CPT 97161, CPT 97162, CPT 97163, CPT 97164, CPT 97140

Physical Therapy CPT Codes & Guidelines

Physical therapy is a service to restore patient healthy through physical activities. CPT 97161, CPT 97162, CPT 97163, CPT 97164 and CPT 97140 can be reported for physical therapy evaluation. For home health physical therapy CPT G0151, CPT G0157 & CPT CPT G0158 can be reported. CPT 97014 can be reported for the application of a modality, CPT 97535 for self care management training and compensatory training, CPT 97112 for neuromuscular reeducation and CPT 97530 for therapeutic activities to improve functional performance with dynamic activities. CPT 90912 and CPT 90913 can be reported for pelvic floor dysfunction physical therapy.

Coding Guidelines For Physical Therapy CPT Codes

The physical therapy CPT codes can be billed for services provided by a therapist to maintain or restore patient health through physical activities. To provide these services, AMA has provided the guidelines how to perform and bill physical services.

A physician or therapist would need to provide evaluation before establishing therapeutic therapy or medication therapy. A physician can bill E&M services when providing evaluation but for physical therapist, we have different codes.

Physical Therapy Evaluation CPT Codes

Evaluation in physical therapy is a dynamic process in which the physical therapist makes clinical judgments based on data gathered during examination.

Examination does include conducting a comprehensive history, by performing a systems review, and directing tests and measures. After that, physical therapist or physician evaluates the findings of examination, do establish any physical therapy diagnosis if identified properly, determine the prognosis and then develop complete plan care that include future goals and expected or unexpected outcomes, interventions to be used and anticipated plans for conclusion of care.

Underneath are the coding guidelines for physical therapy evaluation.

Coding Guidelines

Medicare requires a re-evaluation after every nine visits. Time codes are billed typically with an 8-minute rule and the number of units depends on the time duration that is spent during an encounter.

There are basically three different levels of physical therapy evaluation: one is low, second moderate, and third is high complexity. The level of evaluation performed is dependent on the degree of clinical decision making and on the severity of the patient’s condition.

The following CPT codes can be used for physical therapy evaluation: CPT 97161, CPT 97162, CPT 97163 & CPT 97164.

97161 CPT Code Description

CPT 97161 can be used for physical therapy evaluation.

Complexity: Low
Time: 20 minutes
How: Face to face with the patient or/and family of patient

These services can be performed at multiple places of service (e.g., patient’s home, physical therapist’s office, outpatient hospital). The correct place of service should be indicated on the claim form.

Facility and non-facility rates for the 97161 CPT code is same as $101.89 for both settings.

97162 CPT Code Description

CPT 97162 can can be reported for physical therapy evaluation.

Complexity: Moderate
Time: 30 minutes
How: Face to face with the patient or/and family of patient

97163 CPT Code Description

CPT 9763 can be reported for physical therapy evaluation.

Complexity: High
Time: 45 minutes
How: Face to face with the patient or/and family of patient

97164 CPT Code Description

If there is a requirement for the re-evaluation of a patient, CPT 97164 should be used. This CPT code is used for the re-evaluation of physical therapy established plan of care.

Time: 20 minutes
How: Face to face with the patient or/and family

97140 CPT Code Physical Therapy

The 97140 CPT code can be used for manual physical therapy techniques for 1 or more regions.

Time: 15 minutes

This CPT code can be reported for:

  • manual-traction;
  • manual lymphatic drainage;
  • mobilization;
  • manipulation.

Read more about the 97140 CPT code here.

Physical Therapy CPT Codes 2020

Services which are performed by physical therapist are billed with the following 2020 CPT codes.

Home Health Physical Therapy CPT Codes

Three CPT codes can be used for physical therapy. We have written about the CPT codes for home health physical therapy before. CPT G0151 is used for therapists and CPT G0157 for assistant therapist. The G0159 CPT code is used when there is establishment of therapy program is taken place in home or hospice setting.

CPT Code G0151

Services performed by a qualified physical therapist.. Read More..

CPT Code G0157

Services performed by a qualified physical therapist assistant in.. Read More..

CPT Code G0159

Services performed by a qualified physical therapist, in the home health.. Read More..

97014 CPT Code Physical Therapy

CPT 97014 can be reported for the application of a modality to 1 or more areas; electrical stimulation (unattended).

Description & Guidelines

In order to bill the 97140 CPT code; the health care provider has to apply electrical stimulation to one or more areas in order to stimulate muscle function, enhance healing and alleviate pain or/and edema. The clinician can choose the type of electrical stimulation is appropriate. The treatment requires supervision and typically only one session is reported per day. However, when multiple separate treatment sessions are performed per day, it is appropriate to report each treatment session.

Modifier

CPT 97140 can require Modifier 76 if two separate treatment sessions are provided on the same date of service (e.g., a.m. and p.m.). Both CPT codes may be reported but would require modifier 76 to indicate that the service-based code (not the time descriptors) is being reported for two separate sessions on the same date.

97535 CPT Code Physical Therapy

CPT 97535 can be used to report self-care management training and compensatory training. We have written a separate article with coding guidelines about the 97535 CPT code.

Description

Self-care/home management training and compensatory training, meal preparation, safety.. Read more..

97112 Physical Therapy Code

CPT 97112 can be used to report Neuromuscular Re-education (Therapeutic procedure). We have written an article about the 97112 CPT code with coding guidelines.

Description

Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular.. Read More..

97530 Physical Therapy Code

CPT 97530 can be reported for therapeutic activities to improve functional performance with dynamic activities. We have written an article with coding guidelines for the 97430 CPT code.

Description

Therapeutic activities, direct (one-on-one) patient.. Read More..

Worker Comp Physical Therapy Services

When an injury or illness is work related, a patient would want you to bill the services to WC carrier rather normal primary healthcare insurance. In case of physical therapy, you would usually need to take prior authorizations for services a physical therapist is going to perform. The codes for physical therapy for WC are the same process and the amount paid to the therapist can vary.

CPT Codes For Pelvic Floor Dysfunction Physical Therapy

CPT 90912 and CPT 90913 can be reported for pelvic floor dysfunction and physical therapy. Physical therapy services are performed to restore the function of the pelvic floor. Documents should clearly document the service as per performed like “pelvic muscles exercise/therapy”. The codes that are used section biofeedback training for billing purposes. These exercises are provided mainly for urinary incontinence.

What is Biofeedback?

Biofeedback trains patients to control their autonomic or involuntary nervous system responses to regulate vital signs, like heartrate, blood pressure, temperature, and muscle tension. This code has been updated for providers to bill biofeedback training for monitoring muscles specifically of the anus, rectum, perineum, GI tract, and urethral sphincter.

Electromyography, which measures muscle contractions, and/or manometer to measure pressure are included when performed. This particular biofeedback training is done to help the incontinent patient gain control of the related muscles.

CPT 90912 Description

Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG or/and manometer.

Time: 15 initial minutes
How: One on one professional contact
Performed by: physician or other qualified health care professional

CPT 90912 Description

The 90912 CPT code in an additional code that can be reported for each additional 15 minutes.

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