Physical Therapy CPT Codes: Complete Guide for 2025

Physical therapy practices rely on accurate coding to ensure proper reimbursement for services provided. Understanding physical therapy CPT codes is essential for proper billing and maximum reimbursement. Whether you’re a seasoned physical therapist, a billing specialist, or a practice owner, staying current with the latest coding guidelines is crucial for your practice’s financial health.

This comprehensive guide covers all physical therapy CPT codes you need to know in 2025. We’ll explore everything from basic definitions to complex billing scenarios, providing you with the knowledge needed to optimize your billing processes and avoid costly errors.

According to the American Physical Therapy Association (APTA), proper coding can increase reimbursement rates by up to 15% while reducing claim denials by as much as 30% (APTA, 2025). With recent changes to Medicare reimbursement policies and significant CPT code updates for 2025-2026, there’s never been a more important time to ensure your coding practices are up to date.

What Are Physical Therapy CPT Codes?

PT codes are standardized identifiers used to bill for specific physical therapy services. Developed and maintained by the American Medical Association (AMA), Current Procedural Terminology (CPT) codes provide a uniform language for describing medical, surgical, and diagnostic services. For physical therapy specifically, these codes describe evaluation services, therapeutic procedures, and modalities delivered to patients.

Physical therapy CPT codes are regularly updated, with significant changes implemented in 2025. Each code consists of five digits and may require modifiers in certain circumstances to provide additional information about the service provided. These codes serve several critical functions:

1. Standardization: They create a universal language for describing PT services across all healthcare settings
2. Reimbursement: Insurance companies and Medicare use these codes to determine payment amounts
3. Documentation: They help track the specific services provided to patients

Data Analysis: They allow for the collection of data on treatment patterns and outcomes

Understanding the structure and proper application of CPT codes is fundamental to physical therapy practice management. The codes are organized into sections, with physical therapy services primarily falling under the “Physical Medicine and Rehabilitation” section (97000-97999).

Common Physical Therapy CPT Codes

The common physical therapy CPT codes include 97110 for therapeutic exercise and 97140 for manual therapy. These codes represent the core services provided in most physical therapy practices. Below is a comprehensive list of the most frequently used codes:

Therapeutic Procedures

*Average Medicare reimbursement rates as of July 2025. Commercial insurance rates may vary.

Knowing which common physical therapy CPT codes to use for different treatments is essential for accurate billing. For example, 97110 (Therapeutic Exercise) is used when a patient performs exercises to develop strength, endurance, range of motion, and flexibility. Meanwhile, 97112 (Neuromuscular Re-education) is appropriate when the focus is on retraining movement, balance, coordination, and proprioception.

According to a 2025 utilization analysis by the APTA, the five most frequently billed physical therapy CPT codes are:

1. 97110 - Therapeutic Exercise (42% of all PT claims)
2. 97140 - Manual Therapy (23% of all PT claims)
3. 97112 - Neuromuscular Re-education (15% of all PT claims)
4. 97530 - Therapeutic Activities (12% of all PT claims)
5. 97116 - Gait Training (8% of all PT claims)

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This reference guide includes all common physical therapy CPT codes with detailed descriptions and usage guidelines to help you select the most appropriate code for each service provided.

Evaluation and Re-evaluation Codes

In 2017, the AMA introduced a three-tiered evaluation coding system for physical therapy that remains in effect in 2025. These codes differentiate between low, moderate, and high complexity evaluations based on the patient’s presentation and the clinical decision-making required.

Evaluation Codes

The complexity level is determined by three factors:

1. Patient History: The extent of the review of body systems and past medical history
2. Examination: The number of body regions and systems that need to be examined
3. Clinical Decision Making: The complexity of analytical thinking required

For example, 97161 (low complexity) typically involves addressing 1-2 personal factors that impact the plan of care, a limited examination of 1-2 body regions, and straightforward clinical decision-making. In contrast, 97163 (high complexity) involves addressing 3 or more personal factors, examining 4 or more body regions, and highly complex clinical decision-making.

Dr. Jennifer Martinez, PT, DPT, a coding specialist at the APTA, explains: “Many therapists default to the moderate complexity code (97162), but this can lead to both undercoding and overcoding. A thorough understanding of the requirements for each tier is essential for accurate billing and optimal reimbursement.” (Martinez, 2025)

Re-evaluation code 97164 should be used when there is a significant change in the patient’s condition or functional status that requires revision of the plan of care. This is different from a routine progress note, which does not warrant a re-evaluation code.

Treatment and Modality Codes

Physical therapy treatment codes are divided into two main categories: supervised modalities (97010-97028) and constant attendance modalities (97032-97039). Understanding the distinction is crucial for proper billing.

Supervised Modalities

These services do not require direct one-on-one contact by the provider. Most insurance carriers, including Medicare, consider these bundled into other services and do not reimburse them separately.

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Constant Attendance Modalities

These services require direct one-on-one contact by the provider and are typically reimbursed in 15-minute units.

“When selecting treatment codes, it’s important to understand that the code should reflect the primary focus of the intervention, not just any technique used during the session,” explains Mark Johnson, PT, MBA, a healthcare compliance consultant. “For example, if you’re primarily working on strengthening exercises but include some manual techniques to facilitate movement, you would still bill 97110 rather than 97140.” (Johnson, 2025)

Accurate billing codes for physical therapy services ensure proper reimbursement and reduce claim denials. It’s essential to document the specific techniques used, the time spent, and the clinical rationale for each service to support the CPT codes billed.

Modifier Usage in Physical Therapy

Modifiers provide additional information about the services provided and can significantly impact reimbursement. Proper modifier 59 usage in physical therapy billing can significantly impact reimbursement rates and is one of the most important aspects of PT coding to understand.

Common Modifiers in Physical Therapy

Modifier 59 and NCCI Edit Pairs

The National Correct Coding Initiative (NCCI) identifies code pairs that should not typically be billed together. However, in certain circumstances, these services can be provided separately and distinctly. This is where modifier 59 comes in.

Understanding when to apply modifier 59 usage in physical therapy claims helps prevent denials and audits. For example, therapeutic exercise (97110) and neuromuscular re-education (97112) are considered mutually exclusive procedures. However, if these services are provided to different body parts or for different conditions during the same visit, modifier 59 can be appended to indicate that they are distinct services.

Common NCCI edit pairs in physical therapy include:

• 97110 (Therapeutic Exercise) and 97112 (Neuromuscular Re-education)
• 97110 (Therapeutic Exercise) and 97530 (Therapeutic Activities)
• 97112 (Neuromuscular Re-education) and 97530 (Therapeutic Activities)
• 97140 (Manual Therapy) and 97530 (Therapeutic Activities)

The rules governing modifier 59 usage in physical therapy have been updated for 2025. According to the latest CMS guidelines, documentation must clearly support the distinct and separate nature of the services provided. This includes:

1. Different session
2. Different procedure or surgery
3. Different site or organ system
4. Separate incision/excision
5. Separate lesion
6. Separate injury

“Modifier 59 is one of the most commonly misused modifiers in physical therapy billing,” notes Sarah Thompson, PT, DPT, a Medicare compliance specialist. “When in doubt, ask yourself: Are these truly separate and distinct services? Would I provide this service independently even if the other service wasn’t performed? If the answer is yes, modifier 59 may be appropriate.” (Thompson, 2025)

Billing Rules and Documentation Requirements

Accurate documentation is the foundation of proper coding and billing. For physical therapy services, documentation must support the medical necessity of the treatment and match the CPT codes billed.

The 8-Minute Rule

Medicare and many commercial payers use the “8-minute rule” to determine how many units of time-based CPT codes can be billed. Understanding how to apply billing codes for physical therapy requires knowledge of both CPT and modifier usage, as well as time-based billing rules.

Under this rule:

• A minimum of 8 minutes must be spent providing a service to bill for one unit
• For multiple units, follow this guide:

For example, if you provide 30 minutes of therapeutic exercise (97110) and 15 minutes of manual therapy (97140), you can bill 2 units of 97110 and 1 unit of 97140.

Documentation Requirements

According to the 2025 Medicare guidelines, physical therapy documentation should include:

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“The golden rule of documentation is: If it wasn’t documented, it wasn’t done,” emphasizes Robert Chen, PT, DPT, OCS, a compliance officer at a major rehabilitation network. “Your documentation should tell the complete story of the patient’s care and clearly support the necessity and appropriateness of the services billed.” (Chen, 2025)

Recent Updates to PT CPT Codes (2025-2026)

The physical therapy CPT codes 2025 updates include new codes for caregiver training services and significant changes to existing codes. Staying current with these changes is essential for proper billing and reimbursement.

Upper Extremity Coding Changes

The APTA has announced significant updates to CPT codes for 2025, particularly affecting upper extremity services:

Modified Code Descriptors:

• E1800: Now “Dynamic adjustable elbow ext. AND flex. device”
• E1805: Updated to “Dynamic adjustable wrist ext. AND flex. device”
• E1825: Changed to “Dynamic adjustable finger ext. AND flex. device”

New Codes Introduced:

Caregiver Training Updates

Stay compliant with the latest physical therapy CPT codes 2025 changes to ensure proper reimbursement. Important changes to caregiver training billing thresholds include:

• CPT 97550: Requires full 30-minute session for billing
• CPT 97551: Minimum 15-minute threshold for reimbursement

CG Modifier Updates

Medicare has implemented significant changes regarding elastic materials:

• Discontinued CG modifier for upper extremity orthoses
• L3923 coding required for hand-finger neoprene/elastic supports
• No CG modifier allowed unless moldable support included

Medicare Fee Schedule Changes

The proposed Medicare Physician Fee Schedule for 2026 includes significant updates:

Our comprehensive guide covers all physical therapy CPT codes 2025 updates and their impact on billing practices. Dr. Michael Rivera, Director of Reimbursement at the APTA, notes: “The 2025-2026 updates represent some of the most significant changes to physical therapy coding in recent years. Practices that adapt quickly will be better positioned to maximize reimbursement and avoid claim denials.” (Rivera, 2025)

Frequently Asked Questions

What are the most common physical therapy CPT codes?

The most commonly used physical therapy CPT codes include 97110 (therapeutic exercise), 97112 (neuromuscular re-education), 97116 (gait training), 97140 (manual therapy), and 97530 (therapeutic activities). These codes represent the core treatment procedures typically performed during physical therapy sessions. According to APTA data, therapeutic exercise (97110) accounts for approximately 42% of all physical therapy billing.

What is the difference between CPT 97110 and 97112?

CPT 97110 (therapeutic exercise) involves exercises to develop strength, endurance, range of motion, and flexibility. CPT 97112 (neuromuscular re-education) focuses on retraining movement, balance, coordination, posture, and proprioception. While both are therapeutic interventions, 97112 specifically addresses neurological function and movement patterns rather than general exercise performance.

For example, teaching a patient strengthening exercises for their rotator cuff would be coded as 97110, while training a patient to maintain balance while performing functional activities would be coded as 97112.

What is the CPT code for basic physical therapy?

There is no single “basic physical therapy” CPT code. Instead, physical therapists use specific codes that describe the exact services provided. Common codes include 97110 for therapeutic exercise, 97140 for manual therapy, and 97530 for therapeutic activities. The appropriate code depends on the specific intervention performed during the session.

As Dr. Robert Chen, PT, DPT, explains: “Physical therapy is highly individualized, and the CPT codes should reflect the specific interventions provided rather than using a generic ‘physical therapy’ code.” (Chen, 2025)

What is the CPT code for consult to physical therapy?

For an initial physical therapy evaluation, use one of the tiered evaluation codes: 97161 (low complexity), 97162 (moderate complexity), or 97163 (high complexity). These replaced the older 97001 code in 2017. The complexity level depends on the patient’s history, examination findings, and clinical decision-making required.

According to the APTA, the selection criteria include:

• 97161 (low): Typically 20 minutes face-to-face, addressing 1-2 personal factors, examining 1-2 body regions
• 97162 (moderate): Typically 30 minutes face-to-face, addressing 3+ personal factors, examining 3+ body regions
• 97163 (high): Typically 45 minutes face-to-face, addressing 3+ personal factors, examining 4+ body regions with complex needs

How do I know which evaluation code (97161, 97162, or 97163) to use?

The appropriate evaluation code depends on three factors: patient history complexity, examination complexity, and clinical decision-making complexity. The APTA provides this guidance:

• Use 97161 (low complexity) when evaluating a patient with a recent ankle sprain with minimal comorbidities, requiring examination of only the ankle region and straightforward decision-making.
• Use 97162 (moderate complexity) when evaluating a patient with low back pain that radiates to the leg, requiring examination of the lumbar spine and lower extremity, with moderate comorbidities.
• Use 97163 (high complexity) when evaluating a patient with multiple trauma, complex medical history, or multiple comorbidities requiring examination of multiple body regions and complex clinical decision-making.

Documentation must clearly support the complexity level billed. (APTA, 2025)

When should I use modifier 59 with physical therapy CPT codes?

Use modifier 59 when providing distinct, separate services that would normally be bundled together under National Correct Coding Initiative (NCCI) edits. For example, if you provide both therapeutic exercise (97110) and neuromuscular re-education (97112) to different body parts or for different conditions during the same visit, append modifier 59 to the secondary code.

Key situations requiring modifier 59 include:

• Treating different conditions
• Treating different body parts
• Providing services at different times of day
• Providing services with different goals

Medicare has increased scrutiny of modifier 59 usage in 2025, so ensure your documentation clearly supports the distinct nature of each service provided. (CMS, 2025)

How does the 8-minute rule work for physical therapy billing?

The 8-minute rule determines how many units of time-based CPT codes can be billed. Under Medicare guidelines, you must provide a service for at least 8 minutes to bill one unit. For multiple units, follow this pattern:

• 8-22 minutes = 1 unit
• 23-37 minutes = 2 units
• 38-52 minutes = 3 units
• 53-67 minutes = 4 units

For example, if you provide 30 minutes of therapeutic exercise (97110) and 15 minutes of manual therapy (97140), you can bill 2 units of 97110 and 1 unit of 97140.

When billing multiple service types, Medicare uses the “mixed remainders” approach for calculating total units. This complex rule requires adding all the minutes of service and determining the total billable units based on the total time. (Medicare, 2025)

What documentation is required to support physical therapy CPT codes?

Proper documentation for physical therapy CPT codes must include:

For evaluation codes (97161-97163):

1. Detailed patient history
2. Examination findings for each body region assessed
3. Clinical decision-making process
4. Plan of care with specific goals

For treatment codes (97110, 97112, etc.):

1. Specific interventions provided
2. Time spent on each intervention
3. Patient’s response to treatment
4. Progress toward established goals
5. Any modifications to the treatment plan

Medicare’s 2025 guidelines emphasize the importance of documenting medical necessity for each service provided. Your notes should clearly explain why each intervention was necessary and how it relates to the established plan of care. (CMS, 2025)

What are the new physical therapy CPT codes for 2025?

The 2025 updates include several significant changes for physical therapy coding:

New caregiver training codes:

1. 97550: Caregiver training, initial 30 minutes
2. 97551: Caregiver training, each additional 15 minutes
3. 97552: Caregiver training group (2-5 caregivers)

Modified upper extremity device codes:

1. E1800: Now “Dynamic adjustable elbow ext. AND flex. device”
2. E1805: Updated to “Dynamic adjustable wrist ext. AND flex. device”
3. E1825: Changed to “Dynamic adjustable finger ext. AND flex. device”

New upper extremity device codes:

1. E1803: Dynamic adjustable elbow extension only device
2. E1804: Dynamic adjustable elbow flexion only device
3. E1807: Dynamic adjustable wrist extension only device
4. E1808: Dynamic adjustable wrist flexion only device

These updates reflect Medicare’s increased focus on caregiver involvement and more specific coding for orthotic devices. (APTA, 2025)

Can I bill for physical therapy evaluation and treatment on the same day?

Yes, you can bill for both evaluation (97161-97163) and treatment codes (97110, 97112, etc.) on the same day if both services are medically necessary and properly documented. There is no Medicare rule prohibiting same-day evaluation and treatment.

However, your documentation must clearly support the medical necessity of providing both services on the same day. The treatment provided should be directly related to the findings from the evaluation and consistent with the established plan of care.

Some commercial payers may have specific policies regarding same-day evaluation and treatment, so it’s important to verify individual payer requirements. (APTA, 2025)

How do I bill for group therapy in physical therapy?

Use CPT code 97150 for therapeutic procedures provided in a group setting. Group therapy is defined as simultaneous treatment of two or more patients who may or may not be performing the same activities. Medicare reimburses group therapy at a lower rate than individual therapy.

Key requirements for billing group therapy include:

• The therapist must provide constant attendance but not one-on-one patient contact
• Documentation must reflect the group setting
• Each patient must have their own treatment plan
• Group size is typically limited to 4-6 patients per therapist

For Medicare billing in 2025, group therapy is not subject to the 8-minute rule and is billed as one unit regardless of duration. However, your documentation should still indicate the total time spent in the group session. (Medicare, 2025)

What happens if I use the wrong CPT code for physical therapy services?

Using incorrect CPT codes can lead to several negative consequences:

1. Claim denials or delays in payment
2. Requests for refunds from insurance companies
3. Potential audits and investigations
4. Financial penalties for incorrect billing
5. In severe cases, allegations of fraud

If you discover you’ve used an incorrect code after submission, the proper procedure is to submit a corrected claim as soon as possible. For Medicare claims, use the appropriate claim adjustment reason code and include clear documentation explaining the correction.

The 2025 Medicare guidelines emphasize the importance of regular internal audits to identify and correct coding errors before they become problematic. (CMS, 2025)