Mastering CPT Code 97110 in Rehab Therapy

In the field of rehab therapy, mastering the intricacies of medical billing codes can make a significant impact on your therapy practice’s efficiency and financial health. Within the specific fields of physical therapy and occupational therapy, CPT® code 97110 stands out as one of the most used codes, making it essential for therapists and billing professionals to understand its proper application.

CPT® code 97110 is used for billing therapeutic exercises that are aimed at improving patients’ strength, endurance, range of motion, and flexibility, making it a cornerstone of many treatment plans. By accurately utilizing code 97110, therapists can ensure appropriate reimbursement, maintain compliance with insurance requirements, and improve high-quality, individualized care that drives positive patient outcomes.

In this blog post, we discuss correct coding best practices for therapeutic exercise. This includes when and how to use code 97110 to stay compliant and avoid reimbursement claim denials, as well as how therapeutic exercises can improve functional performance in patients.

What is CPT® Code 97110?

For billing purposes in the medical setting, CPT 97110 stands for “therapeutic procedure, one or more areas, every 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility.” This code is typically used by physical therapists, occupational therapists, and other rehabilitation professionals when they provide individualized therapeutic exercises designed to improve a patient’s functional abilities.

Here’s a closer look at what this means and how CPT 97110 applies in various therapeutic settings.

Definition and Description of CPT® Code 97110

CPT® code 97110 is used to document and bill for individualized therapeutic exercises that a therapist provides to a patient. These exercises are designed to enhance physical capabilities in four key areas.

• Strength: Building muscle power and stability
• Endurance: Increasing the ability to sustain physical activity over time
• Range of Motion: Improving the movement capacity of joints
• Flexibility: Enhancing the elasticity of muscles and tendons

This is a timed code, with each unit representing 15 minutes of direct patient contact. In other words, the 8-minute rule applies. It’s important for therapists to accurately track the time spent on these exercises to ensure proper billing.

Common Uses and Scenarios

CPT® code 97110 is versatile and applicable to a range of conditions and treatment goals. Here are some common scenarios where this procedural code is used.

Post-Surgical Rehabilitation

After surgeries such as ACL reconstruction or joint replacement, patients often need structured exercise programs to regain strength and mobility. For example, a patient recovering from knee surgery might perform leg press exercises and guided range-of-motion activities to rebuild muscle and improve joint function.

Chronic Pain Management

Patients dealing with chronic pain conditions, like lower back pain or osteoarthritis, benefit from therapeutic exercises that enhance their physical capabilities and reduce discomfort. Exercises targeting core stability and flexibility can significantly alleviate pain and improve quality of life.

Neurological Rehabilitation

Individuals recovering from neurological issues and emergencies such as stroke or traumatic brain injury often require exercises to restore function. Therapeutic exercises help retain muscles, improve coordination, and increase strength, which are critical for regaining independence.

General Strength and Conditioning

Beyond specific medical conditions, CPT® code 97110 is used for general strengthening and conditioning programs. These programs are designed to prevent injuries, maintain physical health, and improve overall fitness, particularly in aging populations or those with sedentary lifestyles.

In all these scenarios, the therapeutic exercises billed under code 97110 are integral to the patient’s rehabilitation process, providing structured and measurable improvements in physical health. By understanding the definition, application, and common uses of this CPT® code, therapists can ensure they are maximizing its potential to benefit their patients and their practice.

Why is it Important to Correctly Apply CPT Code 97110?

Proper utilization of CPT® code 97110 is essential for several reasons, ranging from financial integrity to ensuring the highest quality of patient care. Here are the key aspects highlighting its importance.

Accurate Billing and Reimbursement

The accurate use of code 97110 ensures that therapists and clinics receive fair compensation for the therapeutic exercises provided. Misbilling or underbilling can lead to significant financial losses, while overbilling may result in penalties or audits.

In addition, proper coding minimizes the risk of insurance claim denials. Insurers require detailed and accurate physical therapy documentation to justify the necessity and appropriateness of billed services. Adhering to correct coding practices ensures smoother claim processing and timely reimbursements.

Documentation and Justification of Services

Rehab therapists must maintain detailed documentation of each session, including the specific exercises performed in the same session, the duration of each exercise, and the patient’s response. This documentation is crucial for supporting the medical necessity of the therapy and for audits. That’s because insurers require clear justification for the services billed, and a medical necessity is exactly that.

Proper use of CPT® code 97110 involves demonstrating that the therapeutic exercises prescribed are essential for the patient’s treatment plan, based on their diagnosis and individual needs.

Ensuring High-Quality Patient Care

CPT 97110 is used for personalized therapeutic exercises tailored to each patient’s specific condition and goals. Correct application of this code ensures that patients receive appropriate, customized care that addresses their unique rehabilitation needs.

Accurate documentation and coding also allow for effective tracking of patient progress. Therapists can adjust treatment plans based on documented improvements or challenges, leading to better patient outcomes.

Compliance with Insurance and Medicare Guidelines

Finally, adhering to the correct use of code 97110 ensures compliance with insurance policies and Medicare regulations. This reduces the risk of legal issues, audits, and penalties associated with incorrect billing practices.

Proper coding reflects a commitment to ethical standards in healthcare, as well. It demonstrates that physical and occupational therapists are providing necessary and appropriate care, billed accurately and transparently.

What Are Some Examples of Exercises Under CPT Code 97110?

CPT® code 97110 encompasses a wide range of therapeutic exercises designed to improve a patient’s strength, endurance, range of motion, and flexibility. These exercises are crucial components of many rehabilitation programs and are tailored to meet the specific needs of each patient.

Here are some detailed examples of exercises that fall under this code.

Strength

Strength exercises in rehab therapy involve targeted activities designed to increase muscle power and stability, aiding in the recovery and enhancement of physical function after injuries or surgeries. Examples include:

• Leg Press Exercises. These are commonly used in post-surgical rehabilitation for knee or hip surgeries to rebuild lower body strength.
• Bicep Curls. Curls are useful for patients recovering from arm or shoulder injuries to regain upper body strength.

Endurance

Endurance exercises in rehab therapy (rehab therapy being physical therapy primarily in this case, but also refers to occupational therapy and speech language pathology) focus on improving cardiovascular fitness and the ability to sustain prolonged physical activity, an exercise program which helps patients build stamina and recover from conditions affecting their overall physical endurance. Examples include:

• Stationary Biking. This is often used in cardiac rehabilitation or for patients needing to enhance their overall cardiovascular health.
• Treadmill Walking. Walking is ideal for patients recovering from lower extremity injuries or surgeries, helping them regain stamina.

Range of Motion

Range of motion exercises in rehab therapy involve activities that enhance joint flexibility and mobility, crucial for restoring normal movement patterns and reducing stiffness following injuries or surgeries. These include:

• Pendulum Exercises. Frequently used for patients with frozen shoulder (adhesive capsulitis), pendulum exercises  increase shoulder range of motion.
• Shoulder Wall Slides. These are beneficial for patients recovering from shoulder surgeries or injuries to restore full range of motion.

Flexibility

Flexibility exercises in rehab therapy aim to stretch and lengthen muscles and tendons, improving elasticity and range of motion to facilitate easier movement and reduce the risk of injury recurrence.

• Hamstring Stretches: Commonly used for patients with lower back pain or tight hamstrings to improve flexibility.
• Cat-Cow Stretches: Effective for patients with back stiffness or those needing to improve spinal flexibility.

Comprehensive Examples

While the above examples are cut-and-dry depictions of specific exercises that fall under the category of code 97110, they are not completely representative of the needs of typical rehab therapy patients. Many patients require a combination of all four types of exercise interventions—all of which fall under code 97110—to remaster various functional activities used for daily living. For example:

• Post-Stroke Rehabilitation. Therapeutic activities may include hand grip exercises using a stress ball or therapy putty to improve grip strength, seated marching exercises to build leg endurance, assisted shoulder movements to increase range of motion, and gentle yoga poses to enhance overall flexibility.
• Arthritis Management. This therapy offers some pain relief and improves functionality for those suffering from arthritis, with therapeutic activities that may include resistance band exercises for upper and lower body strength; low-impact aerobic exercises, like water aerobics, to improve endurance; joint mobilization exercises to maintain movement and range of motion; and stretching routines targeting major muscle groups to reduce stiffness.

By incorporating these examples into their practice—while keeping detailed records of the exercises performed, including duration and patient response—therapists can effectively use CPT® code 97110 to enhance patient outcomes through structured and goal-oriented therapeutic exercises.

What is the 8-Minute Rule?

As stated earlier, the eight-minute rule applies whenever a clinician uses CPT® code 97110. What does this mean? Here’s a brief refresher.

For a deeper dive on using Medicare’s 8 minute rule check out this in-depth guide

The eight-minute rule governs how time-based CPT® codes are billed in increments. Specifically, each unit of CPT® code 97110 represents 15 minutes of therapeutic exercise. To bill for a unit, therapists must meet specific time requirements, a critical component of compliance and proper reimbursement.

Within this framework, rehab therapists bill for one unit of a time-based code if they provide at least eight minutes, but less than 23 minutes, of a specific service. Here’s a breakdown of what this looks like.

• 1 Unit: 8 to 22 minutes of therapy
• 2 Units: 23-37 minutes of therapy
• 3 Units: 38-52 minutes of therapy
• 4 Units: 53-67 minutes of therapy

For each additional 15-minute block beyond these ranges, another unit can be billed. So, if a rehab therapist provides a single patient with a therapy procedure (or procedures) that lasts 70 minutes, they are required to bill for five units.

Of course, accurate time tracking as well as detailed documentation is required to support the exercises and treatments performed throughout the entire session.

What Other CPT® Codes Are Commonly Used with 97110?

While CPT® code 97110 is integral to many rehabilitation therapy programs, it is often used in conjunction with other CPT® codes to provide comprehensive patient care. Understanding when and how to use these complementary codes is essential for the treatment program, delivering effective therapy, ensuring accurate billing, and maintaining compliance with insurance guidelines.

Here are some commonly used CPT® codes that often accompany CPT 97110:

• CPT® Code 97112 – Neuromuscular Re-Education: This code is for treatments aimed at improving balance, coordination, posture, and proprioception. It is applicable for patients with neurological impairments, such as those recovering from a stroke, traumatic brain injury, or other conditions affecting motor control. For example, a patient recovering from a stroke may receive balance training exercises to improve stability and coordination, alongside strength exercises billed under 97110.
• CPT® Code 97116 – Gait Training: Gait training code 97116 is used for training patients to walk more efficiently and safely, often incorporating assistive devices. Such treatments are ideal for patients with walking impairments due to surgeries, injuries, or neurological disorders. For instance, a post-hip replacement patient might engage in gait training to learn how to use a walker, in addition to lower body strengthening exercises billed under 97110.
• CPT® Code 97140 – Manual Therapy Techniques: This code covers hands-on therapy techniques, such as joint mobilization, manipulation, and manual lymphatic drainage. This code is to be used for patients requiring manual intervention to address joint dysfunctions, muscle tightness, or soft tissue restrictions. A patient with lower back pain might receive manual therapy to relieve muscle tension, followed by core strengthening exercises billed under 97110.
• CPT® Code 97530 – Therapeutic Activities: Not to be confused with 97110, which is used for therapeutic exercise, this code is for activities aimed at improving functional performance through dynamic movements and tasks. The use of this code is suitable for patients needing to improve their ability to perform daily activities, often in a simulated real-life scenario. A patient recovering from shoulder surgery, for example, might engage in reaching and lifting tasks to restore functional use of the shoulder, alongside specific exercises for strength billed under 97110.
• CPT® Code 97535 – Self-Care/Home Management Training: This involves training patients in activities of daily living (ADLs) and home management skills. It is useful for patients who need to regain independence in daily activities such as dressing, cooking, or managing household tasks. An elderly patient recovering from a hip fracture may receive training on safe ways to perform activities for daily living (ADLs), in addition to exercises for mobility and strength billed under 97110.

By effectively using CPT® code 97110 alongside these complementary codes, physical therapists can provide a holistic approach to patient care. This not only enhances the quality of treatment but also ensures accurate and compliant billing, optimizing both patient outcomes and practice efficiency.

Bringing It All Together with CPT® Code 97110

Proper utilization of CPT® code 97110 is integral to the success of any rehabilitation therapy practice. By combining accurate billing, detailed documentation, individualized therapy plans, and compliance with guidelines, therapists and billing professionals can achieve several critical goals.

By bringing all these elements together, rehabilitation therapy practices can not only improve their financial health but also enhance the quality of care they provide. This comprehensive approach ensures that patients receive the best possible treatment, while therapists and billing professionals work within a framework that supports accuracy, compliance, and efficiency.

This holistic strategy ultimately benefits everyone involved, from the patients who receive better care to the practices that operate more smoothly and profitably.