People with injuries, long-term illnesses, and other problems that restrict mobility and function, regardless of age, benefit from physical therapy. They benefit from physical therapy services to maintain their physical wellness and mobility. However, physical therapists frequently have their claims denied because of eligibility problems, reimbursement schedule changes, a lack of medical necessity, telemedicine considerations, and improper use of codes and modifiers.
For clinicians to effectively handle claim submission to Medicare and private insurers in the face of all these difficulties, RCM Matter’s physical therapy medical billing and coding services are a viable solution. An expert can assist physicians in using the most precise physical therapy CPT codes to describe the services they perform accurately, correctly charge units of both timed and untimed treatment, and more.
Stay tuned as we cover the most popular CPT codes for physical therapy.
Physical therapy common CPT codes
Codes for examinations, re-evaluations, and treatments are all part of physical therapy procedural, or CPT, coding.
PT evaluation and Re-evaluation of CPT codes
Specific elements needed for reporting are listed in the description of physical therapy evaluations, along with the usual face-to-face times for each treatment.
Depending on whether a therapeutic evaluation of a low, moderate, or high complexity level was conducted, the evaluation CPT codes are assigned:
- 97161: Low-complexity physical therapy evaluation
- 97162: Moderate complexity physical therapy evaluation
- 97163: High complexity physical therapy evaluation
Documentation must cover the History, Examination, Clinical Decision-Making, and Development of care plan components to document the desired level of PT evaluation.
PT reassessment for 97164: According to the AMA’s CPT descriptions and standards for re-evaluation of physical therapy established plan of care (97164), the following components must be completed and documented:
It’s necessary to conduct an examination that looks at the history and application of standardized tests and measurements;
a Revised care plan that makes use of a uniform patient assessment tool and quantifiable measurements of functional outcome
Use 97164 if a patient’s response to the treatment outlined in the present plan of care is less than expected, and an alteration to the program is required.
According to Medicare regulations, a re-evaluation is only medically necessary (and hence billable) if the patient’s health or level of functioning has significantly changed in a way that was not expected in the POC, such as a notable improvement, diminish, or other alteration.
Standard CPT codes for physical therapy interventions
Standard CPT codes used to report services related to physical therapy include:
- 97110: Therapeutic Exercise
Physical therapy that uses specially created workouts and activities to improve patients’ movement and fitness levels is known as a therapeutic exercise. It is typically applied to those with disabilities brought on by injuries. Still, it can also be used by people who are generally active and healthy to enhance their general health.
- 97140: Manual Therapy
Physical therapy, known as “manual therapy,” treats a variety of soft tissue and musculoskeletal diseases, such as chronic back pain, by carefully controlling the pressure and movement of the hands. Improved tissue repair, lymphatic drainage, joint mobility, alignment, and traction are all benefits of manual treatment.
- 97112: Neuromuscular Reeducation
A doctor may administer neuromuscular reeducation through clinical expertise and services as a treatment (exercise) to try to lessen deficits and restore function. In a fair and typically predictable amount of time, these approaches are anticipated to improve the restrictions or deficiencies. The exercises improve the communication between the brain and the problem muscles as they contract.
- 97035: Ultrasound/Phonophoresis
Physical therapists employ a variety of therapeutic approaches to treat strained muscles by strengthening, relaxing, and healing them.
- 97116: Gait Training
The patient receives instruction from the physical therapist on performing various exercises properly, including ascending stairs and concentrating on one or more areas that help them walk for 15 minutes comfortably and without strain.
- 97535: Home management and self-care instruction
A patient must receive appropriate instruction from a doctor or nurse, especially when recovering from an acute illness.
- 97016: Vasopneumatic Equipment
The physical therapist uses a vast pneumatic device to reduce edema or swelling by applying pressure to an extremity.
- 97032: Manual Electrical Stimulation
To treat pain and other muscle-related illnesses, the doctor uses electrical stimulation therapy to stimulate the muscles with electricity. An electric current of varying intensities is sent through the electrode pads after electrodes have been applied to the affected muscle locations, causing the muscles to enlarge and contract.
- 97012: Machine Traction
Surgery can often be avoided with the use of mechanical traction. The methods used in mechanical traction depend on the condition, disease, level of tolerance, and spinal level that needs to be treated by the patient. Both intermittent and continuous forces can be used to apply traction.
- 97113: Water Exercise
The patient does water therapy exercises for one or more body parts under the physical therapist’s guidance for 15 minutes.
- 97150: Group Therapy
In this process, the therapist supervises and directs a group of patients’ therapeutic activities, such as exercise therapy.
- 97124: Massage Treatment
Massage aims to improve blood circulation, relax muscles, and stimulate soft tissues by delivering light to hard pressure with various movement patterns using the palms, fingers, and thumbs. For therapeutic reasons, a massage professional or therapist applies different sorts of stroking and other massages to a patient’s body.
15-minute intervals are used for reporting this code.
- 97018: Paraffin bath
During this treatment, the doctor covers the joints in paraffin wax or dips the limb in the paraffin wax solution.
- 98941: 3 or 4 regions of the spine
The physical therapist manipulates joints and neurophysiological activity in three to four spinal regions through various methods and modalities.
- 97022: Whirlpool
The whirlpool method uses water and air at different temperatures and pressures to treat certain diseases. The whirlpool bathtub uses pumps to produce and transport water and air bubbles. Each whirlpool treatment lasts 10–30 minutes and occurs once or twice a day.
- 97033: Iontophoresis
Iontophoresis, a technique that uses electric current to deliver medication through the skin, is used in this process by the physical therapist. For every 15-minute session, use one unit of this code.
- 97039: Laser/Other
When a medical professional employs a form of physical therapy that lacks a specific code, they should report the practice using code 97039.
- 97026: Infrared light
The application of infrared light treatment by the practitioner, who may be a doctor, physical therapist, or massage therapist, among others, reduces pain, improves joint mobility, stimulates blood flow, and aids in healing certain body regions. Patients with diabetes, arthritis, or traumatic traumas can use this technique.
- 97750: Physical Performance Test, or FCE
Through tests and activities of daily life, the doctor assesses the patient’s functioning and musculoskeletal abilities, as well as overall physical performance. The healthcare professional evaluates the patient’s physical performance and writes a report.
Contracting RCM Matter for Physical Therapy Medical Billing
All codes must correspond to the services provided to avoid denials. Medical billing for physical therapy can be challenging due to the numerous regulations and time constraints, payer policies that can vary by state, prerequisites for prior authorization, and changing codes.
The only way to guarantee proper claim submission and maximum compensation is to outsource medical coding to a professional. Concerning medical billing and coding, insurance confirmations and authorizations, and revenue cycle management in general, RCM Matter offers complete solutions. We help physicians avoid denials, increase revenue flow, and uphold compliance by handling their medical billing procedures.