The 97110 CPT codes (therapeutic exercise) are a cornerstone of rehab billing, but misuse triggers 35% of denials in PT, OT, and chiropractic practices. As a billing specialist, understanding the nuances of time requirements and Medicare modifiers is key to clean claims. In this guide, I’ll decode the top 97110, share reimbursement strategies, and help you avoid costly audits.
97110 covers therapeutic exercises to improve strength, mobility, and function. Key details:
Pro Tip: Documentation must specify how exercises address the patient’s diagnosis (e.g., “rotator cuff strengthening post-surgery”).
Medicare (Rates)
Commercial Payers
Denial Triggers
Modifier | Use Case |
-59 | Distinct service (e.g., 97110 + 97140 on the same day). |
-GP | Physical therapy under Medicare. |
-KX | Exceeds therapy cap with medical necessity. |
-96 | Habilitative services (e.g., pediatric PT). |
Example: Use 97110-GP-KX for Medicare patients who exceed the therapy cap.
Chiropractic
Occupational Therapy
For billing teams, the 97110 CPT codes are both a revenue driver and an audit risk. A single error, like missing a GP modifier for Medicare, can cost clinics $15k+ annually in denials. By training providers on documentation (e.g., “3×12 reps of resistance band rows for rotator cuff weakness”) and staying updated CMS rules, you’ll:
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Yes! Append modifier -59 if services are separate (e.g., 97110 for strength + 97112 for balance).
Total timed units = (Total minutes / 15). Bill 1 unit for 8–22 minutes, 2 units for 23–37, etc.
How to appeal a 97110 denial for “lack of medical necessity”?
Submit progress notes showing functional gains (e.g., “patient climbed 5 stairs independently post-knee rehab”).
Yes, use Z47.89 for joint replacement aftercare or M25.511 for right
38–38–52 per unit (varies by payer).
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