Medical billing is often challenging, and the 97110 CPT code is no exception. It’s a code assigned to treatments that restore injured tissues. If you are a physical therapist or work in rehabilitation services, you must know that it’s important or necessary, can say that, to use each code properly.
In this post, we will look at how to use billing code 97110 properly. And what problems are likely to lead to getting denied by insurers. It can guide new and seasoned therapists through the challenges in 97110.
First, understand Who Uses 97110 and why.
The CPT 97110 physical therapy code is a common therapeutic procedure.
It also enables therapists to claim payment for organized therapeutic exercises that are done to restore function after an illness, surgery, or injury. It is for Physical therapists, occupational therapists, and other rehabilitation providers.
Whether you are in a large clinic like Stockwell PT or a solo provider, having the right Therex CPT code facilitates smoother claim payments that align with insurance strategies.
What Does 97110 Cover?
The patient’s condition and goals may determine the type of exercises included for the 97110 CPT code therapeutic exercise. Therapists sometimes use a resistance band to support the recovery of a fractured arm.
They can advise a person with lower back pain to do some core exercises and also help someone recovering from surgery by suggesting muscle stretches to increase flexibility.
As long as medically necessary exercise is part of the treatment plan, billing 97110 should be possible. However, each session must remain focused on a goal. For instance, passive cycling or walking without any instruction is not a part of the qualifying treatment.
Examples of Therapeutic Exercises
Common examples of therapeutic exercises billed under this code are
- functional strength training
- Resistance training with bands
- Balancing core exercises
- and stretching of tight muscles.
An individual treatment plan should be able to include therex CPT code 97110, and these activities must be incorporated into the treatment. It also needs the supervision by a legal provider.
Applying the 8-Minute Rule
As each therapy procedure code is associated with a specific duration, the “8-minute rule” applies for CPT 97110. The 8-minute rule is something that Medicare and many private insurers use. You must spend at least eight minutes performing therapy to bill for one unit.
If you spend 23 minutes providing direct care, you may bill for two units. This simple logic follows an easy outline: 8 to 22 minutes is one unit, 23 to 37 equals two units, and so on.
For instance, enabling a patient to perform therapeutic exercises for 30 minutes enables the therapist to bill for two units of 97110. Having a stopwatch or EMR timer is useful in ensuring proper physical therapy coding and helps in collecting information for audits.
How to Document 97110 Correctly?
You must always have proper documents when making a claim using medical billing code 97110. The most important thing is that the document should outline which exercises were done, the time spent on each exercise, and how the outcomes helped with those exercises.
Clear supportive notes include: “Standing leg raises were performed for 15 minutes to improve balance and strengthen the legs.” Whether you’re with a large clinic like Stockwell PT or a smaller one like Embody PT, documenting each session individually reduces claim denials.
Necessary Modifiers and ICD-10 Codes
Applying the correct 97110 modifier is vital. GP is appropriate for physical therapy, while GO is appropriate for occupational therapy.
The KX modifier is mandatory if a patient surpasses therapy thresholds under Medicare, marking that services must still be provided under medical necessity. Always attach the CPT code with relevant diagnosis codes, such as M54.5 for lower back pain or M25.511 for shoulder pain, alongside therapeutic exercise.
Medicare Therapy Threshold for 2025
There is no longer a cap on the number of therapy services that can be provided; however, a therapy threshold requires close scrutiny. For the year 2025, the limit on two combined physical therapy and speech therapy services is set at $2,410, while the same limit applies separately to occupational therapy.
What Are the Common Billing Mistakes to Avoid?
It is quite easy to make billing mistakes regarding proprietary procedures, even if you are an experienced therapist.
- A typical billing mistake is using CPT exercise 97110 for group therapy instead of appropriately billing it under 97150.
- Also, if you are going to bill for both 97110 and 97140 in the same session, ensure you account for the time in a divided manner.
- Misuse of the CPT code therapeutic exercise has the potential to deny claims or, at the very worst, subject the practitioner to audits. Hence, it is best to avoid violating compliance rules.
How is 97110 Different from Other Codes?
The 97110 medical code is specially for therapeutic exercises that improve strength and range of motion. For a variety of codes, 97112 is used for neuromuscular re-education, 97116 for gait training, and 97530 for codes that cover lifting, pushing, or pulling activities.
Even though various rehab exercises share the same actions, your notes should clearly mention the goals, not only list the movements performed.
Best Practices for Using CPT 97110
To bill the therex CPT code accurately and avoid any reimbursement delays:
- Pay attention to time billing as it follows the 8-minute rule.
- General documentation should be concise and specific.
- A modifier should be applied corresponding to 97110.
- Relevant diagnosis codes must be associated.
- Therapy limits must be tracked for Medicare patients.
- Guideline policies set by different payers should be monitored.
Leading clinics use advanced herbal systems to streamline billing processes, minimizing the need for manual input.
If your practice also offers speech therapy, accurate billing is just as critical.
Check out our guide on CPT Code 92507 and how it impacts your revenue for smarter speech therapy claims.
Final Thoughts!
To sum it up, the 97110 CPT code is an important part of billing for physical and occupational therapy. It helps you get paid for the right kind of exercises that support a patient’s recovery.
Knowing how to use this code correctly can help your clinic, big or small, get paid on time, stay within the rules, and avoid denied claims in 2025 and beyond. Taking the time to learn and apply the code properly can save you from billing headaches later. It also shows insurance companies that your care is both professional and necessary.
