Introduction
Sports medicine involves the diagnosis, treatment, and rehabilitation of sports-related injuries. Proper CPT coding ensures accurate reimbursement and prevents denials due to incorrect modifier use or bundling issues. This guide covers key CPT codes for sports injury evaluations, rehabilitation, and procedural interventions, along with billing guidelines, modifier use, and a final reference table with CPT descriptions and RVUs.
Understanding Sports Medicine Coding
- Evaluation & Management (E/M) Codes – Used for new and established patient visits.
- Therapeutic Procedures – Includes rehabilitation services such as manual therapy and therapeutic exercises.
- Interventional Procedures – Covers joint injections, ultrasound-guided therapies, and regenerative medicine treatments.
CPT Codes for Sports Medicine & Rehabilitation
Evaluation & Management CPT Codes
- 99202-99205 – New patient E/M visits (varies by complexity).
- 99212-99215 – Established patient E/M visits (varies by complexity).
- 99241-99245 – Consultation services.
Rehabilitation & Therapeutic Exercise CPT Codes
- 97110 – Therapeutic exercises, per 15 minutes.
- 97112 – Neuromuscular re-education.
- 97116 – Gait training therapy.
- 97140 – Manual therapy techniques.
- 97530 – Therapeutic activities, direct patient contact.
Interventional Procedures & Joint Injections CPT Codes
- 20600 – Small joint injection (e.g., fingers, toes).
- 20605 – Intermediate joint injection (e.g., wrist, elbow, ankle).
- 20610 – Large joint injection (e.g., shoulder, knee, hip).
- 76942 – Ultrasound guidance for needle placement.
- 20550 – Injection of tendon sheath or ligament.
- 20551 – Injection of tendon origin/insertion.
- 20552 – Trigger point injections, 1-2 muscle groups.
- 20553 – Trigger point injections, 3 or more muscle groups.
Regenerative Medicine & Advanced Treatments
- 0232T – Platelet-rich plasma (PRP) injection.
- 20999 – Unlisted procedure, musculoskeletal system.
- G0447 – Obesity counseling (for weight management in athletes).
Billing Guidelines & Modifier Usage
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Common Modifiers:
- -25 – Used when an E/M service is performed on the same day as a procedure.
- -59 – Distinct procedural service (if multiple interventions are performed).
- -GP – Indicates services provided under a therapy plan of care.
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Bundling Considerations:
- Joint injections (20600-20610) should not be billed separately from ultrasound guidance (76942) without appropriate justification.
- Therapeutic procedures (97110-97530) are often bundled together—check payer guidelines.
Common Denials & How to Avoid Them
- Medical Necessity Denials: Ensure documentation includes functional deficits, pain scores, and prior conservative treatment failures.
- Modifier Use Issues: Append -25 modifier when an E/M service is billed with a procedure.
- Duplicate Claim Rejections: Avoid submitting the same therapy codes multiple times within a session unless justified.
Final CPT Code Table: Descriptions & RVUs
| CPT Code | Description | RVU |
|---|---|---|
| 99202-99205 | New patient E/M visits | Varies |
| 99212-99215 | Established patient E/M visits | Varies |
| 99241-99245 | Consultation services | Varies |
| 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 |
| 97530 | Therapeutic activities, direct patient contact | 1.00 |
| 20600 | Small joint injection | 0.70 |
| 20605 | Intermediate joint injection | 0.90 |
| 20610 | Large joint injection | 1.20 |
| 76942 | Ultrasound guidance for needle placement | 1.25 |
| 20550 | Injection of tendon sheath or ligament | 0.75 |
| 20551 | Injection of tendon origin/insertion | 0.85 |
| 20552 | Trigger point injections, 1-2 muscle groups | 0.80 |
| 20553 | Trigger point injections, 3 or more muscle groups | 0.90 |
| 0232T | Platelet-rich plasma (PRP) injection | 1.50 |
| 20999 | Unlisted procedure, musculoskeletal system | N/A |
| G0447 | Obesity counseling | 0.60 |
Conclusion
Accurate CPT coding for sports medicine and rehabilitation is essential for maximizing reimbursement and preventing denials. Understanding modifier use, bundling rules, and payer-specific guidelines will help ensure accurate claims.
If this guide was useful, check out our other rehabilitation CPT coding guides on physical therapy, chiropractic services, and osteopathic manipulation!