Physical Therapy Insurance and CPT Codes – What Providers Need to Know

Physical therapists open clinics with the goal of helping people heal and lead more fulfilling lives, but revenue is what keeps the doors open. One of the biggest challenges with revenue and physical therapy is determining the right amount to charge patients. To aid in this determination, the American Medical Association (AMA) developed the Current Procedural Terminology (CPT). 

Physical therapy CPT codes can help your practice process accurate health insurance claims, but it is important to understand what they are, and how they work.  

What Are CPT Codes? 

CPT comprises numerical codes that qualified healthcare professionals use to report various procedures and services provided to patients. They are an integral part of medical billing since they describe the type of care offered. Without the correct CPT code, a patient’s insurance company can deny your physical therapy claims. 

Physical Therapy Billing Challenges 

Insurance companies should pay for physical therapy services rendered to a qualified individual. At the same time, they have immense control over the criteria for honoring or denying claims – resulting in inaccurate collections by providers. 

For example, insurance carriers typically don’t find the need for physical therapy intervention once a patient is declared “functional.” Functional Assessments can be given to patients and are measured through the use of impairment measures, self-report measures, and physical performance measures (PPMs).  

To avoid insurance billing mistakes, you must understand how to charge your patients and submit their claims correctly, which includes understanding how to prepare clean insurance claims and the use of the correct CPT codes.  

Preparing a Clean Claim 

After offering therapy services to a patient, you should submit a bill to the patient or the party responsible for making the payment. Alternatively, you can present the billing information to a claims clearinghouse for bill preparation. Ensure the form is complete, accurate, and legible.  

Avoid submitting any insurance claims before verifying the patient’s information, the party responsible for the bill, and health insurance information. Familiarize yourself with coordination of benefits issues to smooth out bill payment where a patient has more than one policy.  

If this process becomes too time consuming for you or your billing specialist(s), Reliable Revenue Cycle Management (RCM) services can help. RCM billing services, provided by denial management experts, can meet all your billing needs, including claim review for accuracy. Additionally, this billing solution option can assist clinics in identifying, collecting, and managing all payments from patients or third-party payers based on the services provided. For physical therapy practices where you must invoice each patient for unique interventions, this solution can be seen as indispensable.  

Therapy CPT Codes and Billing 

Your reimbursement for therapy services significantly relies on your ability to prepare bills, including utilizing the right CPT codes. In a nutshell, you must learn how to prove that the services you are providing are essential to the health of the patient.  

Understanding common physical therapy CPT codes can help in making an additional argument for your services. You can write detailed descriptions of the interventions you intend to bill and submit to insurance companies. By doing so, you’ll prove your value as a therapist and capture every justifiable opportunity for getting paid. 

Types of CPT Codes: Timed versus Untimed 

Besides your effort in offering therapeutic interventions, you need to know how to charge for your time. Let’s distinguish between timed and untimed codes. 

Timed CPT Codes 

Timed codes represent the services for which you can bill patients for the time you spend with them one-on-one. This includes the time for pre-treatment, treatment, and post-treatment. 

Untimed CPT Codes 

With untimed codes, the therapist receives a predetermined amount regardless of the time spent applying the intervention or the number of body areas treated. You can only bill your services once per therapy session, without including the treatment duration. 

Common Physical Therapy CPT Codes 

Below is an overview of some of the most popular CPT codes in physical therapy.  

97110: Therapeutic Exercise 

This code includes exercises for: 

  • Strengthening 
  • Endurance 
  • Flexibility 
  • ROM therapy 

The therapeutic exercise code doesn’t require high-level skills, which may explain why insurance companies offer relatively low reimbursement for it. Many therapists erroneously use this code for interventions that better fit therapeutic activity below. 

97530: Therapeutic Activities 

These are dynamic activities meant to boost functional performance. Examples include:  

  • Hip-hinge training 
  • Sit-to-stand training 
  • Bed mobility 
  • Car transfer training 
  • Squats 
  • Swinging a bat 
  • Throwing a ball 

Compared to therapeutic exercise, this code gets a higher reimbursement. The activities involved are repetitive and require skilled intervention. 

97112: Neuromuscular Re-education 

The code encompasses the activities that help re-educate posture, balance, movement, coordination, and kinesthetic sense. Activities requiring high-level coordination and cueing to retrain neuromuscular output are in this category. They include stabilization exercises, Kinesio-taping, ergonomic training, improving motor control, jump training, and facilitation or inhibition. 

97116: Gait Training 

You can only use the gait training code if you are using biomechanics of the gait cycle in a certain way. Examples include but are not limited to utilizing assistive devices, training with a weight-bearing status, and sequencing. 

97140: Manual Therapy 

Under this code, you can seek reimbursement for interventions like joint and tissue mobilization, manipulation, manual lymphatic drainage, and muscle energy techniques. The reimbursement rate for manual therapy is lower than therapeutic activities, therapeutic exercise, and neuromuscular re-education. 

97761: Prosthetic Training 

This area of physical therapy revolves around fitting and training patients on the use of prosthetic devices. It also includes the assessment of the appropriate prosthetic device, excluding fabrication time. 

97762: Checkout for Prosthetic Use 

Also referred to as Checkout for Orthotic Use, this code describes the evaluation of an existing orthotic or prosthetic device for effectiveness. It also includes a therapist’s recommendation for orthotic device change. 

A2C Medical’s EMR for Billing and Claims 

Are you a physical, occupational or speech therapist looking for help with the insurance claims process? With a complete RCM billing solution integrated directly into our EMR, A2C Medical can be your solution. Our software offers cash flow transparency and brings you peace of mind that your insurance billing process is organized and complete. Fill out the form below to speak to a specialist today to learn more.  

0 Comments

Leave a Reply

Popular Posts

Physical Therapy Assessments and Why You Need Them
Physical Therapy Assessments and Why You Need Them

Physical therapy assessments and forming a detailed case based on the assessment outcomes are a crucial part of ensuring proper treatment for your patients – and may also uncover some knowledge that may help you understand your patient better. Failing to perform assessments or basing...

read more