(2023) CPT Code 97110 | Description & Billing Guidelines
CPT code 97110 can be billed for a therapeutic procedure using exercise to develop strength, endurance, range of motion, and flexibility. The 97110 CPT code can be reported in units of 15 minutes. In addition, the patient can be engaged in therapeutic exercises during individual occupational therapy, as indicated by CPT 97110.
Summary
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 crucial factors are reported correctly.
Modifier GO, modifier GQ, Modifier CO, Modifier CQ, and Modifier 59 can be used for CPT code 97110.
The 97110 CPT code can be used for therapeutic exercises and includes physical therapy, occupational therapy, and chiropractic services. CPT 97110 and CPT 97140 can be billed on the same day.
The 97110 CPT Code Procedure Explained
Therapeutic exercise CPT 97110 is described as a fundamental occupational therapy exercise that increases a patient’s strength, range of motion, endurance, or flexibility.
Exercises billed with the CPT code for therapeutic exercise help to restore strength and stamina so that regular activity can be resumed.
Patients can be suffered from muscle stiffness, weakness, and reduced movement, to name a few difficulties.
When directing a patient through targeted exercises designed to develop mobility, strength, and stamina, CTP code 97110 for therapeutic exercise can be used.
Exercising with free weights to build arm muscle or jogging on a treadmill to increase energy are examples of this billing category.
The therapeutic exercise CPT code procedure 92110 denotes a 15-minute therapeutic procedure in one or more areas. Active, active-assisted, or passive therapeutic activities are available.
Examples of therapeutic exercises for CPT 92110 are:
- the treadmill;
- isokinetic exercise;
- lumbar stabilization;
- stretching, and;
- strengthening.
Therapeutic exercises CPT code procedures can be appropriate and medically essential for a loss or restriction of:
- joint motion;
- strength;
- functional capacity, or;
- mobility caused by a specific condition or accident.
Strengthening, endurance training, flexibility, range of action, and other activities can be included in therapeutic exercise.
These can be included lifting free weights, running on treadmills, and performing range-of-motion exercises (passive and active).
Therapeutic exercises should be designed to increase a specific parameter, such as strength or range of motion.
Strength, endurance, range of motion, or flexibility are qualities that therapeutic exercise incorporates into one or more body regions.
Treadmills can be used to develop endurance, isokinetic practices can be used to increase range of motion, lumbar stabilization exercises can be used to increase flexibility, and gymnastic balls can be used to increase strength (for stretching or strengthening)
It is best to find out how many outcomes are expected from the specific processes. If the action has only one desired effect, CPT code 97110 should be used.
For example: Report therapeutic exercise CPT code 97110 as the essential occupational therapy practice that assists patients in increasing their strength and mobility.
Payment for occupational therapy services can be contingent upon providing sufficient evidence of the type, number, and purpose of the exercises performed during sessions.
To be reimbursed under CPT 97110, you must be engaged in therapeutic activities for at least eight minutes. Please wait at least eight minutes before submitting this code.
Furthermore, modifier 52 (reduced service) can be discouraged from being added to the therapeutic exercises CPT code.
Treatment records should include information about the patient’s muscles and joints. Define the expected outcomes of each activity and elaborate on how they will help you achieve your goal.
Before utilizing the therapeutic procedure CPT code, coders should research what their respective states and the federal government perceive as “one-on-one patient involvement.” Following this standard, the doctor and patient must communicate directly and one-on-one.
Description Of CPT Code 97110
A therapeutic operation with the CPT code 97110 can be carried out either actively, actively assisted, or passively.
CPT 97110: This code can be billed for therapeutic exercise and is officially described in CPT’s manual as: “Therapeutic procedure, one or more areas, every 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.
Therapeutic exercises CPT code procedures can be justifiable and medically necessary for patients who have experienced loss or restriction of joint motion, strength, functional capacity, or mobility due to a specific disease or injury.
Consultations with medical professionals are only regarded face-to-face in the patient’s presence. A medical professional, therapist, or therapy physician must perform these procedures.
There should be defined goals during therapeutic exercise centered on the patient’s functional limits, and the therapist should stay close the entire time.
Strength training, cardio, stretching, and bending are all part of therapeutic exercise. When billing and documenting therapeutic exercise, it should include the area(s) of the body treated and the precise muscles and joints worked (s).
How And When To Report
Suppose a patient is given and completes an exercise program designed to improve their functional strength, range of motion, endurance training, and flexibility. In that case, this should be recorded with the CPT code 97110 for therapeutic exercise.
Five minutes of CPT 97035 (ultrasound), six minutes of CPT 97140 (manual treatments), and ten minutes of CPT 97110 (deep tissue massage) total 21 minutes of treatment. However, one payment unit can be allowed (therapeutic activity).
Therefore, as long as the first unit of 97110 is completed (representing the longest-lasting service), the clinical record should be provided as evidence that the subsequent two units of the 97110 CPT code were also conducted.
Therapeutic exercises recommended can be medically essential to promote a patient’s strength and mobility to boost involvement in activities of daily living, such as dressing, feeding, and various other functional activities, for them to be billed.
These exercises can be performed actively or assisted with the client’s help.
Another prerequisite for billing using the 97110 CPT code for therapeutic procedures is that you should be engaged in one-on-one work with the client throughout the session.
Each unit of the CPT code for therapeutic exercise lasts for 15 minutes. Exercises that target a single deficit across one or more body regions can be described by the CPT code 97110.
Documentation enables you to give clients more excellent care and, crucially for invoicing, demonstrates to insurers the value of your services if a claim can be canceled or you are subject to an audit.
A clear correlation should be reported regarding how that deficit negatively influences the patient’s quality of life. Commonly used deficit areas can include reductions in strength, endurance, flexibility, and range of motion.
Before working with the patient, you should be aware of an objective measurement of the deficit region and update it as they progress through the therapy program.
The part of the body you are working on and the kind, number, and goal of the exercises you conduct during your occupational therapy sessions should all be noted in your paperwork.
Document any modifications you made to the patient’s workout regimen as they advance, including any new exercises you added.
You’ll need to demonstrate unequivocally that the customer is improving in a quantifiable way and that there is a clear, planned progression leading to an eventual switch to a home workout regimen.
It should only be possible to submit claims for reimbursement using the 97110 CPT code for physical therapy sessions in which you had direct patient contact.
Strength training, flexibility work, and range-of-motion and endurance drills are part of the program.
Some doctors avoid using therapeutic exercise CPT codes because it appears too risky, but you’ll get paid more if you use them to claim therapeutic activity. The difference should be slight now, but it will significantly impact by year’s end.
Therapeutic exercises can be typically underpaid since they do not require as much skill as neuromuscular rehabilitation or therapeutic activities.
The paperwork should include details about the patient’s limitations and how overcoming them has improved their ability to perform. Loss of joint mobility or muscle strength are two indicators that should be included.
Reports of progress show that the condition is improving while on the chosen therapy and that the improvement is clinically meaningful (or expected to be so). It is preferable to record metrics of progress that are functionally meaningfully related to clinical and functional improvement).
Long-term therapy programs, for example, can not be meaningful therapeutic progress that enhances the patient’s function if they only slightly increase their range of motion.
Expertise claims need to be backed up by evidence, so keep track of any changes or additions you make to your workout plan or the exercises themselves.
Keeping records showing that the activities can be modified into a home exercise program (HEP) with the help of a caregiver or without one should be saved.
Adjustments to the HEP are necessary as the patient improves throughout treatment, making it an integral part of the overall care plan. As the patient or caretaker gains competence in the exercise techniques, it is advised that more of the treatment should be performed using the HEP.
Reimbursement
CPT Code 97110 is part of the 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 affects their physical motion needs.
The type of exercises used includes but are 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 an assistant can perform these procedures.
A provider should remain with direct patient contact during therapeutic exercise, and there should be proper goals focusing on the functional disabilities of the patient.
There are three essential factors while billing the 97110 CPT Code to any insurance for reimbursement:
- The patient has a weakness, mobility problems, physical imbalance, cognition problem;
- Exercise will help in strengthening, coordination, improving mobility and help them with daily living activities with goals to be achieved;
- Provider spent time is documented in medical notes.
After every ten visits, supportive documents must be submitted to show what goals were achieved and what is next to come.
If there is no improvement in the patient’s condition, medical services become medically unnecessary, and reimbursement becomes impossible.
Reimbursement Rate
CMS has announced new rates from 1st Oct 2021 and revised some code fees. The rate for 97110 is the same, 30.30 for facility and non-facility.
Fees can be varied for other commercial insurances, and the rate for therapist assistants would be paid less than for a physical or occupational therapist.
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 treatment intervals 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 six units per DOS for the 97110 CPT code.
Does CPT 92110 Require A Modifier?
Services given as part of an outpatient occupational therapy care plan can be used with the GO modifier. Modifier GPs can be used for outpatient physical therapy services that are part of a care plan.
Modifier CQ can be used when a physical therapist assistant provides all or part of the outpatient physical therapy services. CO Modifier can be used when an occupational therapy assistant provides all or part of outpatient occupational therapy services.
Modifier 59 can be used for CPT 92110; another code in the exact category overlaps. The 92110 CPT code can also be reported using the XE, XU, and XS modifiers instead of the 59 modifier.
Modifier GO & Modifier GP
Both institutional and professional claims require Modifier GO and Modifier GP for the 97110 CPT code when billed under the therapy plan of care.
Modifier GO: Services are delivered under an outpatient occupational therapy care plan.
Modifier GP: Services are delivered under an outpatient physical therapy care plan.
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 whole or partially by a physical therapist assistant.
CO Modifier: Outpatient occupational therapy services furnished whole or partially by an occupational therapy assistant.
Does CPT 97110 Need A Modifier?
Modifier 59 is a level I modifier that is used when there is an overlapping of CPT 97110 with any other code from the same category. Alternatives to the 59 modifier are XE, XU, and XS, which can also be used to report the 97110 CPT code.
CPT Code 97110 & Physical Therapy
CPT 97110 is a code mainly used by physical therapists to treat patients using therapeutic exercise to increase their physical strength.
Insurances require a GP modifier when services are performed under a physical therapy plan of care.
In the case of physical therapy, the diagnosis should be appropriate to show medical necessity information on the claim; never use the 52 modifier with the 97110 CPT code if the time is less than 8 minutes.
Two weekly visits are (usually) covered with medical documents needed after every ten visits. The number of visits varies based on the active or passive treatment of a condition; follow the payer guidelines for that purpose.
Some insurances may have different guidelines regarding paying several units per single day. Different diagnoses require a couple of visits for complete care.
97110 CPT Code & Occupational Therapy
CPT 97110 can be reported for occupational therapy. Occupational therapy is used to treat patients by helping them perform meaningful activities and helping them in their occupations.
Maintenance services are not covered, and services are not helping patients after reaching a specific threshold.
Mostly, Occupational therapists use this code to treat patients with cardiopulmonary impairment; activities are performed to help them with daily breathing problems.
Remember to use Modifier GO for the 97110 CPT code and follow the LCD policy of a specific state for diagnosis to meet the medical necessity on the claim.
CPT Code 97110 For Chiropractic Exercises
Chiropractors help the mobility of muscles, joints, and extremities and often report therapeutic exercise CPT code 97110.
The description of CPT 97110 states “therapeutic exercise,” which can include any exercise performed by a physical therapist, occupational therapist, or chiropractic.
The diagnosis must be related to chiropractic and fall under the local coverage determination of a specific state.
The 97110 CPT code does not fall into specific specialty groups and can be used by different providers under different guidelines.
There is no separate payment for educational treatment components or time spent on documentation.
A patient can fall into any program, but the essential requirement to bill CPT 97110 will always be the same.
Documentation of condition improvement and time used to treat the patient are the most critical factors 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 the same day for the same patient; instead, using these codes together on the same day is very common.
CMS has instructed us not to use the 59 Modifier when billing CPT 971140 and CPT 97110.
Example 1
Gym ball exercises can improve the patient’s strength; these activities are classified as therapeutic exercises.
In addition, time spent taping (including McConnell taping) can be used to implement a reinforcement intervention and falls under CPT code 97110.
Example 2
A 50-year-old female with severe low back pain and manual traction with therapeutic exercise was used to treat the woman. Thirty minutes were used to perform manual traction and 10 minutes for another therapeutic exercise.
You will be billing it as CPT 97140 with two units and one unit for CPT 97110.
Some insurances require Modifier 51 or Modifier 59 even though no CCI edit exists between these codes. Primarily, commercial insurances require Modifier 59 or 51 to be used for claims to go through their customary edits, but this is not a requirement by CMS.
