Anyone who does medical coding regularly understands the importance of a cheat sheet. We have built a list of time-saving CPT Codes for Physical Therapy to help you use them.
According to the American Physical Therapy Association, more than 300 million physical therapy sessions occur yearly, and the profession is expected to grow 17% by 2031. We want to help you save time by scanning this list.
What are physical therapy CPT codes?
Current procedural terminology (CPT) codes are similar to ICD codes in that they both give providers and insurers a language for medical treatments.
However, the difference between CPT and ICD codes is that CPT codes describe the medical services provided, while ICD codes identify a diagnosis. A CPT code marks the procedure or prescription issued in response to a diagnosis.
For instance, suppose you treat a physical therapy patient with low back pain. The ICD 10 code for the low back pain diagnosis would be M54.5. If you provide a hot /cold pack for the pain, the CPT code for that treatment will be 97010. CPT codes are generally numeric as compared to the alphanumeric system of ICD codes.
How do I bill time units in physical therapy CPT codes?
Many of these procedures are performed multiple times per session. Therefore, it is essential to understand time units and the 8-minute rule to bill correctly.
The standard unit of time for the AMA is 15 minutes, which means if you bill an hour-long manual therapy session, it will have four 97140 codes, as each code shows one 15-minute therapy time. Non-timed services are marked as N/A and you can bill them as per service unit. For example, if you perform an ultrasound, you will mark code 97035 only once, regardless of the time it takes.
Common CPT Codes for Physical Therapy
Physical therapists receive payment for their services depending on the coding of the medical bill. If coding is not correct or codes overlap, it creates difficulty for the providers to get payments on time.
Insurance companies will deny reimbursing the business if healthcare providers don’t properly code their medical bills. Denied claims lead to a loss of revenue. Physical therapists don’t want to lose this money; therefore, companies need to ensure that they use the correct codes.
Free CPT codes are harder to find as compared to ICD codes. Many websites provide paid cheat sheets and codes. We are providing it free of charge. You can access physical therapy CPT codes here – from evaluations to therapeutic exercises and massage therapy CPT codes.
If you are new to the billing world of physical therapy, here are 13 common codes that you will most likely use in your career.
29240, 29530, and 29540: Strapping
Strapping is the procedure of placing adhesive strips to help with the stability of a joint. The strips provide support to the joint while healing.
Several codes are used when strapping is applied to different parts of the body using a similar technique. These include shoulders, ankles, knees, or other joints that are prone to injury from getting overworked. These joints may dislocate or be injured during a difficult exercise. Taping techniques provide stability, immobility, or comfort for a patient to stabilize the joint.
It is important to note that this code doesn’t involve any use of plaster to create the same effect as tape. It also doesn’t involve kinesiotaping techniques that promote movement.
97110: Therapeutic Exercise
These exercises develop strength and endurance in one or more areas and help with range of motion and flexibility. These are billed following the 8-minute rule. This means a physical therapist can bill until the service lasts for at least 8 minutes. If they provide service for 22 minutes, then they will get the payment for a single unit.
This code often gets confused with therapeutic activity. There is a significant difference in the bill between the two.
The reimbursement rate for therapeutic activity is higher than that for therapeutic exercise. This difference is due to skill. Insurance companies believe that therapeutic exercise requires less skill than other therapeutic activities, which is why they agree that it deserves less compensation.
97112: Neuromuscular Re-Education:
It is a sort of exercise that includes activities to restore the function of the brain and muscle control. Again, the 8-minute rule applies to these billing services. Neuromuscular re-education helps improve posture, movement, coordination, balance, and kinesthetic sense. The relevant activities for this code are Kinesio® Taping, facilitation or inhibition, stabilization exercises, ergonomic training, improving motor control, desensitizing the muscles, and plyometrics.
Desensitizing the muscles may include a variety of activities. For example, rolling the back on a piece of foam to eliminate pain. Another form is massaging an area of the body to increase blood flow, making the joints less stiff. These simulations and exercises count towards this specific CPT code.
97116: Gait Training
Gait training involves exercises to help patients stand and walk to strengthen muscles and joints. It helps improve balance, posture, and endurance. This improves muscle memory and helps retain leg movements using repetitive motions. It increases their mobility by allowing them to walk comfortably.
People with broken legs, broken pelvis, musculoskeletal disorders, strokes, spinal cord injuries, neurological disorders, and brain injuries need gait training.
These types of exercises often use machines to help people walk safely. These machines help maintain body weight, develop strength, improve balance, and provide stability.
97140: Manual Therapy:
This code is used for manual therapy, whose purpose is to restore joint and soft tissue mobility, reduce joint contracture, and increase muscle energy. This manual therapy involves manual resistance exercise to improve strength and endurance, which helps increase muscle energy.
97150: Group Therapy
Group therapy means providing services to two or more patients at the same time. The activities of this code may occur in different settings, like a gym. This type of treatment requires a physical therapist or an assistant to provide constant supervision.
97530: Therapeutic Activities
This code is used for services or activities that improve the functional performance of muscles, ligaments, and other tissues in the body. This involves direct contact with the patient. The activities include hip-hinge training, bed mobility, swinging a bat or golf club, practicing going up and down stairs, lifting heavy objects using proper form, and a lot more. These types of exercises require a highly skilled physical therapist so that patients don’t injure themselves and to help them master the proper movements.
97535: Self-Care / Home Management Training
If you experience an injury like a broken arm or a double knee replacement, home management training helps you live independently. Treatment sessions teach you how to properly use assistive devices like a walker. Activities of daily living training strengthen muscles and improve flexibility and balance. It is specially designed to help someone with bathing, eating, getting dressed, and transferring. Transferring means physically moving your body to get in and out of a bed, comfortably getting into and out of a vehicle, and moving to and from a wheelchair.
97750: Physical performance test or measurement
This code is used for physical performance to understand the severity of a patient’s situation and decide their needs. They test the different functions of multiple parts of the body to determine physical performance. These include Cybex testing, grip tests, functional capacity evaluations, pinch tests, sport-related tests, and video analysis of gait, throwing, and running.
97761: Prosthetic Training
This CPT code is used for prosthetic training, in which a patient learns how to move properly with their new limb. Similarly, someone with a new leg would need to get used to walking, running, sitting, and standing with prosthetic training.
97762: Checkout for orthotic/prosthetic use
This code involves evaluating the effectiveness of an existing prosthetic device. A physical therapist may recommend a change in the device or determine a slight adjustment of the current one if necessary.
Less Common Physical Therapy Codes:
Here are the most common physical therapy codes. It’s still worth knowing, as physical therapists may end up using them at some point.
Here’s a list of less common codes of physical therapy:
- 97010: Hot or cold packs therapy
Application of thermal energy for relief in one or more parts of the body. It is used to improve blood circulation, relieve pain, and decrease swelling, along with other procedures.
- 97012: Mechanical Traction therapy
The application of mechanical therapy provides relief in one or more areas of the body. It improves blood circulation, decreases swelling, relieves pain, and reduces muscle spasms, in addition to other procedures.
- 97014: Electric stimulation therapy
It involves the application of electrical energy to provide relief to the body that improves blood circulation, decreases swelling, relieves pain, or reduces muscle spasms, in addition to other procedures.
- 97016: Vasopneumatic device therapy
- 97018: Paraffin bath therapy
Using warm water or wax to reduce pain and tenderness in the hands while improving muscle strength.
- 97022: Whirlpool therapy
Using warm water to decrease swelling, improve motion, and decrease pain and muscle spasms.
- 97024: Diathermy
- 97026: Infrared therapy
Using infrared light to decrease swelling, improve wound healing, decrease pain, and decrease muscle spasms.
- 97028: Ultraviolet therapy
Ultraviolet light usage decreases swelling, improves motion and wound healing, decreases pain, and reduces muscle spasms.
- 97032: Electrical Stimulation
Electrical stimulation decreases swelling, improves wound healing, and decreases pain and muscle spasms.
- 97033: Electric current therapy
- 97034: Contrast bath therapy
- 97035: Ultrasound therapy
This therapy decreases swelling, pain, and muscle spasms and improves wound healing and motion.
- 97036: Hydrotherapy
- 97113: Aquatic therapy
Using water to relieve stress on joints, along with exercises
| Code Name | Diagnosis Common Name |
| 97124 | Massage therapy |
| 97127 | Therapeutic Interventions to improve cognitive function |
| 97139 | Physical medicine procedure |
| 97010 | Hot packs |
| 97010 | Cold packs |
| 97530 | Therapeutic Activities |
| 97035 | Electrical stimulation (unattended) |
| 97016 | Vasopneumatic devices |
| 97151 | Behavioral Identification assessment |
| 97153 | Adaptive behavioral treatment by protocol |
| 97154 | Group Adaptive behavior |
| 97155 | Adaptive behavior treatment by modification |
| 97156 | Family adaptive behavior treatment guidance |
| 97157 | Multi-family adaptive behavior treatment guidance |
| 97542 | Wheelchair management |
| 97158 | Group adaptive behavior treatment |
| 97750 | Physical performance test |
| 97755 | Assistive technology assessment |
| 97760 | Orthotic management and training |
| 97761 | Prosthetic training |
| 97762 | Prosthetic Checkout |
| 97763 | Prosthetic management, subsequent encounters |
Conclusion
Reimbursement of different CPT codes occurs at different rates depending on the skill and time needed to complete the therapy exercises. It is important to code the services perfectly; otherwise, the insurance company rejects the claims. As a result, the provider loses money, and it delays revenue.
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