Physical Therapy Coding Guidelines

Physical Therapy Coding – CPT codes with 48-unit cap

Under Medicare guidelines, physical therapy is services prescribed by a qualified physician or medical practitioner and is done under the supervision of a qualified physical therapist.  In order for Medicare to pay a physical therapist for its billing claims, there are physical therapy coding guidelines that need to be followed.

There are limits set forth by the Healthcare Common Procedure Coding System (HCPCS).  One such limit is the 48-unit cap for common Current Procedural Codes (CPT) codes.  These physical therapy CPT codes are timed and every 15 minutes is considered as one unit.  Documentation for timed physical therapy procedures should indicate beginning and ending time.  The list of physical therapy coding which falls under this limitation includes:

  • 97012 – physical therapy coding for mechanical traction therapy
  • 97016 – for vasopneumatic device therapy
  • 97018 – is for paraffin bath therapy
  • 97022 – used when client needs whirlpool therapy
  • 97024 – physical therapy coding for diathermy therapy
  • 97026 – for infrared therapy
  • 97028 – is the CPT code for ultraviolet therapy
  • 97032 – physical therapy coding for electric stimulation
  • 97033 – for electric current therapy
  • 97034 – used for contrast bath therapy
  • 97035 – CPT code for ultrasound therapy
  • 97036 – physical therapy coding when hydrotherapy is used
  • 97039 – for physical therapy treatment
  • 97110 – code used for therapeutic exercises
  • 97112 – for neuromuscular reeducation
  • 97113 – applicable when patient needs aquatic therapy or exercises
  • 97116 – physical therapy coding for gait training therapy
  • 97124 – applies to massage therapy
  • 97140 – used for manual therapy
  • 97150 – CPT code for group therapeutic sessions
  • 97530 – applies to therapeutic activities
  • 97535 – physical therapy coding used for self care management education and training
  • 97537 – for community and or work integration
  • 97750 – used when patient’s physical performance is tested
  • 97755 – CPT code for assistive technology assessment
  • 97761 – is used when patient undergoes prosthetic training

Also, it should be noted that modalities using CPT codes 97010 – 97028 does not require direct patient contact while modalities for CPT codes 97032 – 97039 does.

There are also procedures that are not limited to 48 units.  These are:

  • CPT codes 95831 – 95852 which are used when the patient needs procedures for muscle testing
  • CPT code 97001 for patient evaluation
  • CPT code 97002 for patient re-evalutation
  • CPT code 96125 used to perform cognitive testing
  • CPT code 97760 which is for orthotics fitting, education and training for upper and lower extremities

As a business owner who aims to succeed and grow his private practice, using the correct physical therapy coding is a must.  Maintaining a healthy cash flow through efficient billing is the key to keeping the business afloat and eventually, having enough cash for growth and expansion.

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