CATEGORY
physical medicine and rehabilitation therapeutic procedures
CODE TYPE
Timed-based code
billed in 15 mins increment
ADD-ON CODE
No add-on code
THERAPEUTIC EXERCISES
CPT 97110 consists of all the exercises and therapeutic procedures that are necessary to improve a person’s strength and movement. It covers one or more parts of the body and requires direct contact with a qualified healthcare professional.
Types of Exercises that are included:
- Strengthening Exercises— Biceps Curls, Shoulder Press, Bent over row, squats, bridging
- Endurance Exercises— Treadmill, Cycle Ergometer
- ROM—- Passive, Active Assistive, Active
- Flexibility Exercises—- Forward lunges, Side lunges, Knees to chest
CODING GUIDELINES
» Require the skills of qualified healthcare professionals that includes:
- Physical Therapist
- Occupational Therapist
- Chiropractors
- Physical Therapist Assistant
- Occupational Therapy Assistant
» Billed in 15 minutes increment
» Requires physical therapy modifier (GP, GN, GO, CO, CQ)
» CMS 8-minute rule and AMA rule of Eights are applied
CMS 8-Minute Rule:
A minimum of 8 minutes of direct contact with the patient must be provided for a single unit of 97110 to be billed:
| Units | Number of Minutes |
|---|---|
| 1 unit | ≥ 08 minutes through 22 minutes |
| 2 units | ≥ 23 minutes through 37 minutes |
| 3 units | ≥ 38 minutes through 52 minutes |
| 4 units | ≥ 53 minutes through 67 minutes |
| 5 units | ≥ 68 minutes through 82 minutes |
| 6 units | ≥ 83 minutes through 97 minutes |
| 7 units | ≥ 98 minutes through 112 minutes |
| 8 units | ≥ 113 minutes through 127 minutes |
The pattern remains the same for treatment times of more than 2 hours.
AMA Rule of Eights:
“AMA guidelines state that incremental intervals of treatment performed on the same session may be added together when determining total time in direct contact of a qualified healthcare provider with the patient is necessary. Each unique timed service is counted separately instead of combining the time from multiple units”
Physical Therapy Modifiers
Below mentioned modifiers are used when services are provided for the respective plan of care:
| MODIFIERS | PLAN OF CARE |
|---|---|
| GP | Outpatient Physical Therapy |
| GO | Outpatient Occupational Therapy |
| GN | Outpatient Speech-Language Pathology |
| CQ | Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially) |
| CO | Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially) |
TOTAL NO. OF BILLABLE UNITS
06 units are allowed per date of service by CMS but more units can be billed if justified by medical notes.
MEDICAL NECESSITY
02 visits per week are usually covered. After 10 visits, reevaluation of treatment program to assess any improvement in patient condition and to see if the treatment goals are being achieved and if any modification is required in the treatment program.
REIMBURSEMENT GUIDELINES
For reimbursement of these CPTs following elements must be documented in the Physical Therapy Notes:
- Physical Therapy diagnosis such as muscle weakness, impaired mobility etc
- Exercise will help in developing strength and endurance, increasing or maintaining range of motion and flexibility
- Total direct time spent by the provider with patient
