Introduction
Physical therapy (PT) plays a crucial role in rehabilitation and injury recovery. Proper CPT coding ensures accurate reimbursement and prevents denials due to incorrect modifier use or bundling issues. This guide covers key CPT codes for physical therapy evaluations, therapeutic exercises, and modalities, along with billing guidelines, modifier use, and a final reference table with CPT descriptions and RVUs.
Understanding Physical Therapy Coding
- Evaluation Codes – Used for assessing a patient’s functional status.
- Therapeutic Exercise & Manual Therapy – Includes exercise-based interventions and hands-on techniques.
- Modalities – Encompasses electrical stimulation, ultrasound, and hot/cold therapy.
CPT Codes for Physical Therapy
Evaluation & Re-Evaluation CPT Codes
- 97161 – PT evaluation, low complexity.
- 97162 – PT evaluation, moderate complexity.
- 97163 – PT evaluation, high complexity.
- 97164 – Re-evaluation of physical therapy plan.
Therapeutic Exercise & Manual Therapy CPT Codes
- 97110 – Therapeutic exercises, each 15 minutes.
- 97112 – Neuromuscular re-education.
- 97116 – Gait training therapy.
- 97140 – Manual therapy techniques.
Physical Therapy Modalities CPT Codes
- 97010 – Hot or cold pack application (not typically reimbursed by Medicare).
- 97012 – Mechanical traction therapy.
- 97016 – Vasopneumatic device therapy.
- 97032 – Electrical stimulation, manual.
- 97035 – Ultrasound therapy.
Billing Guidelines & Modifier Usage
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Common Modifiers:
- -GP – Services delivered under an outpatient physical therapy plan.
- -59 – Distinct procedural service (if multiple interventions are performed).
- -25 – When an evaluation is performed on the same day as treatment.
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Bundling Considerations:
- Medicare considers 97010 (hot/cold packs) bundled with other PT services and does not reimburse separately.
- Evaluation codes (97161-97163) should not be reported on the same day as a reevaluation (97164).
Common Denials & How to Avoid Them
- Medical Necessity Denials: Ensure documentation includes functional goals and progress reports.
- Modifier Use Issues: Append -GP modifier correctly when billing for outpatient physical therapy.
- Duplicate Claim Rejections: Avoid submitting the same treatment codes multiple times within a session unless justified.
Final CPT Code Table: Descriptions & RVUs
| CPT Code | Description | RVU |
|---|---|---|
| 97161 | PT evaluation, low complexity | 1.20 |
| 97162 | PT evaluation, moderate complexity | 1.50 |
| 97163 | PT evaluation, high complexity | 1.75 |
| 97164 | Re-evaluation of physical therapy plan | 1.30 |
| 97110 | Therapeutic exercises, per 15 minutes | 0.90 |
| 97112 | Neuromuscular re-education | 0.85 |
| 97116 | Gait training therapy | 0.80 |
| 97140 | Manual therapy techniques | 0.95 |
| 97010 | Hot/cold pack therapy | 0.30 |
| 97012 | Mechanical traction therapy | 0.65 |
| 97016 | Vasopneumatic device therapy | 0.60 |
| 97032 | Electrical stimulation, manual | 0.75 |
| 97035 | Ultrasound therapy | 0.70 |
Conclusion
Accurate CPT coding for physical therapy services is essential for maximizing reimbursement and preventing denials. Understanding bundling rules, modifier application, and payer-specific guidelines will help ensure accurate claims.
If this guide was useful, check out our other rehabilitation CPT coding guides on occupational therapy, chiropractic care, and sports medicine!