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Quick Reference: CPT 97110

  • Definition: Therapeutic exercises to develop strength, endurance, range of motion, and flexibility.
  • Billing Unit: 15 minutes (Time-Based). Follows the 8-Minute Rule (8 mins or more = 1 unit).
  • Requirement: Direct, one-on-one patient contact. Group exercises must use code 97150.
  • 2026 Medicare Threshold: The KX modifier threshold is now $2,480.
  • Bundling: Commonly bundled with Manual Therapy (97140). Use Modifier 59 only if services are distinct (separate region or time).

Definition and Included Services

CPT code 97110 refers to therapeutic exercises provided to a patient, typically by a physical therapist, occupational therapist, or other qualified provider. The goal is to improve strength, endurance, range of motion (ROM), and flexibility.

The official code descriptor is: "Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility."

In practical terms, 97110 covers:

  • Active, active-assisted, or passive exercises.
  • Stretching routines for flexibility.
  • Resistance training (weights, bands, machines) for strength.
  • Endurance training (treadmill, bike) specifically for deconditioning.

Importantly, 97110 is a time-based code billed in 15-minute units. The therapist must provide at least 8 minutes of direct, one-on-one contact to bill a single unit. Group exercise sessions do not count for 97110.

Typical Clinical Indications and ICD-10 Codes

Therapeutic exercise is medically necessary when a patient has a specific loss of function that can be improved through exercise. Common indications include:

  • Muscle Weakness/Atrophy: e.g., Generalized muscle weakness (M62.81) after immobilization.
  • Limited Range of Motion: e.g., Stiffness of joint (M25.60) following surgery or injury.
  • Post-Surgical Rehab: e.g., Rotator cuff repair aftercare (Z47.89) requiring strengthening.
  • Chronic Pain Deconditioning: e.g., Low back pain (M54.5) requiring core stabilization.
  • Balance Deficits: Difficulty walking (R26.2), often used alongside neuromuscular re-education (97112).

Documentation Requirements (Audit-Proofing)

To ensure reimbursement and survive audits (like TPE reviews), documentation must be specific:

  • Evaluation: Must establish a baseline with objective measures (e.g., "Quad strength 3/5", "Knee flexion 90 degrees").
  • Plan of Care (POC): Must include diagnosis, long-term goals, and frequency/duration (e.g., "3x/week for 6 weeks").
  • Daily Treatment Notes:
    • Specifics: List the exercises (e.g., "3 sets of 10 leg presses at 50lbs").
    • Time: Document total timed minutes. (e.g., "25 mins therapeutic exercise").
    • Skilled Intervention: Document what the therapist did (e.g., "Provided verbal cues for lumbar alignment," "Adjusted resistance to prevent substitution").
  • Progress Reports: Required every 10 visits (Medicare). Must show functional improvement (e.g., "Patient can now climb stairs reciprocally").

Medicare and Payer Coverage Rules (2026)

Medicare Part B

  • KX Modifier Threshold (2026): The threshold for PT/SLP combined is $2,480. Once a patient's therapy costs exceed this amount in a calendar year, you must append the KX modifier to 97110 to attest that services remain medically necessary.
  • Discipline Modifiers: All claims must include GP (Physical Therapy), GO (Occupational Therapy), or GN (Speech Therapy).
  • Certification: The Plan of Care must be certified by a physician/NPP within 30 days of the initial visit.

Private Payers (Aetna, UHC, BCBS)

  • Unit Limits: Many commercial payers (e.g., Aetna, UHC) limit daily reimbursement to a maximum of 4 units of timed therapy per visit, regardless of duration.
  • Assistant Modifiers: As of 2025/2026, major payers like Aetna and Anthem require the CQ (PT Assistant) or CO (OT Assistant) modifiers, mirroring Medicare policy.

Time-Based Billing (The 8-Minute Rule)

Medicare and most federal payers use the 8-Minute Rule to calculate billable units for timed codes like 97110. You cannot bill for services lasting less than 8 minutes.

Billable Units Total Timed Minutes Provided
1 Unit 8 minutes to 22 minutes
2 Units 23 minutes to 37 minutes
3 Units 38 minutes to 52 minutes
4 Units 53 minutes to 67 minutes

Warning: Only skilled time counts. If a patient is on a treadmill for 15 minutes unsupervised while the therapist charts or treats another patient, that time is not billable under 97110.

Comparing 97110 vs. 97530, 97112, 97140

Selecting the right code depends on the intent of the intervention:

CPT Code Description Key Differentiator
97110 Therapeutic Exercise Focus on single parameters: Strength, ROM, Flexibility (e.g., weights, stretching).
97112 Neuromuscular Re-ed Focus on neurological control: Balance, coordination, proprioception (e.g., foam pad balance).
97530 Therapeutic Activities Focus on dynamic functional tasks: Lifting, carrying, transfers, throwing.
97140 Manual Therapy Hands-on techniques: Joint mobilization, manipulation, manual lymphatic drainage.
97150 Group Therapy Two or more patients performing exercises simultaneously. Not one-on-one.

Modifier Guide (59, GP, KX, CQ)

Modifiers are essential for bypassing NCCI edits and meeting payer rules.

  • Modifier 59 (Distinct Procedural Service): Used to unbundle codes that are linked by NCCI edits. The most common pair is 97140 (Manual) and 97110 (Exercise). Rule: You can only use 59 if the services were performed in separate 15-minute intervals or on distinct anatomical regions.
  • Modifier GP/GO: Always required to indicate the therapy plan of care.
  • Modifier KX: Mandatory for claims over $2,480 (2026 threshold).
  • Modifier CQ/CO: Used when a Physical Therapist Assistant (CQ) or Occupational Therapy Assistant (CO) provides at least 10% of the service.
flowchart TD
    A[Bill 97110?] --> B{Service ≥ 8 min\none-on-one?}
    B -- No --> C[Do NOT bill 97110]
    B -- Yes --> D{Also billing\n97140 same visit?}
    D -- No --> E[Bill 97110 units\n+ GP/GO modifier]
    D -- Yes --> F{Separate time block\nor distinct region?}
    F -- No --> G[Bundle: bill 97110 only]
    F -- Yes --> H[Bill 97110 + 97140-59]
    E --> I{Year-to-date\ntherapy > $2,480?}
    H --> I
    I -- No --> J[Submit claim]
    I -- Yes --> K[Add KX modifier\nthen submit]

Real-World Coding Scenarios

Scenario 1: The "Bundled" Session (Knee Rehab)

Service: Therapist spends 25 minutes on leg strengthening exercises (97110) and 15 minutes performing manual joint mobilization (97140) to the same knee.

Coding: 97110 (2 units) + 97140-59 (1 unit).

Reasoning: NCCI bundles 97140 into 97110. Modifier 59 is required on 97140 to indicate it was a distinct skilled service performed in a separate time block.

Scenario 2: Stroke Rehab (Balance vs Strength)

Service: 15 minutes of balance training on a wobble board + 15 minutes of leg press exercises.

Coding: 97112 (1 unit) + 97110 (1 unit).

Reasoning: No modifier needed. 97112 targets balance (neuro re-ed), while 97110 targets strength. They are distinct codes.

Scenario 3: Mixed Group and Individual

Service: Patient attends a 45-minute group circuit class, then receives 15 minutes of one-on-one shoulder stretching.

Coding: 97150 (1 unit) + 97110 (1 unit).

Reasoning: Group therapy (97150) is untimed (always 1 unit). The individual session meets the 8-minute rule for 1 unit of 97110. Documentation must clearly separate the two sessions.

Official Description

Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Therapeutic exercise, as defined by CPT® Code 97110, involves the application of controlled and graduated force to specific areas of the body with the aim of enhancing various physical capabilities. This procedure is designed to develop strength and endurance, improve range of motion (ROM), and increase flexibility. The process of increasing muscle strength is achieved through the deliberate overloading of targeted muscles or muscle groups, which encourages adaptation and growth. Endurance is similarly enhanced by progressively increasing the intensity of exercises directed at specific areas over an extended duration. Maintaining ROM and flexibility is crucial, particularly in cases where contractile and non-contractile tissues may become tight due to injury or neurological conditions, leading to weakness or spasticity. Through therapeutic exercise, blood flow to the affected areas can be improved, which aids in reducing pain and inflammation, lowers the risk of blood clots associated with venous stasis, decreases muscle atrophy, and enhances coordination and motor control. This type of exercise is often prescribed following acute illnesses or injuries, as well as for chronic conditions that impair physical activity or overall function.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

Therapeutic exercises are indicated for a variety of conditions and symptoms that affect physical function and mobility. These indications include:

  • Acute Illness or Injury Therapeutic exercises may be prescribed following an acute illness or injury to facilitate recovery and restore function.
  • Chronic Conditions Conditions that affect physical activity or function, such as arthritis, neurological disorders, or musculoskeletal injuries, may warrant therapeutic exercise to improve overall physical capabilities.
  • Muscle Weakness Patients experiencing muscle weakness due to disuse, injury, or disease may benefit from targeted therapeutic exercises to rebuild strength.
  • Reduced Range of Motion Individuals with limited ROM due to injury, surgery, or chronic conditions may require therapeutic exercises to enhance flexibility and mobility.
  • Spasticity Patients with spasticity may need therapeutic exercises to help manage muscle tightness and improve functional movement.

2. Procedure

The procedure for therapeutic exercises involves several key steps that are executed to ensure effective treatment. Each step is designed to address specific physical capabilities and needs of the patient.

  • Assessment Initially, a thorough assessment of the patient's physical condition is conducted. This includes evaluating strength, endurance, range of motion, and flexibility to identify specific areas that require intervention.
  • Exercise Prescription Based on the assessment, a tailored exercise program is developed. This program outlines specific therapeutic exercises aimed at improving strength, endurance, ROM, and flexibility in the targeted areas.
  • Supervised Exercise The patient performs the prescribed exercises under the supervision of a qualified healthcare professional. This supervision ensures that exercises are performed correctly and safely, maximizing their effectiveness while minimizing the risk of injury.
  • Progress Monitoring Throughout the course of therapy, the patient's progress is regularly monitored. Adjustments to the exercise program may be made based on the patient's response to treatment, ensuring that the exercises remain effective and aligned with their recovery goals.
  • Education Patients are educated on the importance of therapeutic exercises and how to perform them correctly. This education empowers patients to continue their exercises independently, promoting long-term health and wellness.

3. Post-Procedure

After the therapeutic exercise sessions, patients may be advised on specific post-procedure care to enhance recovery and maintain the benefits achieved through the exercises. This may include recommendations for continued home exercises, stretching routines, and strategies to manage any post-exercise soreness. Patients are encouraged to stay active and incorporate physical activity into their daily routines to support ongoing strength and flexibility. Follow-up appointments may be scheduled to reassess progress and make any necessary adjustments to the exercise program, ensuring that the patient continues to improve and achieve their functional goals.

Short Descr THERAPEUTIC EXERCISES
Medium Descr THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES
Long Descr Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
Status Code Active Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 7 - Physical Therapy Service, for which Payment may not be Made
Multiple Procedures (51) 5 - Special payment adjustment rules on the RVU practice expense component of multiple therapy service applies...
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
Type of Service (TOS) 1 - Medical Care
Berenson-Eggers TOS (BETOS) P6C - Minor procedures - other (Medicare fee schedule)
MUE 6
CCS Clinical Classification 213 - Physical therapy exercises, manipulation, and other procedures

This is a primary code that can be used with these additional add-on codes.

0770T Add-on Code MPFS Status: Carrier Priced APC E1 Virtual reality technology to assist therapy (List separately in addition to code for primary procedure)
GP Services delivered under an outpatient physical therapy plan of care
CQ Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant
KX Requirements specified in the medical policy have been met
GO Services delivered under an outpatient occupational therapy plan of care
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
CO Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
97 Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
GA Waiver of liability statement issued as required by payer policy, individual case
GW Service not related to the hospice patient's terminal condition
96 Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living.
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
95 Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XP Separate practitioner, a service that is distinct because it was performed by a different practitioner
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GX Notice of liability issued, voluntary under payer policy
GZ Item or service expected to be denied as not reasonable and necessary
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
RT Right side (used to identify procedures performed on the right side of the body)
UB Medicaid level of care 11, as defined by each state
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
24 Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service.
25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59.
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
56 Preoperative management only: when 1 physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number.
57 Decision for surgery: an evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of e/m service.
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
90 Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.
93 Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.
99 Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service.
A1 Dressing for one wound
A9 Dressing for nine or more wounds
AI Principal physician of record
AJ Clinical social worker
AK Non participating physician
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AT Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942)
CA Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CG Policy criteria applied
CP Adjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification (c-apc) procedure, but reported on a different claim
CR Catastrophe/disaster related
CS Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency
EP Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program
F1 Left hand, second digit
F2 Left hand, third digit
F3 Left hand, fourth digit
F4 Left hand, fifth digit
F5 Right hand, thumb
F6 Right hand, second digit
F7 Right hand, third digit
F8 Right hand, fourth digit
FA Left hand, thumb
FP Service provided as part of family planning program
G0 Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
G3 Most recent urr reading of 65 to 69.9
G5 Most recent urr reading of 75 or greater
G6 Esrd patient for whom less than six dialysis sessions have been provided in a month
G8 Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure
G9 Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition
GB Claim being re-submitted for payment because it is no longer covered under a global payment demonstration
GC This service has been performed in part by a resident under the direction of a teaching physician
GK Reasonable and necessary item/service associated with a ga or gz modifier
GN Services delivered under an outpatient speech language pathology plan of care
GQ Via asynchronous telecommunications system
GT Via interactive audio and video telecommunication systems
GU Waiver of liability statement issued as required by payer policy, routine notice
HA Child/adolescent program
HM Less than bachelor degree level
HP Doctoral level
HX Funded by county/local agency
JK One month supply or less of drug or biological
JZ Zero drug amount discarded/not administered to any patient
K0 Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.
KA Add on option/accessory for wheelchair
KC Replacement of special power wheelchair interface
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KK Dmepos item subject to dmepos competitive bidding program number 2
KL Dmepos item delivered via mail
KM Replacement of facial prosthesis including new impression/moulage
KO Single drug unit dose formulation
KP First drug of a multiple drug unit dose formulation
KS Glucose monitor supply for diabetic beneficiary not treated with insulin
KV Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
KW Dmepos item subject to dmepos competitive bidding program number 4
KY Dmepos item subject to dmepos competitive bidding program number 5
LT Left side (used to identify procedures performed on the left side of the body)
N1 Group 1 oxygen coverage criteria met
PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
PN Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
PO Excepted service provided at an off-campus, outpatient, provider-based department of a hospital
PT Colorectal cancer screening test; converted to diagnostic test or other procedure
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q3 Live kidney donor surgery and related services
Q5 Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
QC Single channel monitoring
QQ Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional
SA Nurse practitioner rendering service in collaboration with a physician
TF Intermediate level of care
TL Early intervention/individualized family service plan (ifsp)
U5 Medicaid level of care 5, as defined by each state
UA Medicaid level of care 10, as defined by each state
V1 Demonstration modifier 1
X2 Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services
X3 Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
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2010-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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