Accurate CPT coding is critical for physical therapy billing success. Below is a breakdown of the most-used PT codes, their applications, and tips to avoid claim denials. Common physical therapy CPT codes include 97110 (therapeutic exercise), 97530 (activity training), and 97140 (manual therapy).
These codes cover rehab for orthopedic, neurological, and post-surgical conditions. Proper documentation ensures compliance and reimbursement.
Whether you’re a PT, clinic owner, or biller, this guide breaks down standard codes, Medicare rules, and billing best practices in simple terms.
CPT (Current Procedural Terminology) codes serve as the universal language for therapists to document and bill their services. Selecting incorrect codes can result in:
Let’s dive into the most essential PT codes, how to use them, and what’s changed in 2024.
What It Covers: Strength/flexibility drills (resistance bands, weights).
Best For: Post-knee replacement (ICD-10: M25.561), rotator cuff rehab (S46.011A).
Billing Tip: Track time in 15-minute increments; maximum payers’ cap at 8 units/day.
Used for: Balance, coordination, and posture retraining (common for stroke or Parkinson’s patients).
What is the difference from 97110?CPT code 97112 targets coordination and movement training, while 97110 is centered on strengthening specific muscles.
Used for: Hands-on techniques (joint mobilization, soft tissue work).
Is it PT? Yes! However, some insurers require proof of medical necessity.
(See the full table below for more codes.)
CPT Code | Description | Avg. Reimbursement | Key ICD-10 Pairings |
97110 | Therapeutic Exercise | 25−25−35 | M25.561 (knee pain), S83.519A (ACL sprain) |
97530 | Therapeutic Activities | 40−40−50 | I69.351 (stroke), Z96.64 (hip implant) |
97140 | Manual Therapy | 35−35−45 | M54.5 (low back pain), M75.00 (frozen shoulder) |
97750 | Physical Performance Test | 50−50−70 | Z79.899 (long-term drug therapy), S72.001A (hip fracture) |
(Ranges vary by state/payer. Medicare pays ~20% less than private insurers.)
Choosing the correct codes helps ensure proper reimbursement and reduces the risk of audits. Bookmark this guide, and always double-check payer-specific policies.
Need help? Consult a medical billing expert to streamline your claims!
Yes! It covers hands-on techniques like joint mobilization—but some insurers require documentation proving medical necessity.
There’s no single “session” code—you bill based on time and services (e.g., 97110 + 97140 for exercise + manual therapy).
A high-complexity evaluation for patients with multiple conditions (e.g., post-surgical + neurological deficits).
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