Guide to Physical Therapy Billing CPT Codes

 

Physical Therapy Billing

Get Paid Quicker With Guide to Physical Therapy CPT Codes 

Physical therapy is a medical specialty that helps individuals recover from injuries, manage chronic pain, and improve their overall physical function. CPT codes are a crucial aspect of the billing for physical therapy services.  

Understanding CPT codes can help physical therapists ensure accurate billing, receive timely payments, and avoid potential errors or audits. This guide provides an overview of CPT codes for physical therapy, with a focus on timed and untimed codes. 

What are CPT codes? 

CPT codes are five-digit codes that represent medical procedures and services. They are used by healthcare providers to bill insurance companies and other payers for services rendered. CPT codes are created and maintained by the American Medical Association (AMA), which updates them annually to reflect changes in medical technology and practice.  

Each CPT code has a specific definition and a relative value assigned by the Centers for Medicare and Medicaid Services (CMS) that determines its reimbursement rate. 

Timed Physical Therapy CPT Codes 

Timed codes are used for services that are performed for a specific amount of time, typically in 15-minute increments. In physical therapy, timed codes are used for interventions that require constant attendance and are measured by the time spent with the patient.  

Timed codes are reported in units of 15 minutes, with one unit representing 15 minutes of treatment time. The following are some of the most commonly used timed physical therapy CPT codes: 

97110 - Therapeutic exercises: This code is used for exercises that are designed to improve strength, range of motion, and endurance. It includes activities such as stretching, strengthening, and conditioning exercises. 

97112 - Neuromuscular reeducation: This code is used for activities that help the patient regain control of their muscles and movements. It includes exercises such as balance training, proprioceptive training, and gait training. 

97116 - Gait training: This code is used for exercises that focus on improving a patient's ability to walk. It includes activities such as stride training, step-up training, and stair training. 

97140 - Manual therapy: This code is used for hands-on techniques that are designed to relieve pain, reduce muscle spasms, and improve joint mobility. It includes activities such as massage, myofascial release, and mobilization. 

Untimed Physical Therapy CPT Codes 

Untimed codes are used for services that are not based on time, but rather on the specific service provided. In physical therapy, untimed codes are used for evaluations, assessments, and re-evaluations.

These codes are typically reported once per episode of care, and are not subject to the 8-minute rule. The following are some of the most commonly used untimed physical therapy CPT codes: 

97161 - Physical therapy evaluation: This code is used for the initial evaluation of a patient, which includes a review of medical history, assessment of current physical abilities, and development of a treatment plan. 

97162 - Physical therapy re-evaluation: This code is used for subsequent evaluations of a patient's progress and treatment plan modification. 

97163 - Occupational therapy evaluation: This code is used for the initial evaluation of a patient who is receiving occupational therapy services. 

97164 - Occupational therapy re-evaluation: This code is used for subsequent evaluations of a patient's progress and treatment plan modification in occupational therapy. 

Conclusion 

CPT codes play a crucial role in the billing process for physical therapy services. Timed codes are used for services that are performed for a specific amount of time, while untimed codes are used for services that are not based on time. 

Physical therapists should ensure that they are using the correct codes for each service provided, and that they are reporting them accurately. By understanding CPT codes, physical therapists can improve the efficiency of their billing processes, ensure timely payments.

HMS USA LLC is among the most top rated medical billing companies where physicians are getting the best physical therapy billing services for their patients.