CPT 97110 Billing Guide 2025 - Therapeutic Exercise Documentation & Rates

CMS 2026 Update — CPT 97110

CY2026 guidance for CPT 97110 (Therapeutic exercise) remains consistent: document specific exercises, targeted impairments, and progress toward functional goals. CMS highlighted accurate time tracking and medical necessity as audit priorities.

What is CPT 97110?

CPT 97110 represents therapeutic exercise — a procedure involving exercises to develop strength, range of motion (ROM), and endurance.

Typical uses: Rehabilitation post-surgery, chronic pain management, and improving functional mobility.

In short: CPT 97110 = Targeted therapeutic exercise for strength, ROM, and endurance.

When to Use CPT 97110 (and When Not To)

Use 97110 for individualized therapeutic exercises aimed at improving physical function.

Do not use for general fitness or exercises not requiring skilled intervention.

Clinical Examples

97110 vs 97112 (Quick Comparison)

     Feature
     

97110 — Therapeutic Exercise

97112 — Neuromuscular Reeducation

     Purpose
     

Improve strength, ROM, endurance

Enhance balance, coordination, posture

     Documentation focus
     

Exercise specifics and progress

Functional improvement in neuromuscular control

     Typical examples
     

Strength training post-surgery

Balance training for stroke recovery

     When billed together
     

Use -59 if both are distinct

Differentiate therapeutic intent

2025/2026 Medicare Reimbursement Rates-CPT 97110

Medicare reimbursement for CPT97110 is calculated by multiplying the code's Relative Value Units (RVUs) bythe annual CMS Conversion Factor. For 2025, the CMS Conversion Factor droppedto $32.35, resulting in an average Medicare payment of approximately $28.79 perunit for CPT 97110 in non-facility settings.

For 2026, CMS introduced atwo-tier conversion factor for the first time in Medicare history:

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Two-Tier 2026 Conversion Factor (APM vs Non-APM)

2026 CMS Update: Two Conversion Factors — What PT Clinics Must Know

For the first time in Medicare'shistory, CMS implemented two separate conversion factors in 2026. Which rateapplies to your practice depends entirely on your participation in anAlternative Payment Model (APM).

What ThisMeans Practically

•       If your practiceparticipates in a qualifying ACO or Advanced APM, you receive the higher$33.5675 conversion factor — a 3.77% increase from 2025.

•       If your practice does NOTparticipate in an APM, you receive $33.4009 — still a 3.26% increase from 2025.

•       APM Qualifying Participant(QP) status for 2026 payment is based on your 2024 performance data. Check yourstatus at qpp.cms.gov immediately.

CQ Modifier: Billing CPT 97110 When a PTA Provides the Service

If a Physical Therapist Assistant(PTA) provides any portion of CPT 97110, you must apply the CQ modifier — and understand the financial impact before your next claim submission.

The 15%PTA Differential Rule

Under CMS rules effective since 2022, when a PTA provides more than 10% of the total service minutes for atimed code like 97110, Medicare automatically applies a 15% payment reduction. Without the CQ modifier appended to your claim, Medicare cannot apply this rule correctly — and your claim will be flagged or denied.

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Real-World Example

A patient receives 30 minutes of CPT 97110. The PT supervises and treats for the first 10 minutes. The PT treats for the remaining 20 minutes (67% of total service time).

•       Because the PTA provided>10% of service minutes, the CQ modifier is required on the entire claim.

•       Without CQ: Medicare flags the claim as potentially miscoded, resulting in a denial or post-payment audit.

•       With CQ correctly applied: Medicare pays at the reduced -15% rate, but the claim is clean and paid without delay.

KX Modifier 2026: Updated Threshold You Must Know

The KX modifier is required on Medicare claims for CPT 97110 once a patient reaches the Medicare therapy cap threshold. CMS updates this threshold annually based on the Medicare Economic Index (MEI).

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How to Apply KX Correctly for 97110

•       The KX modifier certifies that the services are medically necessary and that clinical documentation supports continued treatment beyond the threshold.

•       KX must be applied to EVERY timed code claim — including 97110 — once the patient's cumulative PT + SLP charges for the year reach $2,480 in 2026.

•       Document a functional maintenance plan or continued skilled care justification in the patient record before appending KX.

KX without supporting documentation is an immediate audit trigger. CMS auditors specifically look for KX claims without a corresponding functional goal in the SOAP note.

Can CPT 97110 Be Billed Via Telehealth in 2026?

Yes — with important conditions. The Consolidated Appropriations Act of 2026, signed February 3, 2026, extended Medicare telehealth flexibilities for PT, OT, and SLP through December 31 ,2027. This means therapeutic exercise (97110) can be billed via telehealth under Medicare — but only if specific requirements are met.

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What Cannot Be Billed via Telehealth

•       Services requiring physical contact (manual therapy, electrical stimulation) cannot be billed as telehealth— these require in-person delivery.

•       97110 billed via telehealth must involve active PT supervision and engagement — it cannot be a patient performing exercises independently while on a video call.

New 2026 RTM Codes: Additional Revenue Alongside CPT 97110

CMS finalized three new Remote Therapeutic Monitoring (RTM) codes effective January 1, 2026 that PT clinics can use alongside CPT 97110 to capture additional Medicare reimbursement for home exercise program monitoring.

How toUse RTM Alongside 97110

If your practice uses a homeexercise app or wearable device that transmits patient compliance data:

•       Enroll the patient in RTMat initial evaluation when prescribing a home exercise program alongsidein-clinic 97110.

•       Bill 98985 monthly when thedevice transmits at least 2 days of data — this is in addition to yourin-clinic 97110 billing.

•       Bill 98979 when a clinicalstaff member spends at least 10 minutes reviewing RTM data and has one liveinteraction (call or message) with the patient that month.

•       RTM is NOT bundled with97110 — these are separately billable services for separately occurringactivities.

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Documentation Guidelines (CMS & MIPS 2025 Compliant)

‍
 

Thorough documentation demonstrates medical necessity, skilled care, and functional intent. Include:

Sample SOAP Note (De-identified)

 
S: Patient reports mild discomfort during exercises but is motivated to continue.
O: Patient completed 20 minutes of therapeutic exercises focusing on lower extremity strength.
A: Improved endurance noted; patient tolerated exercises well with minimal cues.
P: Continue current exercise regimen, increase resistance as tolerated.
 



 

Modifiers & Coding Tips

-59

Distinct procedural service

-52

Reduced services

GP

Services delivered under an outpatient physical therapy plan of care

Claim tip: Ensure documentation supports the use of modifiers to avoid denials.

Common Denials & How to Prevent Them

Audit trigger: Frequent use of -59 modifier without clear documentation.

Region & Local Payer Notes

In California, CPT 97110 is subject to specific guidelines under Palmetto GBA. Providers should verify local MAC policies and ensure compliance with state-specific Medicaid rules.

FAQs

What qualifies as therapeutic exercise under 97110?

Therapeutic exercise includes active, repeated movements to restore strength, endurance, or range of motion. Document the exercise type, repetitions, resistance, and patient response.

How do I document units for 97110?

Record precise start/end times and minutes spent on each exercise to apply the 8-minute rule for timed codes.

Can 97110 be billed with 97530?

Yes, when services are distinct in purpose and content; document separate goals and skilled actions.

What causes denials for 97110?

Denials commonly result from vague documentation, lack of measurable goals, or incorrect unit calculation.

Is prior authorization needed for exercise therapy?

Some commercial payers require prior authorization for prolonged therapy courses; Medicare rarely does for standard outpatient PT.

How to demonstrate progress in notes?

Include objective measures and comparisons over time tying improvements to functional gains.

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