Current Procedural Terminology (CPT) codes are developed and maintained by the American Medical Association (AMA). CPT codes are composed of five alphanumeric digits. For a physical therapist, he or she needs to use the appropriate physical therapy CPT codes for reimbursement purposes.
Using the correct physical therapy CPT codes allows healthcare providers to efficiently and effectively communicate with insurance payers on the procedures and services performed to a patient.
Submitting the CMS 1500 form containing the correct physical therapy CPT codes is vital to getting reimbursed promptly and accurately. Submitting incorrect claims, whether it was a simple mistake, can be misconstrued as fraud. Due diligence should always be exercised to avoid getting into any legal mess.
Medical billing is a dynamic process and physical therapy CPT codes and procedures do change from time to time. As a therapist, it is important to be always updated when it comes to changes in the billing and reimbursement processes.
Below is a list of the most commonly used physical therapy CPT codes:
- 97010 – 97028 are used when applying modalities that does not require direct contact with the patient
- 97032 – 97039 on the other hand, are for modalities used with direct contact with the patient
- 97110 – 97139 are physical therapy CPT codes for therapeutic exercises
- 97140 is applied to manual therapy
- 97150 is used for therapeutic procedures
- 97761 is for prosthetic training
- 97530 is the CPT code for therapeutic activities
The physical therapy CPT codes listed above fall under the 48-unit limitation program. Knowing the limitation for these codes will ensure that the physical therapist will not go over the limit and thus get paid for every procedure done for these CPT codes.
The physical therapy CPT codes on this second list are not limited to the 48-unit rule:
- 95831 – 95852 are codes for muscle testing procedures
- 97001 is for the initial evaluation while
- 97002 is used when a re-evaluation is called for
- 96125 is the code for cognitive testing
- 97760 is used for orthotics fitting as well as training of the extremities, upper and/or lower.
Knowing the appropriate physical therapy CPT codes for each procedure is a must for a billing claim to be reimbursed. Getting confused with which CPT codes to use can be minimized by keeping on top of things and getting constantly updated with any changes or updates with the billing codes.