, or flexibility. For example, prescribing resistance band exercises or stretching routines to help a patient regain shoulder mobility after surgery would fall under this code.
• Code 97112 – Neuromuscular re-education: This code is for techniques that enhance balance, coordination, posture, and proprioception. You might use code 97112 when helping a patient recover motor control following a stroke by practicing balance drills on a wobble board.
• Code 97140 – Manual therapy: Use this code for hands-on treatments like joint mobilization, myofascial release, or soft tissue mobilization. For instance, performing deep tissue massage on a patient with chronic neck pain would be an appropriate use of this code.
• Code 97530 – Therapeutic activities: This code covers dynamic activities designed to improve functional performance. You could use code 97530 when working with a patient on bed mobility or simulating daily tasks like lifting and carrying objects to enhance their ability to perform these activities independently.
• Code 97035 – Ultrasound therapy: Ultrasound is used for deep tissue heating, improving circulation, and reducing pain. Apply code 97035 when using ultrasound to target a patient’s lower back to improve relaxation and reduce muscle tension.
• Code G0283 – Electrical stimulation (unattended): This code is used when delivering electrical stimulation without the need for constant supervision. For example, using a TENS unit for pain management during a session would fit under this code.

Each of these codes is linked to specific treatments that are vital in most physical therapy practices. Correctly choosing and documenting them is key to getting reimbursed appropriately.

Best practices for using physical therapy CPT codes

1. Maintain detailed documentation

Always ensure that your treatment notes clearly justify the services you provided. Payers may request detailed documentation, and this must align with the codes you use. For example, if you bill 97112 for neuromuscular re-education, your notes should describe why this service was necessary, such as addressing balance deficits after a neurological injury.

2. Stay updated with code changes

CPT codes are updated annually, so it’s important to stay informed about any changes. Being unaware of new codes or modifications could lead to missed revenue opportunities or claim denials. Regularly review updates from the American Medical Association CPT releases to ensure your billing practices remain current and compliant.

3. Use modifiers appropriately

Modifiers are two-digit additions to a CPT code that provide extra details about the service. It’s essential to use them correctly to avoid denials while ensuring accurate billing:

• 59 Modifier: Use this to indicate that two services normally bundled together were performed as distinct or separate on that particular day. This helps avoid confusion and ensure both services are appropriately reimbursed.
• GP Modifier: This indicates that the service was provided as part of a physical therapy care plan. Applying the GP modifier ensures the payer knows the treatment aligns with an ongoing care plan.

4. Train staff regularly

Ensure all clinic staff—billing specialists, front office personnel, and clinicians—receive ongoing training in CPT coding. Miscommunication between providers and billing teams can lead to costly errors, so having everyone on the same page will improve compliance and revenue cycle management.

Start optimizing your CPT coding today

Accurately using physical therapy CPT codes is essential for ensuring proper billing, maintaining compliance, and securing appropriate reimbursement. By understanding what CPT codes are, knowing how and when to use them, and following best practices such as maintaining proper documentation and keeping your staff trained, you can prevent common errors and optimize your practice’s revenue cycle.