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A Beginner’s Guide to CPT Codes for Physical Therapy

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The healthcare industry is dynamic, and CPT codes change constantly. Keeping up with these changes can be challenging for physical therapists. This piece will serve as a readily available quick guide on the most frequently used CPT codes physical therapists will need.

 

What are CPT codes?

CPT codes, also referred to as Current Procedural Terminology codes, were developed by the American Medical Association (AMA). They are consistent terms developed to classify all medical operations and services. The codes enable healthcare professionals to provide a detailed account of the services they render to a client. CPT codes are essential for simplifying reporting, enhancing reliability and effectiveness, filing claims, and setting criteria for health-related evaluation.

Here are some terminologies commonly used in CPT:

  • Modifiers: They are two additional digits usually added to CPT codes to provide more information about the procedure or services offered.
  • Global Period: This is the time frame during which services are considered part of a surgical package; it could be 90, 10, or 0 days.
  • Unbundling: This is the act of billing parts of a procedure or service separately when they should be included in a single code.
  • Evaluation and Management (E&M): These codes ranging from 99202 to 99499, represent the initial assessment and ongoing management of a client’s condition.
  • Place of Service (POS): This code indicates the location where the service was performed, such as a hospital outpatient department, a private practice clinic, or the client’s home.
  • Code: A unique five-digit number assigned to a specific service or procedure.

 

 

Commonly Used CPT Codes in Physical Therapy

As a physical therapist running your business, one critical decision to make is how you would get paid. Would you want to bill the customer directly or bill their insurance? Choosing to bill the insurance company requires some sort of understanding of the CPT codes. Because the CPT codes must be used to report services and procedures provided, the insurance company will go through the codes provided in the report and decide which of the codes qualifies for reimbursement. Now, let’s discuss various commonly used CPT codes in physical therapy.

CPT Code

Name 

97110

Therapeutic exercise

97112

Neuromuscular re-education

97116

Gait training

97124

Massage Therapy

97140

Manual therapy

97150

Group Therapy

97161

Low Complexity Evaluation

97162

Moderate Complexity Evaluation

97163

High Complexity Evaluation

97164

Physical therapy re-evaluation

97530

Therapeutic activity

97535

Self-care/Home management training

97750

Physical performance test or measurement 

97761

Prosthetic Training

 

97110: Therapeutic exercise

These exercises are used to improve strength, endurance, range of motion, and flexibility; their goal is to restore physical function. It’s perfect for exercises that are directly related to the client’s diagnosis and are part of a planned treatment. To avoid errors, make sure to properly document the specific exercises performed, the rationale behind them, and the client’s response to treatment.

Some therapeutic exercises include active stretching, active-assisted or passive ROM of a joint, treadmill, or bicycle, and resistance exercises.

 

97112: Neuromuscular Re-education

This code is used for therapies that aim to improve balance, coordination, posture, and proprioception. It should be selected when treatment focuses on re-educating the neuromuscular system to enhance movement and function. Detail the specific techniques used and the functional outcomes aimed at through the therapy.

Relevant activities that could also be considered in this code are ergonomic training, improving motor control, plyometrics, kinesiotaping, facilitation or inhibition, and performing stabilization exercises.

 

97116: Gait training

This involves activities that cover teaching a client how to walk safely and efficiently, often after an injury or surgery. When using this code, the primary focus of the session must cover activities that aim to improve gait patterns, balance, and coordination during walking. For documentation to be successful, it must include details on the type of assistance or devices used and progress in gait patterns. Some common gait training includes leg lifts, stepping over objects, treadmills, and strength training machines.

 

97124: Massage Therapy

This code for massage therapy should not be mistaken for manual therapy. Massage therapy involves the application of therapeutic massage to relieve muscle pain, improve circulation, and reduce stress. It’s suitable for sessions primarily consisting of massage techniques. Proper documentation includes recording the areas treated, the techniques used, and the therapeutic goals. Examples include the following techniques: petrissage, tapotement, and effleurage.

 

97140: Manual therapy

The manual therapy code is different from massage therapy in the sense that it covers techniques like mobilization/manipulation, manual lymphatic drainage, and manual traction. Physical therapists should use this code for treatments involving direct hands-on techniques to treat soft tissues and joints. To avoid errors during documentation, the therapist should specify the techniques used, the duration of therapy, and the client’s response. Don’t use this code for resistance training through exercises, since it falls under the category of exercises, where the therapist applies resistance to help improve strength or endurance.

 

97150: Group Therapy

For a treatment to be called a group, there must be at least two individuals. The activities of a group therapist could be done in a gym-like setting or other open spaces to accommodate 2 or more persons. The individuals in the group therapy may not necessarily perform the same exercise. Because there’s more than one client, PTAs are often necessary for proper supervision. This code must be selected when conducting a therapy session for multiple clients simultaneously. Note that for proper documentation, the number of participants, the nature of the therapy provided, and how it addresses each participant’s needs must be noted.

 

97161: Low Complexity Evaluation

For an initial client evaluation that presents with low complexity regarding clinical decision-making and client history. Appropriate for evaluations requiring a limited examination and straightforward clinical decision-making. Outline the client’s condition, the extent of the examination, and the complexity of clinical decision-making.

 

97162: Moderate Complexity Evaluation

This code is used for initial evaluations with moderate complexity, involving a detailed history and examination with moderate clinical decision-making. Use this code when the evaluation involves a more comprehensive assessment than a low-complexity evaluation. Always document the detailed client history, examination findings, and the rationale for the moderate complexity decision-making to reduce mistakes.

 

97163: High Complexity Evaluation

The third complexity evaluation is the initial evaluations that are high in complexity, necessitating an extensive examination and high-level clinical decision-making. It suits complex client cases requiring a thorough assessment and complex decision-making. During documentation, always provide a comprehensive overview of the client’s history, complex needs, and the intricate nature of the clinical decision-making process.

 

97164: Physical therapy re-evaluation

This code is used to review a client’s advancement and amend the course of treatment as required. It’s recommended for use during an evaluation to assess progress and revise the treatment plan accordingly. When documenting, emphasize any alterations in the client’s status, accomplishments made, and adjustments to the treatment strategy.

 

97530: Therapeutic activity

This code is used for tasks involving engaging activities aimed at enhancing abilities. It’s suitable for tasks that replicate work-related, living, or other significant activities. For documentation, be sure to record the details of the activities, their objectives, and how they align with the client’s goals.

 

97535: Self-care/Home management training

This specific CPT code focuses on educating individuals about self-care, managing household responsibilities, and using adaptive tools. It’s used to instruct clients on routine tasks at home. When it comes to documentation, it’s important to note the training given, the tools or equipment used, and the client’s capability to independently carry out these tasks.

 

97750: Physical performance test or measurement

This code is primarily used to assess fitness levels or performance, which includes conducting tests and measurements of capacity. It’s a code for evaluating a client’s abilities using standardized tests. To ensure accuracy, document the specifics of the tests or measurements employed, the outcomes achieved, and their significance to the treatment plan.

 

97761: Prosthetic Training

This specific CPT code pertains to the training and therapy that clients receive to adjust to the use of a limb. It’s applicable when the emphasis lies on adapting to and acquiring the skills to use a device. The description should include information, about the type of prosthetic the training sessions offered, and the individual’s advancements in using the device.

 

CPT Code Updates and Revisions

Ensuring that you’re using the latest codes is crucial for accurate billing and reimbursement of services provided. Keeping your codes up to date helps maintain communication among therapists, insurance companies, and other healthcare providers regarding the services given.

In 2024, new CPT codes (97550, 97551, and 97552) were introduced for caregiver training services, which are sometimes categorized as therapy by the Centers for Medicare & Medicaid Services (CMS). Now, physical and occupational therapists have the option to offer supervision to their therapy assistants for RTM services under conditions outlined in the 2024 Physician Fee Schedule final rule.

 

97550: Under Caregiver Training Without the Client Present

The therapist provides face-to-face training to one or more caregivers, focusing on strategies and techniques to assist patients with functional deficits. This code covers the initial 30-minute training session.

 

97551: Under Caregiver Training Without the Client Present

The therapist provides face-to-face training to one or more caregivers, focusing on strategies and techniques to assist patients with functional deficits. This add-on code covers each additional 15 minutes of training beyond the initial 30 minutes.

 

97552: Under Caregiver Training Without the Client Present

The provider conducts in-person training for a group of caregivers to help multiple patients with functional deficits using various strategies and techniques.

 

Frequently Asked Questions

How do I choose between similar CPT codes for therapy services?

Selecting the correct code often depends on the specifics of the therapy provided. Detailed documentation of the service can help determine the most appropriate code.

 

Can I use multiple CPT codes for a single visit?

Yes, if multiple distinct services are provided during a visit, each can be billed with its corresponding CPT code. Ensure that documentation supports the use of each code.

 

What happens if I use the wrong CPT code?

Using the wrong code can lead to claim rejections or audits. It’s important to review and correct any coding errors promptly to avoid reimbursement delays.

 

Understanding and effectively using CPT codes is crucial for physical therapists to get paid for the services they provide. With the ever-changing healthcare landscape and the complexity of the coding system, physical therapists need to stay informed and up-to-date on the latest CPT codes relevant to their practice.

Billing and documenting are hard, but the right tools can make them easier. Fusion is an all-in-one EMR built for and by physical, occupational, and speech therapists. Therapists can integrate their AMA subscription within Fusion to access the code database without leaving the platform, ensuring accurate and efficient coding. The software also automates parts of the billing process, reducing administrative tasks and helping physical therapists get reimbursed more quickly. Schedule a demo to experience firsthand how Fusion can optimize your practice management, save you time, and help you provide the best care for your patients.

 

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