CPT Code 97110

One of the most commonly utilized physical therapy codes is CPT 97110 - Therapeutic Exercise. Since it is actively used by therapists, it is also extensively scrutinized by payers in connection with reimbursement. Now, to ensure that you are receiving proper reimbursement for your hard work, it is very critical that you understand how to properly document this code.

What is CPT 97110?

CPT 97110 is specially designed for specific therapeutic exercises, aiming at the development of strength, endurance, range of motion, and flexibility. Forasmuch as this statement seems quite simple, then its appropriateness would be subject to some very important key points in reference, though not limited to; the exercises' supervision amount, the same exercises' time spent, and they must be prescribed specifically.

Common Uses and Scenarios for CPT 97110

CPT code 97110 is applicable to a wide range of conditions and treatment goals. Here are some common scenarios:

‍

1. Post-Surgical Rehabilitation:

• Joint replacements: Knee, hip, shoulder
• ACL reconstruction
• Rotator cuff repair

2. Chronic Pain Management:

• Lower back pain
• Osteoarthritis
• Fibromyalgia

3. Neurological Rehabilitation:

• Stroke
• Traumatic brain injury
• Spinal cord injury

4. General Strength and Conditioning:

• Injury prevention
• Aging-related muscle loss
• Improved overall fitness

Importance for Therapists

Understanding CPT 97110 is crucial for physical therapists to ensure proper billing and reimbursement. Accurate use of this code helps in documenting the therapeutic exercises performed and justifying their medical necessity, which in turn supports appropriate reimbursement from insurance providers and prevents claim denials.

When to Use CPT Code 97110

• Clinical Scenarios: Use CPT 97110 when performing exercises that directly target deficits in strength, flexibility, endurance, or range of motion. For example, exercises like resistance training with weights or stretching routines for an injured shoulder would be billed under this code.
• Typical Uses: It is applicable for patients recovering from surgeries, injuries, or conditions that impair their physical function, such as rotator cuff repairs or stroke rehabilitation.

Common Misconceptions 

• Not for All Exercises: CPT 97110 is specific to therapeutic exercises aimed at functional improvement and should not be used for non-rehabilitative or recreational activities.
• Timed Code Requirements: The code is a timed code, requiring direct supervision for each 15-minute increment (IE for every 15 minutes of therapeutic exercise provided and supervised by the therapist, one unit of CPT 97110 can be billed. If the session lasts for 30 minutes, for example, two units of CPT 97110 would be billed). Misunderstanding this can lead to improper billing and reimbursement issues.

Associated Codes

• CPT 97530 (Therapeutic Activities): Used for exercises that involve dynamic, functional tasks to improve performance in daily activities.
• CPT 97112 (Neuromuscular Re-education): Used for exercises that focus on improving motor control and coordination.

Time Matters: The Timed Code Aspect of CPT 97110

CPT 97110 is a time-based code, so the number of units that you can bill is based on how long it takes to do the exercise. Most payers use Medicare's guidance, and for CPT 97110, there is what's called the eight-minute rule. The exercise must last a minimum of eight minutes and up to 22 minutes in order for you to bill one unit of CPT 97110. 

This is, of course, a trickier rule, especially with mixed remainders—that is, the leftover minutes from other modalities that could be sum-mated and used to bill another unit. Appropriate documentation of time can prevent difficulty with reimbursement.

Modifier to CPT 97110

In addition to providing appropriate units, some payers may ask you to add a modifier that describes further the type of service you delivered. Services would typically be documented with the GP modifier, reflecting a service that is unique in terms of skills and knowledge for a physical therapist.

Take note that the GP modifier is used in cases where the services are provided under an outpatient physical therapy plan of care. Attachment of this makes the billing understandable and easily interpretable by the payers, hence helping them know why and where the services were being used.

For filing claims, it should be confirmed whether any insurance payer has a specific requirement for modalities used and, if so, which modality is to be used.

Step-by-Step Guide to Using CPT Code 97110

1. Assess the Patient:some text
   • Initial Evaluation: Conduct a thorough assessment to identify specific deficits in strength, range of motion, endurance, or flexibility.
   • Setting Goals: Establish clear, measurable goals based on the patient's needs and functional limitations.
2. Plan the Exercises:some text
   • Exercise Selection: Choose exercises that specifically address the identified deficits and align with the patient’s goals. Examples include resistance band exercises for strength and stretching routines for flexibility.
   • Treatment Plan: Develop a structured treatment plan that outlines the exercises, duration, frequency, and expected outcomes.
3. Document Thoroughly:some text
   • Detailed Records: Record the type of exercises performed, the duration of each exercise, and the specific body parts targeted.
   • Objective Measurements: Include baseline and progress measurements to show improvement over time.
4. Supervise Directly:some text
   • Active Engagement: Ensure you are actively supervising the patient during the entire exercise session to meet the requirements of CPT 97110.
   • Adjustments: Make real-time adjustments to the exercise routine based on the patient’s performance and feedback.
5. Review and Adjust:some text
   • Progress Monitoring: Regularly review the patient’s progress and adjust the exercise program as needed to address evolving needs and goals.
   • Documentation Updates: Update documentation to reflect any changes in the exercise program and patient progress.

Compliance Considerations

• Regulatory Requirements: Ensure compliance with state and federal regulations regarding direct supervision and documentation.
• Payer Policies: Review specific payer policies to align with their requirements for CPT 97110 billing.

Reimbursement Rates for CPT Code 97110 Across Different Insurance Companies

Common Reasons for Denials of CPT 97110

Even with documentation, denials can still occur. Some of the most common reasons for denials are that the exercises that have been done are not documented well enough, they were not supervised effectively, or there was not enough supporting documentation to show patient progress. To avoid these pitfalls, your documentation should contain:

• Specific exercises performed and their purpose.
• Length of the exercise portion and number of units billed.
• Details of the supervisor clinician.
• Evidence that the patient has improved over time.

In other words, the more detailed and thorough the documentation, the less the chance of denials and the more apt the practice will be for improved reimbursement.

Conclusion:

CPT 97110 is integral to billing for therapeutic exercises that enhance patient function and recovery. Understanding its application, documentation requirements, and reimbursement considerations helps physical therapists ensure accurate billing and improve patient care outcomes.

Struggling with your billing and revenue cycle management? Schedule a demo today and take the first step towards a more profitable and efficient practice.