Physical Therapy CPT Codes – Everything You Need to Know

Physical therapy billing and coding consists of diagnosis codes (ICD-10) and physical therapy CPT codes / treatment codes. The ICD-10 selection tells the payer “here’s the diagnosis” and the CPT code tells the payer “Here’s the treatment – and what you need to pay for”.

The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel.The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.

A CPT code is a five digit numeric code that is used to describe medical, surgical, therapeutic, radiology, laboratory, anesthesiology, and evaluation/management services across the entire spectrum of medical and rehabilitation billing. In this article, we will focus on physical therapy CPT codes as they pertain to physical therapy billing and coding. The complete list of the most common physical therapy CPT codes is very extensive, and we have done the hard work to analyze and compare medical billing software, so that we can present you with digital download file that you can access immediately, for free.

If you like, you can click the ‘Download Now’ button below to get an email with a printer-friendly version of the most commonly used physical therapy CPT codes. If you’re more interested in diagnosis codes, check out the resource on the physical therapy billing and coding cheat sheet, a guide to physical therapy ICD-10 coding.

The Diagnosis

The diagnosis sets the stage for documentation and reimbursement. Click the icon to learn more about ICD-10 coding and download a billing and coding cheat sheet.

The Treatment

The right documentation, to justify the use of the most appropriate CPT codes puts you in the best position to get paid for your services. Click the icon to get examples of physical therapy documentation templates and best practices with physical therapy forms.

The Payment

The right billing and coding team will help you maximize reimbursements. Click the item to discover how to find and screen medical billing companies to help you collect the maximum possible amount from insurance companies.

The Importance of Physical Therapy CPT Codes

physical therapy CPT codes

physical therapy CPT codes

Physical therapy CPT codes reflect what was done for that visit, and are an indication to the payer, saying “pay me for this work done”. The clinician must select the most appropriate CPT code for that encounter and make sure that documentation is compliant, and supportive of the codes that are billed out.

The best way to justify physical therapy coding with CPT codes is to enter supporting documentation in the flowsheet.

A flowsheet should be more than an exercise log. It should be a complete summary of all services rendered (procedures and modalities), duration of service (used to calculate units), extent of services rendered (repetitions, sets and duration) and supporting documentation to justify services rendered.

With In Touch EMR, supporting documentation in the flowsheet can be made mandatory, improving physical therapy billing and coding compliance. Comprehensive notes from the clinician enable auditors and payors to verify that the clinician is meeting or exceeding medical necessity for that visit.

The flowsheet is the foundation of physical therapy billing. It reveals not only what the clinician is doing and what the clinician is billing out, but also why it is being done. In the absence of supporting documentation on the flowsheet, payments for services may be withheld or recouped by payers.

Every time that the patient is seen, it is important to enter supporting documentation to justify the ongoing medical need for therapy services. The question “Why are you continuing to see the patient?” has to be answered conclusively with every flowsheet.

Meeting medical necessity is an ongoing process. As a physical therapy billing best practice, supporting documentation should be distinct and unique for each visit.

Physical therapy CPT codes may also be associated with two digit modifiers, used to clarify or modify the description of the procedure. Adding a modifier to a CPT code line item is saying to the payer “There are some special circumstances related to this treatment, and these codes provide more information and / or impact the payment for these line items”.

The Two Types of Physical Therapy CPT Codes

There are two types of CPT codes used in physical therapy coding: time codes and untimed codes.

Timed Codes

Physical therapists bill one unit for the first 15 minutes of treatment for most timed codes. Additional units can be billed based on the duration of the treatment time. The longer the treatment time, the higher the number of units that can be billed.

Untimed codes

Untimed codes are generally billed once per day. If the treatment area is different and the treatment purpose differs, then the clinician or the physical therapy coder can bill the untimed codes more than once (with appropriate modifiers like 59, 76 or 77 to prove that the second billed CPT code is not a duplicate of first billed same CPT code).

Procedures that REQUIRE direct one-on-one patient contact with therapists

physical therapy CPT codes

physical therapy CPT codes

In the same 15-minute (or other) time period, a therapist cannot bill any of the following pairs of CPT codes for outpatient therapy services provided to the same, or to different patients.

Examples include:

  • Any two CPT codes for “therapeutic procedures” requiring direct one-on-one patient contact (CPT codes 97110-97542);
  • Any two CPT codes for modalities requiring “constant attendance” and direct one-on-one patient contact (CPT codes 97032 – 97039);
  • Any two CPT codes requiring either constant attendance or direct one-on-one patient contact – as described above – (CPT codes 97032- 97542).
  • For example: Any CPT code for a therapeutic procedure (example: 97116-gait training) with any attended modality CPT code (example: 97035-ultrasound);
  • Any CPT code for therapeutic procedures requiring direct one-on-one patient contact (CPT codes 97110 – 97542) with the group therapy CPT code (97150) requiring constant attendance. For example: group therapy (97150) with neuromuscular reeducation (97112);
  • Any CPT code for modalities requiring constant attendance (CPT codes 97032 – 97039) with the group therapy CPT code (97150). For example: group therapy (97150) with ultrasound (97035);
  • Any untimed evaluation or reevaluation code (CPT codes 97001-97004) with any other timed or untimed CPT codes, including constant attendance modalities (CPT codes 97032 – 97039), therapeutic procedures (CPT codes 97110-97542) and group therapy (CPT code 97150)

Procedures that DO NOT REQUIRE direct one-on-one patient contact with therapist

In the same 15-minute time period, one therapist may bill for more than one therapy service occurring in the same 15-minute time period where “supervised modalities” are defined by CPT as untimed and unattended — not requiring the presence of the therapist (CPT codes 97010 – 97028).

One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact.

However, any actual time the therapist uses to attend one-on-one to a patient receiving a supervised modality cannot be counted for any other service provided by the therapist.

The Most Commonly Used Physical Therapy CPT Codes

Most physical therapists believe there are only a handful of cpt codes that can be billed out by physical therapists. The fact is, there are almost 600 physical therapy cpt codes that can be billed out. However, it is true that a small number of them (approximately 30) are the most used physical therapy cpt codes. They are listed in green, and in blue below.

Before you review this list, please note that physical therapy billing and physical therapy coding practices vary from one clinic to another. As a clinician, you always want to bill the most appropriate CPT codes for that encounter, and your clinical judgement and supporting documentation should justify the use of the physical therapy CPT codes that are being billed out.

We have tried to make this list as comprehensive as possible, but we recommend you identify the specific CPT codes that are applicable to your practice and conduct your own research as well.

Green = Most Common (20 codes)

Blue = Somewhat Common (10 codes)

Red = Least Common (574 codes)

This is a total of 604 CPT codes. You can download the entire list of the most commonly used physical therapy CPT codes by clicking on the button below.

  • Most Common Physical Therapy CPT COdes 3.3%
  • Somewhat Common Physical Therapy CPT Codes 1.6%
  • Least Common Physical Therapy CPT Codes 95%

MOST COMMON

97001
Physical therapy evaluation

97002
Physical therapy re-evaluation

97003
Occupational therapy evaluation

97004
Occupational therapy re-evaluation

97012
Application of a modality to 1 or more areas; traction, mechanical

97032
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes

97035
Application of a modality to 1 or more areas; ultrasound, each 15 minutes

Click ‘Download Now’ for the COMPLETE list

SOMEWHAT COMMON

97016
Application of a modality to 1 or more areas; vasopneumatic devices

97018
Application of a modality to 1 or more areas; paraffin bath

97028
Application of a modality to 1 or more areas; ultraviolet

97034
Application of a modality to 1 or more areas; contrast baths, each 15 minutes

97036
Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes

90911
Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG
and/or manometry

Click ‘Download Now’ for the COMPLETE list

LEAST COMMON

97033
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes

97150
Therapeutic procedure(s), group (2 or more individuals)

97533
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minute

97537
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes

Click ‘Download Now’ for the COMPLETE list

Download the Complete List of Physical Therapy CPT Codes

The selection of these CPT codes is very important, since it reflects what procedures / modalities were provided for that visit. This determines how much you get paid. Therefore, it is crucial that you bill out the most appropriate CPT codes at all times.

CMS 1500 form modifier requirements as of Jan. 1, 2014 require that all therapy codes billed on the CMS 1500 form must use modifiers consistent with Medicare rules to distinguish the discipline of the plan of care.

The GP modifier indicates services delivered under an outpatient physical therapy plan of care and the GO modifier indicates services delivered under an outpatient occupational therapy plan of care.

In reviewing the above list, it’s easy for CPT coding to become a bit overwhelming.

That’s why it’s important to have physical therapy billing and coding specialists working to ensure your claims are properly coded (in fact, many physical therapists under-bill their services.).

It is also helpful to download and review the entire list of the most commonly used physical therapy CPT codes. Click here to download the complete list of physical therapy CPT codes.

Need More Information? Contact Us

In Touch Billing provides billing and coding services with an expert team of physical therapy coders.  In Touch Billing has an average first pass rate 8% higher than industry standard, with costs averaging 2% lower.

Schedule a discovery call today to get your no obligation billing quote from In Touch Billing.

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Click here to schedule a free ‘billing strategy’ call with the experts at In Touch Billing, or call (800)-421-8442 to learn more.

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Need More Information about In Touch EMR? Contact Us

In Touch EMR is a fully integrated scheduling, documentation and billing software for physical therapy practices. It is a simple and user friendly web-based, ICD-10 and HIPAA compliant EMR, and it offers customizable templates for notes, the ability to attach files, electronic signatures, and the ability to track progress notes, treatment plans, and assessments.

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Click here for answers to your most frequently asked questions about EMR selection and transition.

In Touch EMR has grown to over 1000 clients, our company / founders have been mentioned on CNN, Forbes, Huffington Post, Amazon, been featured as a Cleardata success story, received the prestigious ONC certification, 2015 and 2016 PQRS registry designation, integrated with Microsoft’s cutting edge patient portal technology and initiated groundbreaking healthcare partnerships with companies like Novartis. All of this is possible thanks to clients across the country, who have embraced In Touch EMR.

In Touch EMR is featured on our HIPAA compliant hosting partner (Cleardata) website along with other industry leaders such as the Cleveland clinic, Nexttech, Saint Mary’s regional medical center and UCLA health.

SIMPLE, TRANSPARENT PRICING MODEL

At In Touch EMR, we charge a flat fee per licensed clinician (no hidden fees or surprises) and it includes everything, unlimited claims and notes and infinite custom template creation. We are also a CMS recognized PQRS registry, we automate the reporting of PQRS and Functional Limitation G codes and provide automatic alerts for plan of care expirations, authorizations, progress note reminders and KX modifier alerts.

Clients also get a self-paced video training program on how to get up and running, custom documentation template builder, iPad app – one touch document import, Instant Intake iPad app, unlimited patient manager and patient portal.

Every license unlimited ongoing support (phone / email / live chat), billing software integration, unlimited appointments, unlimited documentation, unlimited document uploads and unlimited electronic faxing.

OFFICE OF THE NATIONAL COORDINATOR CERTIFIED ELECTRONIC HEALTH RECORD TECHNOLOGY

We are a premier vendor in the rehabilitation space, and on the prestigious, certified Health IT Product List, which is a division of the office of the National Coordinator for Health Information Technology, a division of the Department of Health and Human Services.

Very few vendors can make this claim, and they generally won’t bring this up (in some cases, out of ignorance) mostly because this is not a mandatory certification, it is optional and requires a significant investment of time and effort. This certification is a sign of our commitment to a HIPAA compliant, secure and stable EMR system for your clinic.

If you ever get audited, the fact that you are using ONC-certified EHR technology (CEHRT) will work in your favor. CMS looks favorably on the use of CEHRT since HHS is trying to encourage the adoption of CEHRT amongs providers nationwide as part of a long term push towards electronic documentation and interoperability between EMR systems. Your practice can state that it carefully vetted and selected “a rehabilitation-specific vendor that passed  all of the ONC HIT 2014 Edition EHR Certification criteria required to satisfy the Base EHR definition”

Since In Touch EMR has been very proactive at staying at the forefront of emerging guidelines for EMR vendors, you are assured higher quality, higher security and more compliance with CMS and other payer regulations.

For more information about the ONC, please visit:

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In Touch EMR is one of the only EMR vendors in the rehabilitation space to pass all the 2014 Edition EHR Certification criteria required to satisfy the Base EHR Definition as stated by the Office of the National Coordinator for Health Information Technology, as listed here: http://www.healthit.gov/sites/default/files/pdf/BaseEHR_8-18-12_Final.pdf

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Search for In Touch EMR > CHPL Product Number: 150002R00

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“In Touch EMR has emerged as a comprehensive, customizable EMR solution for our growing organization. Support is always there when we need it, options to customize options to match our workflow are endless, clinicians find it simple and easy to use, front desk and billing love the integration between documentation and claims and compliance is built-in. This is exactly what we needed and it has boosted our efficiency. Couldn’t have asked for more. In Touch EMR is a leader in web-based EMR for our practice. Thank you!”

Julie Edelman PT, DPT – Avanti Therapy

“Moving to In Touch EMR was a process of adjustment, but it was worth it, for several reasons. Not only has the staff at In Touch EMR been proactive in adding new features and responding to support calls and streamlining our billing processes, they have been understanding, professional, polite and patient. The ability to create our own documentation templates, generate professional reports on demand and submit claims to billing with one click has allowed us to streamline our practice. The billing software is extremely versatile – I can review number of claims sent / on hold, payer breakdown, charges per visit and collections per visit. Our biller is able to pull up detailed reports, exactly the way we want. My front desk staff has the ability to track authorizations and create progress note alerts, physician prescription alerts and fax reports to physicians with the click of a button in In Touch EMR. My management is now exploring analytics to identify areas of growth and efficiency and expect to drive our practice further with analytic insights. Best of all, the transition for our entire staff was streamlined and consistent and help was readily available. I like that we are able to talk to someone whenever we need to. If you are looking for a powerful, reliable, and responsive team to help you implement EMR and billing software to grow your practice, look no further than the team at In Touch EMR. We support this therapist owned EMR company wholeheartedly.”

Matthew S. Fischer, MSPT – Fischer Physical Therapy

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Cheryl House RMC, CHI  Compliance Auditor, Author, Coder and Instructor at Illinois Valley Community College

“I was looking for a Practice Management Software that combined both documentation and billing platform systems that work in unison. I had previously tried more complicated systems that made me exhausted at the end of the day. In Touch EMR and In Touch Biller Pro represent a united and unified package that helps the private practice clinician govern a practice. It’s easy to use, it is concise, and it has a plenty of analysis variables to study.”

Sammy K. Bonfim PT – Rehabilitation & Performance Center

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