CPT 97110 can be used for therapeutic procedures in time units of 15 minutes. The reimbursement rate is $30.30 and will be paid if the three important factors are reported correctly.
97110 CPT Code Description
The CPT manual describes CPT Code 97110 as follows: “Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility”
The 97110 CPT Code applies to a single or multiple body part and requires direct contact with a qualified healthcare professional.
This CPT code is billed in units of 15 minutes and use the 8 minute rule if needed.
CPT 97110 Code Reimbursement
CPT Code 97110 is part of Rehab CPT Family; Providers use this code to describe therapeutic exercises to increase the strength and level of motion in case of any weakness that effect his physical motion need.
Type of exercises that are used can include but not limited to treadmill, Isokinetic exercise, lumbar stabilization or gymnastic ball.
A physician or therapist contact needs to be face to face, any other time would not count. A physician, a therapist or therapist assistant can perform these procedures.
A provider should remain with direct patient contact during the performance of therapeutic exercise and there should be proper goals focusing on functional disabilities of patient.
There are three important factors while billing the 97110 CPT Code to any insurance for reimbursement:
- Patient has weakness, mobility problem, physical imbalance, cognition problem;
- Excersise will help in strengthening, coordination, improve mobility and help him/her daily living activities with goals to be achieved;
- Provider spent time is documented in medical notes.
After every 10 visits, supportive documents are necessary to be submitted to show what goals were achieved and what is next to come.
If there is no improvement in patient condition, medical services become medically unnecessary and reimbursement becomes impossible.
Reimbursement Rate For CPT Code 97110
CMS has announced new rates from 1st Oct 2021 and has revised some of the codes fee. The rate for 97110 is same 30.30$ for both facility and non-facility.
Fee can be varied for other commercial insurances and the rate for therapist assistant would be paid lesser as compared to physical or occupational therapist.
97110 CPT Code Time Factor
CPT 97110 is time specific and is billed in 15-minute increments. According to CMS guidelines, at least eight minutes of direct contact with the patient must be provided for a single unit of service to be appropriately billed.
AMA guidelines state that incremental intervals of treatment performed on the same session may be added together when determining total time.
Check with other third-party payers for their guidelines regarding billing and payment of timed codes.
If services are less than 8 minutes, you cannot bill the services.
CMS has allowed 6 units per DOS for the 97110 CPT code.
Does CPT Code 97110 Need A Modifier?
When the 97110 CPT code is reported for a physical or occupational therapy plan of care, most of insurances require a modifier to show which provider has performed these services. Modifier from level I and level II are used for under specific circumstances.
Both institutional and professional claims require Modifier GO and Modifier GP for the 97110 CPT code when billed under therapy plan of care.
Modifier GO: Services delivered under an outpatient occupational therapy plan of care.
Modifier GP: Services delivered under an outpatient physical therapy plan of care.
CQ Modifier & CO Modifier
The following modifiers are used by PT and OT assistants and can be reported with the 97110 CPT code.
Modifier CQ : Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant.
CO Modifier: Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant.
Modifier 59 is level I modifier which is used when there is overlapping of CPT 97110 with any other code from same category. Alternatives to the 59 modifier are modifier XE, modifier XU and modifier XS and can also be used to report the 97110 CPT code.
CPT Code 97110 Physical Therapy
CPT 97110 is a code that is mostly used by physical therapist to treat patient by using therapeutic exercise to increase the physical strength of patient.
Insurances require modifier GP when services are performed under physical therapy plan of care.
In case of physical therapy, the diagnosis should be appropriate to show medical necessity information on claim, never use 52 modifier with the 97110 CPT code if the time is less than 8 minutes.
Two visits per week are (normally) covered with medical documents needed after every 10 visits. Number of visits vary based on active or passive treatment of a condition, follow the payer guidelines for that purpose.
Some insurances may have different guidelines when it comes to paying number of units per single day. Different diagnosis require different number of visits for complete care.
97110 CPT Code Occupational Therapy
CPT 97110 can be reported for occupational therapy. Occupational therapy is used to treat patient in helping them performing meaningful activities of helping them in his/her occupation.
Maintenance services are not covered neither services that are not helping patient after reaching a specific threshold.
Mostly Occupational therapist use this code to treat patient in cardiopulmonary impairment, activities are performed in helping them in daily breathing problems.
Remember to use Modifier GO for the 97110 CPT code and follow the LCD policy of specific state for diagnosis to meet the medical necessity on claim.
CPT Code 97110 Chiropractic
Chiropractors in helping the mobility of muscles, joints and extremities commonly use the 97110 CPT code.
The description of CPT 97110 states “therapeutic exercise” which can include any kind of exercise whether it’s performed by a physical therapist, occupational therapist or a chiropractic.
The diagnosis must be related to chiropractic and fall under the local coverage determination of specific state.
The 97110 CPT code does not fall into specific specialty group and can be used by different provider under different guidelines.
There is no separate payment for educational components of treatment or time spent on documentation.
A patient can fall in any program but the basic requirement to bill CPT 97110 will always be same.
Documentation of improvement of condition and time used to treat the patient are most important factor when billing for the 97110 CPT code.
Can CPT Code 97110 And 97140 Be Billed Together?
Yes, they can be billed together. CPT 97110 and CPT 97140 can be performed on same day for same patient; instead, it is very common practice to use these codes together on same day.
CMS has instructed us not to use the 59 Modifier when billing CPT 971140 and CPT 97110 together.
Example: A 50 year old female who has severe low back pain and she is manual traction with therapeutic exercise was used to treat the woman. 30 minutes were used to perform manual traction and 10 minutes for other therapeutic exercise.
You will be billing it as CPT 97140 with two units and one units for CPT 97110.
Some insurances require Modifier 51 or Modifier 59 even though there is no CCI edit exist between these codes, mostly commercial insurances require Modifier 59 or 51 to be used for claim to go through their customary edits but not a requirement by CMS.