CPT Codes Physical Therapists Need to Know

Billing is a part of being a physical therapist. In order to make a difference in patient’s lives, PTs need to learn how to bill, and bill correctly. A critical component of physical therapy billing are CPT codes. Knowing which codes to use and when will make a huge difference in receiving reimbursements and getting the most revenue for your clinic. 

A quick note on ICD Codes

Not to be confused with CPT Codes, ICD codes are also useful for proper billing procedures. International Classification of Diseases (ICD) Codes denote a diagnosis for a patient condition in a manner that demonstrates the medical need for your services. Make no mistake, the codes can be complicated, but it’s worth spending time to know which ones to use if you need to use them. An updated list can be found here.

If you’re ever confused about whether the code you listed is reimbursable under your payer’s policy, call them before submitting the claim. According to APTA, “Your goal is to maximize the number of claims that are paid on the first submission and to minimize the need for appeals.” In other words, it’s better to double check and get paid then submit a claim and waste your time. 

Current CPT Codes

The American Medical Association developed CPT codes, and describes them as “the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs.” According to the APTA, “When billing most third parties for services…it is necessary to utilize CPT-4 codes to describe the services that were rendered. Although CPT is not an exact description of physical therapists’ interventions, it does provide a reasonable framework for billing.”

The most applicable CPT codes for physical therapists are in the 97000 section, aptly called the “Physical Medicine and Rehabilitation.” But as a therapist, you are not restricted to only using these codes. You can bill any code as long as it truly  represents the service you provide and that it is legal under state law. However, just because you can legally bill for it does not mean your payer will reimburse you for it. Remember what we said above? Double check with your payer if you’re billing for a code that falls outside of this section. 

All physical therapists should know the following CPT codes and categories thoroughly before billing for their services:

• PT evaluations (97161-97163) and OT evaluations (97165-97167), which are tiered according to complexity:
  • 97161: PT evaluation – low complexity
  • 97162: PT evaluation – moderate complexity
  • 97163: PT evaluation – high complexity
  • 97165: OT evaluation – low complexity
  • 97166: OT evaluation – moderate complexity
  • 97167: OT evaluation – high complexity
• PT re-evaluations (97164) and OT re-evaluations (97168)
• Supervised (untimed) modalities (97010–97028)
• Constant attendance (one-on-one) modalities (97032–97039, which are billable in 15-minute increments)
• Therapeutic (one-on-one) procedures (97110–97546)
• Active wound care management (97597–97606)
• Tests and measurements (97750–97755)
• Orthotic and prosthetic management (97760–97762)

Once you’re familiar with the most-used CPT codes, it’s time to pair your aptitude with a comprehensive and affordable EMR software. Schedule a demo with AgileEMR to discover how an efficient, easy-to-use EMR can enhance your clinical procedures.