Medical Billing

# Ultimate Guide on CPT Codes for Physical Therapy

- October 17, 2024
- Posted by Kristen Edwards

30 Sep

For the past few years, the healthcare industry has been under continuous evaluation. Not just the regulations amended for insurance providers and healthcare providers but patients as well. People visit doctors for their tailored needs, however, visiting a physical therapist needs serious bodily pain, injury, or sprain.

To reimburse the treatment, practitioners need to use the CPT pelvic floor physical therapy codes. CPT codes for physical therapy evaluation can differ from those normally used across medical or healthcare reimbursements. Why? Because not many services can be provided via therapists and visiting home.

Physical therapy is one of those few services that restore the health of the patient through physical activities and stimulating muscles through muscular motions. CPT codes for physical therapy, including CPT 97161, CPT 97162, CPT 97163, CPT 97164, and CPT 97140, can be used to report physical therapy evaluations.

## What is CPT 97162 Description?

CPT code 97162 is used to describe a neurobehavioral status exam, which assesses a patient’s cognitive, behavioral, and emotional function. This evaluation is performed by a licensed healthcare professional, typically a physician or neuropsychologist, and is used to diagnose and develop a treatment plan for patients with neurological or psychological disorders. A thorough neurobehavioral status exam involves an extensive interview, review of medical records, and cognitive and behavioral testing. The meta description for CPT code 97162 could be: “CPT code 97162 describes a neurobehavioral status exam, which evaluates a patient’s cognitive and behavioral function. This code is used to diagnose and develop a treatment plan for patients with neurological or psychological disorders.”

For home health physical therapy evaluation, report CPT G0151, CPT G0157 & CPT G0158 codes for correct and accurate evaluation.

When modality therapy is practiced, CPT 97014 would be reported, other CPT codes include CPR 97535 for compensatory training and self-care management training, CPT 97530 for therapeutic activities to improve physical movements, and CPT 97112 reported for neuromuscular reeducation.

Physical therapists also provide therapies for pelvic floor dysfunction. For these treatments, CPT 90913 and CPT 90912 are reported.

## Physical Therapy CPT Codes Coding Guidelines

source:familymedicineaustin.com

A physical therapist uses physical therapy codes for the services provided to restore and maintain the health of patients using physical techniques and activities. To reimburse for the provided services, the American Medical Association has regularized proper guidelines for reporting CPT codes for physical therapy billing claims.

Before a therapist or physician performs medication or therapeutic therapy, they need to provide a physical therapy evaluation. For billing those physical therapy evaluation services, they can bill for E&M services but several CPT codes are specifically designed for physical therapists.

### CPT codes for physical therapy evaluation

Physical therapy evaluation contains a dynamic process in which the clinical data gathered during treatment helps physical therapists to make decisions.

Examination during evaluation involves compiling a comprehensive history, directing labs and tests, and previewing healthcare systems. Once the evaluation is made, the physician or physical therapist analyzes the findings, if the reason for evaluation is determined properly, they establish a comprehensive diagnosis for physical therapy, and provide the prognosis to develop a complete plan for treatments and therapy to attain future goals and forecast expected and unexpected results, make anticipation for both scenarios and make decisions to conclude complete care.

Since it’s a long-term process and needs a proper follow-up regarding evaluation and treatment for physical therapies, providers are strict on AMA coding guidelines. These coding guidelines are further discussed in the article underneath.

### Coding guidelines

Once the whole process of evaluation is done and the decisions are made for a particular treatment of a subject, the story doesn’t end here. According to Medicare guidelines, a re-evaluation is needed to be done after every nine visits of a patient. An 8-minute rule is applied to the reported codes on the reimbursement claims where the number of time codes units depends on the duration a physical therapist spends on a patient during one encounter.

Besides, there are three different types of physical therapy evaluation i.e., low, moderate, and high complexity. These evaluation levels are performed after analyzing how complex the condition of the patient is at the given moment. For these levels of physical therapy evaluations, these CPT codes are reported:

- CPT 97161
- CPT 97162
- CPT 97163
- CPT 97164

### Description for CPT Code 97161:

- The code CPT 97161 is a physical therapy evaluation code that can be reported for low complexities at a therapeutic level.
- Complexity ratio – Low
- Time – 20 minutes
- Physical therapy procedure – Face-to-face evaluation with the family of the patient (because of low complexity) in best practice, with the patient.

This evaluation service is not limited to one place. It can be provided at any place, for example at a patient’s home, outpatient hospital facility, and physical therapist’s office. It is important to note the place where the services are performed when taking notes for HER. The place will be mentioned in the claim form when submitting reimbursement claims.

In addition, the rate for the services provided in the office or outpatient medical facility is the same.

### Description for CPT Code 97162:

- The code CPT 97162 is a physical therapy evaluation code that can be reported for moderate complexities at a therapeutic level.
- Complexity ratio – Low
- Time – 30 minutes
- Physical therapy procedure – Face-to-face evaluation with the family of the patient (because of moderate complexity) in best practice, with the patient.

### Description for CPT code 97163

- The code CPT 97163 is a physical therapy evaluation code that can be reported for high complexities at a therapeutic level
- Complexity ratio – High
- Time – 45 minutes
- Physical therapy procedure – Face-to-face evaluation.

### Description for CPT code 97164

- The code CPT 97164 is a physical therapy re-evaluation code that can be reported for establishing re-evaluating treatment and care.
- Time – 20 minutes
- Physical therapy procedure- Face to face

### 97140 CPT Code for Physical Therapy

- The Code CPT 97140 is a physical therapy code that can be reported for physical therapy techniques. These techniques must be used for more than one region.
- Time – 15 minutes
- CPT code 97140 is used to report:
- Mobilization
- Manual lymphatic drainage
- Manual – Traction
- Manipulation

## Previously Issued Physical Therapy CPT Codes

source:fullrangeptnv.com

United States Centers of Medical Sciences have issued a range of CPT codes and there are continuous amendments in codes reported for every practice and provided service.

Many CPT codes are still in use with the codes released earlier in 2020. They include:

- Therapeutic modalities, PT and OT both use these codes: CPT 97110 – CPT 97546
- Supervision services mostly: CPT 97010 – CPT 97028
- Physical Performance Test or Measurement: CPT 97750
- Prosthetic Training: CPT 97761
- Checkout for Orthotic/Prosthetic Use: CPT 97762

## CPT Codes for Home Health Physical Therapy Service

When a therapist visits places to perform therapy services, three CPT codes can be used to report for home health physical therapy. CPT G0157 is designed for assistant therapists, CPT G0159 is for establishing the therapy program which is determined to perform in a hospice setting or home, and CPT G0151 is for physical therapists.

### Description for CPT Code 97014

The code CPT 97014 is a physical therapy code that can be reported for the application of modality and electric stimulation in one or more areas.

#### Description:

For reporting CPT code 97014, the physical therapy provider must stimulate the muscle function by electrical stimulation method for more than one area. With stimulation, pain/edema would be alleviated but healing would be enhanced.

It depends on the condition and the clinician’s diagnosis to select the type of electrical stimulation. The stimulation treatment requires continuous supervision, this is why physicians are allowed to report one stimulation process in a day. However, treatments other than physical stimulation can be provided and reported on the same day.

#### Usage of Modifier:

In addition to providing more services than stimulation on the same date or day of services, a modifier 76 would be used with the CPT 97140 code. The service code for the additional services can be reported separately which defines the number of services performed on the same date apart from electrical stimulation.

On reporting self-care management and compensatory training CPT 97535 must be used.

### Description for CPT code 97112

The code CPT 97112 is a physical therapy code that can be reported for Neuromuscular Re-education (Therapeutic procedure).

### Description for CPT code 97530

The code CPT 97530 is a physical therapy code that can be used for performing therapeutic activities to improve physical functions by implementing dynamic activities.

## Physical Therapy Services for Workers

When an injury is reported at a workplace, the cost of services can be daunting. The patient would like to bill the worker company instead of going for a primary health insurance provider. As a worker, if you need to take the services of a physical therapist after an injury, you likely need to have pre-authorization from your company and inform them of the type of services a physical therapist will perform.

The process and the CPT codes for the physical therapist for WC will be the same, however, the amount for the therapist services paid can vary according to WC and the level of therapeutic services.

## Pelvic Floor Therapy CPT Code for Pelvic Floor Dysfunction

CPT codes can be reported for physical therapy and pelvic floor dysfunction reported include CPT 90913 and CPT 90912. These physical therapy services are performed to maintain and restore pelvic floor function.

When documenting the physical therapy procedures performed on the pelvic floor, specify the service precisely as they are performed such as ‘pelvic muscles exercise/therapy. Plus, these pelvic floor dysfunction therapies should be mainly for urinary incontinence.

### Description for CPT code 97116

The code CPT 97116 is a physical therapy code that can be reported for Gait training. Gait training is designed to involve exercises with the therapy where they help the patient to stand and walk while moving gradually after an injury or accident. This intention helps in improve muscle function and helps improves balance in twisted joints, and rebuilds posture, and endurance.

The practice further helps in improving muscle memory by using repetitive moments and motions. The main goal of gait training is to bring back someone on his legs to restore the chances of mobility and decrease the chance of slips and falls while walking.

Some common reasons why people might need gait training include:

- Broken pelvis
- Broken legs
- Stroke
- Joint replacement
- Spinal cord injuries
- Neurological disorders
- Brain injuries
- Musculoskeletal disorders

### Description for CPT code 97150

The code CPT 97150 is a physical therapy code that can be reported for group therapy. Group therapy is designed to provide services to two or more patients at a time. The therapy is given to multiple patients in a place where not all the patients need to perform the same exercise.

These activities can be performed at a pool, at a gym, or in a refreshing environment. As this therapy is based on group settings, then a therapist assistant is required to monitor the patients thoroughly.

### Description for CPT code 97530

The code CPT 97530 is a physical therapy code that can be reported for therapeutic activities that require face-to-face interaction with the therapist. This dynamic therapy involves a range of exercises to enhance the functions of ligaments, muscles, and other tissues in the body. The range of dynamic activities includes:

- Moving to a stand position from lying or sitting
- Bed mobility
- Hip-hinge training
- Throwing a ball
- Squatting
- Lifting heavy objects
- Getting in and out of a vehicle
- Going up and downstairs
- Getting in and out of bed safely

### Description for CPT code 97750

The code CPT 97750 is a physical therapy code that is reported for the physical measurement and performance test. Before performing the performance test and making physical measurements, the physical therapist must understand the situation and the needs of the patient.

To identify the condition of a patient, a physical therapist needs to perform multiple tests to determine the physical performance of the body. These tests include:

- Cybex testing
- Functional capacity evaluations
- Functional assessments
- Pinch tests
- Sensory tests
- Grip tests
- Exertional testing
- Sport-related tests
- throwing or running
- Video analysis of gait

Some less common CPT physical therapy codes include:

- 97010: Hot or cold packs therapy
- 97012: Mechanical traction therapy
- 97014: Electric stimulation therapy
- 97016: Vasopneumatic device therapy
- 97018: Paraffin bath therapy
- 97022: Whirlpool therapy
- 97024: Diathermy
- 97026: Infrared therapy
- 97028: Ultraviolet therapy
- 97032: Electrical stimulation
- 97033: Electric current therapy
- 97034: Contrast bath therapy
- 97035: Ultrasound therapy
- 97036: Hydrotherapy
- 97113: Aquatic therapy/exercises
- 97124: A massage therapy
- 97127: Therapeutic interventions with a focus on cognitive function
- 97139: Physical medicine procedure
- 97151: Behavioral identification assessment
- 97153: Adaptive behavior treatment by protocol
- 97154: Group adaptive behavior treatment by protocol
- 97155: Adaptive behavior treatment by protocol (modification)
- 97156: Family adaptive behavior treatment guidance
- 97157: Multi-family adaptive behavior treatment guidance
- 97542: Wheelchair Management
- 97158: Group adaptive behavior treatment
- 97750: Physical performance test
- 97755: Assistive technology assessment
- 97760: Orthotic management and training, the first encounter
- 97761: Prosthetic training, the first encounter
- 97762: Orthotic/Prosthetic Checkout
- 97763: Orthotic/prosthetic management, subsequent encounters

## Benefits of Pelvic Floor Physical Therapy

Pelvic floor physical therapy offers several benefits to people who have pelvic floor dysfunction. This specialist treatment concentrates on enhancing the pelvic muscles, resulting in considerable health benefits. Here are the main benefits:

- Improves muscle strength and coordination, enhancing bladder and bowel control.
- Reduces pain and discomfort with manual therapy and stretching.
- Improved Bladder and Bowel Control: Lowers urine and fecal incontinence, increasing confidence.
- Improves muscle control and relaxation, resulting in a more fulfilling sexual encounter.
- Supports postpartum recovery by restoring pelvic function.
- Empowers patients by educating them on anatomy and pelvic health, encouraging active engagement in their rehabilitation process.
- Early detection of suspected disorders reduces the likelihood of chronic illnesses.
- Improves posture and core stability, reducing back pain.
- Increases self-esteem, resulting in more active engagement in daily activities.
- Therapy is tailored to match individual requirements and goals, resulting in effective outcomes.

## What are Kegel Exercises & How are they Related to Pelvic Floor Therapy?

Kegel exercises, created by Dr. Arnold Kegel in the 1940s, are intended to strengthen the pelvic floor muscles, which support the bladder, uterus, and rectum. These exercises entail relaxing and contracting the pelvic muscles, which can be discovered by attempting to stop urination midway. Kegels are performed by contracting the pelvic floor muscles for 3 to 5 seconds, then relaxing and repeating for 10 to 15 repetitions, ideally three times each day.

They play an important role in pelvic floor therapy by increasing bladder and bowel control, lowering pelvic pain, and enhancing muscular coordination, which helps manage disorders such as urine incontinence. Kegel exercises, which enable patients to take an active part in their pelvic health, are easily adopted into everyday routines and, when combined with other therapy modalities, provide an integrated approach for enhancing pelvic floor function and overall quality of life.

## CPT Codes for Physical Therapy FAQs

### 1. What are some common pelvic floor physical therapy CPT codes?

Common CPT codes for pelvic floor physical therapy include:

- 97161: Physical therapy evaluation (low complexity)
- 97162: Physical therapy evaluation (moderate complexity)
- 97163: Physical therapy evaluation (high complexity)
- 97110: Therapeutic exercises
- 97530: Therapeutic activities
- 97140: Manual therapy techniques

### 2. What types of conditions can pelvic floor physical therapy treat?

Pelvic floor physical therapy can treat various conditions, including:

- Urinary incontinence
- Fecal incontinence
- Pelvic pain syndromes
- Pain during intercourse
- Postpartum recovery
- Pre- and post-surgical rehabilitation
- Does insurance cover pelvic floor physical therapy?

Many insurance plans include pelvic floor physical therapy, but reimbursement varies. It is advisable to speak with your insurance provider about your benefits and any referral or prior permission needs.

### 3. How is pelvic floor physical therapy different from other types of physical therapy?

Pelvic floor physical therapy targets mainly the muscles & underlying tissues in the pelvic area. Assessing and treating pelvic floor issues necessitates particular knowledge and expertise, whereas other types of physical therapy may target various parts of the body or illnesses.

### 4. What techniques are commonly used in pelvic floor physical therapy?

Common techniques include:

- Biofeedback can assist patients learn to manage their pelvic floor muscles.
- Manual therapy aims to reduce stress and improve function.
- Therapeutic activities aim to strengthen the pelvic floor muscles.
- Education and behavior modification: Patients will be taught bladder & bowel control procedures.

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