Table of Contents Hide
- What is the description of CPT code 97110?
- Billing guidelines for CPT code 97110?
- Can you bill 2 units of 97110?
- What is the difference between 97110 and 97140?
- Can you bill 97110 and 97140 together?
- Is 97140 a physical therapy code?
- Can a massage therapist bill 97110?
The American Medical Association maintains the CPT code 97110, a medical treatment code under Physical Medicine and Rehabilitation Therapeutic Procedures. This code is crucial for occupational therapists who want to perform basic exercises to increase the independence of a person with a physical handicap in their everyday activities.
This code will guide patients through exercises designed to improve their range of motion, strength, and flexibility.
Examples of workouts that often fall under this billing code include utilizing free weights to improve arm strength or treadmill jogging to enhance endurance.
Other examples might be employing a TheraBand to stretch overhead to strengthen a shoulder’s range of motion or TheraPutty to regain hand strength following a stroke.
What is the description of CPT code 97110?
Physical therapy techniques like therapeutic exercise involve specially designed workouts and activities to improve patients’ range of motion and fitness. It is frequently used for people with disabilities brought on by injuries, but it can also help healthy people who want to get healthier overall.
Therapeutic activities may help with post-surgery healing, pregnant health promotion, and osteoporosis symptom relief. Each person’s workout program is unique and consists of physical and breathing practices.
When employing fluidotherapy to warm a client’s arm while they practice hand exercises, therapists may bill using the CPT code 97110. Electrical stimulation and ultrasound are paid separately from CPT code 97110 if no exercise is conducted during the modality application.
Billing guidelines for CPT code 97110?
The length of time that a healthcare professional and a patient have had direct, one-on-one interaction is commonly calculated when billing for CPT code 97110. This covers the time spent performing therapeutic exercises and any required coaching or monitoring.
When billing for CPT code 97110, precise and thorough documentation is essential. The medical record should explicitly identify the exercises performed, the targeted areas, the patient’s response or progress, and the session duration.
Applying the correct modifiers
Modifiers may be needed while billing for CPT code 97110, depending on the details of the situation. Common modifiers include -59 (unique procedural service) to denote separate and unique services from other invoiced codes and -59XE (distinct procedural service, separately identifiable evaluator) when a different provider performs the evaluative component.
It’s crucial to confirm the therapeutic exercises being carried out and paid for under CPT code 97110 are medically required. To achieve functional goals or to improve the patient’s general health, they must be appropriately adapted to the patient’s condition, supported by the necessary paperwork, and have these objectives as their primary focus.
Observance of payer regulations
Insurance companies may have special guidelines or restrictions on CPT code 97110’s coverage. Reviewing and abiding by the payer’s policies is essential to ensuring accurate billing and reimbursement.
What modifier is needed for 97110?
-59 modifier is intended to show that any therapeutic exercises conducted are unique from any other services or procedures billed simultaneously. To ensure accurate coding and proper reimbursement, it aids in differentiating therapeutic activities from other operations or therapies. It’s important to check the payer policy to see if CPT code 97110 needs modifiers.
How much does Medicare pay for 97110?
Depending on the circumstances cuts smaller than the projected 3.6% may occur in some coding conditions.
- The price of therapeutic exercise (97110) will decrease on average by 3.3%, from $31.40 to $30.36.
- The price of manual therapy (97140) falls by a similar percentage, from $28.87 to $27.91.
- The price of neuromuscular reeducation (97112) decreases by 2.35% to $35.34.
- Therapeutic activities (97530) decreased by 2.45% from $40.42 in 2020 to $39.43 in 2021.
Since reimbursement rates vary by state, choosing your specific MAC or area is important. Moreover, according to the CMS Physician Fee Schedule, the reimbursement rates between 2023 and 2021 for the code 97110 were $27.89 and $29.21, respectively.
Can you bill 2 units of 97110?
Three methods are available for billing Medicare for therapy sessions under the Medicare 8-minute rule:
- Either through the application of two therapeutic exercise units (97110), one neuromuscular reeducation unit (97112), and one gait training unit (97116);
- Alternatively, you can use two units of gait training and two units of therapeutic exercise.
- Or employ two units of gait training and one unit each of therapeutic exercise and neuromuscular reeducation.
What is the difference between 97110 and 97140?
Various therapeutic procedures are represented by the CPT codes 97110 and 97140.
These two codes differ in the following ways:
- Therapeutic exercise is covered under CPT code 97110: It entails carrying out particular exercises to increase stability, endurance, range of motion, and strength. Stretching, strengthening, and coordination drills that enhance functional capabilities are a few examples of therapeutic exercises.
- Manual therapy procedures are covered by CPT code 97140: It entails physically manipulating soft tissues like muscles, tendons, and ligaments. Myofascial release, joint mobilization, and trigger point therapy are a few examples of manual therapy techniques.
Can you bill 97110 and 97140 together?
CPT Codes 97110 and 97140 can be billed together, so yes. These codes represent the various services within the field of physical therapy. Therapeutic exercise is denoted by CPT Code 97110, whereas manual therapy techniques are denoted by CPT Code 97140. Remember that proper documentation and medical necessity must be established to support billing for both codes. Consulting with a billing specialist or healthcare professional is always advised to ensure accurate coding and billing procedures.
Is 97140 a physical therapy code?
Yes, CPT Code 97140 belongs to the group of codes used for physical therapy. It specifically exemplifies manual therapy techniques a licensed healthcare provider uses, like a physical therapist. These manual therapy methods could include manual lymphatic drainage, mobilization, or other practices.
Is 97110 PT or OT?
Physical (PT) and occupational (OT) therapists can use CPT code 97110. It is a commonly used code for therapeutic exercises provided by both PTs and OTs to improve patients’ strength, range of motion, endurance, and overall functional abilities. The application of CPT code 97110 may vary based on the therapist’s treatment objectives and scope of practice, whether PT or OT.
Can a massage therapist bill 97110?
In most cases, a massage therapist cannot submit a claim using CPT code 97110.
This code is only used for therapeutic exercises that fall within the purview of practice for occupational therapists and physical therapists. Most massage therapists have unique CPT codes for various massage treatment procedures. Healthcare practitioners must bill for services in conformity with payer policies and regulations while adhering to the parameters of their practice.