Physical therapy, also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease prevention, and health promotion. Some common physical therapy procedures are given below:
Physical Therapy CPT codes:
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97110: Therapeutic Exercise
A common code for a therapeutic procedure that aims to improve strength, endurance, flexibility, and range of motion. This procedure takes place in one or more areas every 15 minutes.
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97112: Neuromuscular Re-education
A code for a therapeutic procedure that aims to improve balance, coordination, posture, and more. This procedure also focuses on neuromuscular reeducation to enhance movement and function and takes place in 15-minute increments.
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97116: Gait Training
It is a time-based code used by physical and occupational therapists to bill for gait training. It’s used when a qualified clinician trains a patient in specific activities to improve their walking and functional mobility.
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97140: Manual Therapy
A code for therapy that aims to increase the range of motion, and extensibility of myofascial tissue, and help patients return to functional activities. This code is reported in units of 15 minutes.
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97150: Group Therapy
A code for group therapy in physical medicine and rehabilitation.
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97530: Therapeutic Activities
A code for therapeutic activity that uses skilled activities to improve a patient’s health or functional capacity. These procedures use performance skills like reaching, standing, bending, lifting, and more.
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97535: Self-Care/Home Management Training
A code for self-care or home management training. The goal of this therapy is to help patients build confidence and independence in activities of daily living.
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97750: Physical Performance Test or Measurement
It is a Current Procedural Terminology (CPT) code that describes a physical performance test or measurement, also known as a Functional Capacity Evaluation (FCE)
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97761: Prosthetic Training
It is a medical procedural code under the range – Orthotic Management and Training and Prosthetic Training.
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97010: Hot or cold packs therapy
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97012: Mechanical traction therapy
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97014: Electric stimulation therapy
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97016: Vasopneumatic device therapy
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97018: Paraffin bath therapy
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97022: Whirlpool therapy
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97026: Infrared therapy
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97028: Ultraviolet therapy
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97032: Electrical stimulation
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97033: Electric current therapy
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97034: Contrast bath therapy
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97035: Ultrasound therapy
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97036: Hydrotherapy
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97039: Physical therapy treatment
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97113: Aquatic therapy/exercises
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97124: Massage therapy
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97127: Therapeutic interventions with a focus on cognitive function
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97139: Physical medicine procedure
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97151: Behavioral identification assessment
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97153: Adaptive behavior treatment by protocol
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97154: Group adaptive behavior treatment by protocol
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97155: Adaptive behavior treatment by protocol (modification)
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97156: Family adaptive behavior treatment guidance
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97157: Multi-family adaptive behavior treatment guidance
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97158: Group adaptive behavior treatment
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97161: PT evaluation, low complexity, 20 minutes
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97162: PT evaluation, moderate complexity, 30 minutes
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97163: PT evaluation, high complexity, 45 minutes
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97164: PT re-evaluation
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97750: Physical performance test
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97755: Assistive technology assessment
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97760: Orthotic management and training, first encounter
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97761: Prosthetic training, first encounter
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97763: Orthotic/prosthetic management, subsequent encounters
Specialty Specific Modifiers:
To ensure accurate adjudication of claims physical therapy, occupational therapy, and speech therapy service providers are required to append the claim with HCPCS specialty-specific modifiers.
When physical therapy, occupational therapy, or speech therapy services are provided, the claim must include the following modifiers to identify the therapy benefit to which the services will be applied:
Modifiers GN GO GP
| Modifier | Description |
|---|---|
| GN | Services delivered under an outpatient speech therapy plan of care. |
| GO | Services delivered under an outpatient occupational therapy plan of care. |
| GP | Services delivered under an outpatient physical therapy plan of care. |
Applicable Modifiers for Therapy Codes:
| CPT Code | Applicable Modifier |
|---|---|
| 92507 | GN, GO or GP |
| 92508 | GN, GO or GP |
| 92526 | GN, GO or GP |
| 92608 | GN, GO or GP |
| 92609 | GN, GO or GP |
| 96125 | GN, GO or GP |
| 97012 | GN, GO or GP |
| 97016 | GN, GO or GP |
| 97018 | GN, GO or GP |
| 97022 | GN, GO or GP |
| 97024 | GN, GO or GP |
| 97026 | GN, GO or GP |
| 97028 | GN, GO or GP |
| 97032 | GN, GO or GP |
| 97033 | GN, GO or GP |
| 97034 | GN, GO or GP |
| 97035 | GN, GO or GP |
| 97036 | GN, GO or GP |
| 97039 | GN, GO or GP |
| 97110 | GN, GO or GP |
| 97112 | GN, GO or GP |
| 97113 | GN, GO or GP |
| 97116 | GN, GO or GP |
| 97124 | GN, GO or GP |
| 97136 | GN, GO or GP |
| 97140 | GN, GO or GP |
| 97150 | GN, GO or GP |
| 97530 | GN, GO or GP |
| 97533 | GN, GO or GP |
| 97535 | GN, GO or GP |
| 97537 | GN, GO or GP |
| 97542 | GN, GO or GP |
| 97750 | GN, GO or GP |
| 97755 | GN, GO or GP |
| 97760 | GN, GO or GP |
| 97761 | GN, GO or GP |
| 97763 | GN, GO or GP |
| 97799 | GN, GO or GP |
| 98975 | GN, GO or GP |
| 98976 | GN, GO or GP |
| 98977 | GN, GO or GP |
| 98980 | GN, GO or GP |
| 98981 | GN, GO or GP |
| G0281 | GN, GO or GP |
| G0283 | GN, GO or GP |
| G0329 | GN, GO or GP |
| G0515 | GN, GO or GP |
| 92521 | GN |
| 92522 | GN |
| 92523 | GN |
| 92524 | GN |
| 92597 | GN |
| 92607 | GN |
| 97161 | GP |
| 97162 | GP |
| 97163 | GP |
| 97164 | GP |
| 97165 | GO |
| 97166 | GO |
| 97167 | GO |
| 97168 | GO |
Modifiers CQ and CO:
The HCPCS modifiers CQ and CO modifiers are required to be used for services furnished “in whole or in part” by a physical therapy assistant (PTA) or occupational therapy assistant (OTA). These modifiers should be used on the claim line of the service, alongside the respective GP or GO therapy modifier. Modifier CQ must be paired with the GP therapy modifier and modifier CO must be paired with the GO therapy modifier.
HCPCS modifiers CQ and CO do not apply to services furnished by PTAs and OTAs that are “incident to” the services of physicians or nonphysician practitioners.
Modalities in physical therapy:
- Therapeutic ultrasound
- electrical stimulation
- Traction (orthopedics)
- Transcutaneous electrical nerve stimulation
- Phonophoresis
- Cryotherapy
- Heat
- Iontophoresis
- Low-level laser therapy
- Massage
- Elastic therapeutic tape
- Biofeedback
- Heating Pad
- Exercise
- Ice massage
- Mineral oil
- Heat therapy
- Electrotherapy
- Manual therapy
- Dry needling
- Neuromuscular rehabilitation
- Acupuncture
- Hot Packs
CPT codes for physical therapy modalities:
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97110
A common code for a therapeutic procedure that develops strength, endurance, flexibility, and range of motion
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97112
A code for neuromuscular re-education, which uses exercises and techniques to improve balance, posture, coordination, and more
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97530
A code for therapeutic activities that require face-to-face interaction with a therapist, such as exercises that improve the function of muscles, ligaments, and other tissues
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97162
A code for a moderate complexity physical therapy evaluation that includes a patient’s history to rule out adverse factors
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97035
A code for ultrasound, which can be pulsed or continuous, and is often used with other therapeutic procedures
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97010
A code for cryotherapy, which may be bundled into the payment of other physical medicine services
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97750
A code for a physical performance test, which is an objective assessment of a patient’s abilities in various functional tasks
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97124
A code for massage therapy, which may be used as an adjunctive treatment to restore muscle function, improve joint motion, or relieve muscle spasms
Modifier 59 description with example
Modifier 59 in medical billing signifies that a distinct procedural service was performed, meaning you are billing for a procedure that is not typically reported together with another procedure, but is appropriate under the specific circumstances of the patient’s case; it’s used to indicate that two procedures were done at the same visit but on different anatomical sites or involved separate injuries, requiring separate billing.
Here are some examples of when to use modifier 59:
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Multiple therapy codes
Modifier 59 can be used when multiple therapy codes are billed on the same day
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Different sessions or patient encounter
Modifier 59 can be used when procedures are performed during different patient encounters.
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Different procedures or surgery
Modifier 59 can be used when different procedures or surgeries are performed.
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Different site or organ system
Modifier 59 can be used when procedures are performed on different sites or organ systems.
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Separate incision or excision
Modifier 59 can be used when procedures are performed through separate incisions or excisions.
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Separate lesion
Modifier 59 can be used when procedures are performed on separate lesions.
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Separate injury
Modifier 59 can be used when procedures are performed on separate injuries.
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Diagnostic procedure and linked therapeutic procedure
Modifier 59 can be used to indicate that a diagnostic procedure was the basis for a linked therapeutic procedure.
Modifier 59 should not be used on Evaluation and Management Codes.