The good news is that physical therapy billing doesn’t have to feel overwhelming. By mastering CPT codes, applying payer rules correctly, and ensuring documentation compliance, therapists can streamline claims, reduce denials, and secure timely payments. In this guide, we’ll walk you through everything you need to know about physical therapy billing, coding services, and strategies to maximize reimbursements.
Step 1: Learn the Basics of CPT Codes
CPT codes are five-digit numeric codes that standardize how treatments are reported for billing. They directly connect the care provided—whether therapeutic exercises, manual therapy, or gait training—to the payment received. Understanding them is the foundation of accurate physical therapy billing.
Step 2: Choose the Right CPT Code for Each Service
Correct code selection ensures accurate billing. Physical therapy CPT codes fall into two categories:
Timed Codes (billed in 15-minute units, requiring one-on-one time):
97110 – Therapeutic Exercise (strength, endurance, flexibility, range of motion)
97112 – Neuromuscular Re-education (balance, coordination, movement control)
97140 – Manual Therapy (mobilization, manipulation, drainage)
97116 – Gait Training Therapy (walking, mobility, balance improvement)
97530 – Therapeutic Activities (functional tasks like lifting or bending)
97535 – Self-Care/Home Management Training (training for ADLs)
Untimed Codes (billed once per session, regardless of duration):
97010 – Hot/Cold Pack Therapy (pain, swelling, stiffness relief)
Evaluation & Re-evaluation Codes:
97161 – Low-Complexity Evaluation
97162 – Moderate-Complexity Evaluation
97163 – High-Complexity Evaluation
97164 – Re-evaluation
Step 3: Apply the 8-Minute Rule Correctly
The 8-minute rule determines how many units of a timed CPT code can be billed.
8–22 minutes = 1 unit
23–37 minutes = 2 units
38–52 minutes = 3 units
53–67 minutes = 4 units
For example, if a therapist provides 12 minutes of 97110 and 11 minutes of 97140, the total time equals 23 minutes. That qualifies for 2 units billed, even though neither service alone reached 15 minutes.
Step 4: Ensure Accurate Documentation
Clear documentation is essential for payer approval. Key elements include:
Initial Evaluation – Diagnosis, goals, treatment plan
Daily Notes – Services performed, duration, patient response
Progress Reports – Ongoing improvement and medical necessity
Discharge Summary – Final outcomes and recommendations
Step 5: Use Modifiers Correctly
Modifiers clarify billing details for payers. Important ones include:
GP – Services under a PT plan of care
59 – Distinct services billed on the same day
KX – Required when Medicare therapy thresholds are exceeded ($2,410 in 2025)
CQ/CO – Services by PTAs/OTAs (reimbursed at 85%)
Step 6: Follow Medicare Guidelines
Medicare has strict billing policies. For 2025, keep in mind:
Therapy Thresholds – Above $2,410 requires KX modifier
MPPR – 50% reduction for multiple therapy services in one session
Telehealth – Only select CPT codes (97110, 97112, 97530, 97161–97164) qualify
Conversion Factor – Reduced to $32.36, requiring accurate workflows
Step 7: Avoid Common Billing Mistakes
Frequent errors that cause denials include:
Incorrect rounding under the 8-minute rule
Duplicate billing without modifier 59
Forgetting GP or KX modifiers
Using codes not covered by a payer
Step 8: Prevent Denials with Smart Practices
Denials are costly, but preventable. Strategies include:
Track denial reasons (e.g., missing modifiers, incomplete notes)
Submit corrected appeals promptly
Train staff based on denial patterns
Conduct quarterly internal audits
Use technology tools like:
EHR Systems – Track treatment times and create compliant notes
Billing Software – Flag missing or incorrect codes
Claim Scrubbing Tools – Prevent errors before submission
Step 9: Strengthen Your Revenue Cycle
A strong revenue cycle ensures smooth cash flow:
Verify insurance before starting care
Educate patients about out-of-pocket costs
Submit claims promptly
Monitor accounts receivable (AR) and follow up on unpaid claims
Outsource Physical Therapy Billing for Better Results
Managing complex coding, payer rules, and denials can take valuable time away from patient care. That’s why many practices choose to outsource physical therapy billing to trusted partners like 24/7 Medical Billing Services.
By leveraging professional physical therapy billing coding services, clinics benefit from:
Expert knowledge of CPT codes and payer rules
Advanced billing technology for accuracy
Faster reimbursements with fewer denials
24/7 support for claim management and AR follow-up
Outsourcing ensures practices stay compliant, reduce revenue loss, and focus on what matters most—delivering quality care to patients.
FAQs
Q1. Can physical therapy CPT codes be billed via telehealth?
Yes, but only specific codes are approved for telehealth reimbursement.
Q2. Can assistants bill under physical therapy CPT codes?
Yes, but PTA/OTA services are reimbursed at 85%.
Q3. Is there a cap on Medicare payments for PT services?
There’s no hard cap, but therapy thresholds apply. Claims above $2,410 require the KX modifier.
For More Information:
Call us at 888–502–0537 or [email protected]
Visit at https://www.247medicalbillingservices...
Our Office Locations:
Ohio: 28405 Osborn Road, Cleveland, OH, 44140
Texas: 2028 E Ben White Blvd, #240–1030 Austin TX, 78741
Subscribe @247medicalbillingservices
Follow us on social media channels-
Facebook: https://www.facebook.com/247MBS
Twitter: https://x.com/247MBServices
Instagram: https://www.instagram.com/247mbs
LinkedIn: https://www.linkedin.com/company/24-7-medical-billing-services/