CPT Code 97110: When to Use It

What is CPT Code 97110?

CPT Code 97110 is one of the most frequently used codes in physical therapy (PT) and occupational therapy (OT) billing. It refers to therapeutic exercises aimed at improving strength, endurance, range of motion (ROM), and flexibility for one or more areas of the body.
This code is time-based, billed in 15-minute increments, and requires direct one-on-one contact between the provider and the patient.Correct use of CPT 97110 is essential not only for proper patient care documentation but also to ensure accurate reimbursement and avoid denials during insurance audits.

Understanding CPT Code 97110

What Does CPT Code 97110 Mean?

According to the American Medical Association (AMA), CPT 97110 is defined as:

“Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength, endurance, range of motion and flexibility.”

It applies when a licensed therapist actively engages the patient in specific exercises that have measurable goals tied to functional improvement.

The Purpose of CPT Code 97110 in Physical Therapy

The primary goal of CPT 97110 is to:

Restore physical function after injury, surgery, or illness.
Prevent deterioration in conditions where loss of mobility or strength is a risk.
Improve performance in activities of daily living (ADLs) or instrumental activities of daily living (IADLs).

Examples of clinical purposes:

Increasing shoulder ROM after a rotator cuff repair.
Strengthening lower limb muscles for improved walking ability.
Building core strength to reduce chronic back pain.

Who Can Bill for CPT 97110?

Only qualified healthcare professionals can bill CPT 97110, including:

Physical Therapists (PTs)
Occupational Therapists (OTs)
Physicians
Certain assistants (PTAs, OTAs) when working under direct supervision and within their scope of practice

Note: Some payers require the GP modifier for physical therapy services and the GO modifier for occupational therapy.

When to Use CPT Code 97110

When Should You Use CPT Code 97110 in Therapy?

You should bill CPT 97110 when:

The treatment focuses on a specific physical parameter (strength, ROM, endurance, flexibility).
Exercises are clinically necessary and part of a documented plan of care.
The therapist is providing constant, one-on-one skilled intervention.

Examples of Therapeutic Exercises Covered by CPT Code 97110

Strength Training: Resistance band rows, dumbbell curls, leg press.
Range of Motion (ROM): Passive or active-assisted shoulder stretches, ankle circles.
Endurance Training: Stationary cycling, treadmill walking.
Flexibility: Hamstring stretches, yoga-based postures.

Common Conditions Treated with CPT 97110

Orthopedic injuries: ACL tears, fractures, sprains.
Post-surgical rehab: Joint replacements, tendon repairs.
Neurological conditions: Stroke, multiple sclerosis.
Chronic conditions: Arthritis, degenerative disc disease.

Documentation Requirements for CPT 97110

CPT 97110 Documentation Tips: What to Include

Your documentation must:

Identify the body part(s) treated.
Describe specific exercises performed.
Note sets, reps, resistance level, or time.
Connect the exercise to functional goals.
Include start and stop times for accurate unit billing.

How to Document Exercises for CPT Code 97110

Example format:

Patient performed 3 sets of 10 reps of resisted shoulder abduction with a red Theraband to improve overhead reaching for ADLs. Resistance increased from yellow to red band this week. Total time: 15 minutes.

The Importance of Medical Necessity for CPT 97110 Billing

Insurance reimbursement depends heavily on proving medical necessity.
Your notes should clearly show:

The deficit (e.g., limited ROM, weakness).
The impact on daily life (e.g., difficulty dressing).
The plan for improvement through targeted exercises.

Tracking Progress and Adjusting Exercises in Documentation

You should update:

Objective measurements (e.g., goniometer readings, strength grades).
Modifications in resistance or technique.
Patient’s tolerance and response.
New goals if progress plateaus.

Billing for CPT Code 97110

How to Bill for CPT Code 97110: Time-Based Billing Explained

97110 is billed per 15 minutes of direct one-on-one therapy.
Bill 1 unit for 8–22 minutes.
Bill 2 units for 23–37 minutes, and so on.

Understanding the 8-Minute Rule for CPT Code 97110

Medicare and many private insurers follow the 8-Minute Rule:

At least 8 minutes of service is needed to bill 1 unit.
Combine minutes from multiple time-based codes to determine total billable units.

How to Track Units and Time for CPT 97110

Keep exact start and end times for each CPT code in your daily note.
Example:

97110: 12 minutes
97530: 10 minutes
Total: 22 minutes = 1 unit (most time-intensive code gets billed).

Common Billing Errors to Avoid with CPT 97110

Billing without direct contact.
Using 97110 for functional activities (should be 97530).
Missing documentation of medical necessity.
Incorrect time calculations leading to overbilling.

Maximizing Reimbursement with CPT Code 97110

How to Maximize Reimbursement for CPT 97110

Maximizing reimbursement for CPT Code 97110 is crucial for ensuring that you get paid fairly for the services you provide. Since CPT 97110 is a time-based code, reimbursement depends on accurate billing, proper documentation, and adherence to payer guidelines. Here’s how to maximize your reimbursement:

Ensure Accurate Time Tracking: Use the 8-minute rule to track therapy time accurately. You must provide at least 8 minutes of direct, one-on-one therapy to bill for one unit of service.
Document Medical Necessity: Clearly show that the exercises are medically necessary and directly related to the patient’s functional goals. Link each exercise to an improvement in strength, range of motion, or endurance.
Optimize Session Length: Aim to provide the right amount of therapy in each session. Billing for multiple units when the therapy duration justifies it increases reimbursement.

Best Practices for Reimbursement of CPT Code 97110

To improve the accuracy and efficiency of reimbursement, follow these best practices:

Follow Payer Guidelines: Each insurer may have specific rules regarding CPT code 97110. Always check payer policies before submitting claims.
Use Clear, Concise Documentation: Record the exact details of the therapeutic exercises provided, including the type of exercise, duration, sets and reps, and outcomes.
Track Units Correctly: Ensure that the units billed correspond to the actual direct therapy time provided.
Review Billing Codes Regularly: Stay up to date with any changes in CPT guidelines or payer requirements that may affect 97110 reimbursement.

Using Modifiers with CPT 97110 to Avoid Denials

Modifiers can be used to clarify billing and avoid denials. Common modifiers used with CPT code 97110 include:

Modifier GP: Required for physical therapy services, indicating the treatment was provided under a physical therapy plan of care.
Modifier 59: Used when CPT 97110 is billed alongside other codes that are not part of the same treatment.
Modifier KX: Indicates that services exceed the therapy cap but are still medically necessary.

Proper use of modifiers ensures that your claims are processed correctly, reducing the chances of delays or denials.

Common Mistakes When Using CPT Code 97110

Common Billing Mistakes to Avoid with CPT Code 97110

Incorrect billing for CPT 97110 is one of the main reasons for claim denials and audits. The most common billing mistakes include:

Incorrect Time Reporting: Billing for time not directly spent on therapeutic exercises (such as time spent preparing the patient or documenting) can lead to overbilling or underbilling.
Vague Documentation: Failing to provide clear and detailed documentation can result in claims being rejected. Always ensure that you link exercises to functional goals.
Misuse of CPT Code 97110: Using 97110 for activities that don’t match the code’s requirements, such as functional activities (which should be billed under CPT 97530), can result in under-reimbursement.

How to Avoid Overuse of CPT Code 97110

Overuse of CPT 97110 can lead to audits and lower reimbursement rates. Avoid this by:

Using the Right Code: For exercises that improve functional performance (like lifting or coordination), use CPT 97530.
Limit Billing to Therapeutic Exercises: Ensure that the exercises being billed under CPT 97110 focus on strength, endurance, flexibility, or ROM.
Adjust Based on Progress: As the patient improves, consider transitioning to exercises or treatments that require different CPT codes.

How to Correctly Combine CPT 97110 with Other Codes

When using multiple CPT codes for a patient session, it’s essential to combine them correctly. For instance:

If you provide 97110 (therapeutic exercise) alongside 97112 (neuromuscular re-education), ensure that the time spent on each service is accurately recorded, and modifier 59 may be used to indicate distinct services.
97140 (manual therapy) can also be billed with 97110, but keep track of time spent on each to ensure correct unit billing.

Practical Examples of CPT Code 97110 Exercises

Examples of Exercises Covered Under CPT Code 97110

Therapists commonly use CPT code 97110 for foundational exercises like:

Active and Passive ROM: Exercises to improve joint mobility, such as shoulder or knee stretches.
Strength Training: Resistance exercises using dumbbells, TheraBands, or resistive bands to target muscle strength.
Endurance Training: Activities like walking on a treadmill or using a stationary bike to enhance cardiovascular endurance.

Resistance Exercises and Range of Motion Work for CPT 97110

Examples:

Seated leg press to strengthen quadriceps and hamstrings.
Bicep curls with free weights for strengthening arm muscles.
Ankle circles to improve ankle joint mobility.

Using TheraBands, Free Weights, and Stretching for CPT 97110

Incorporating TheraBands, free weights, and stretching into therapy is a common and effective way to use CPT 97110:

TheraBands: Excellent for improving strength and range of motion in a low-impact manner.
Free weights: Can be used for targeted strengthening exercises for arms, legs, and core.
Stretching: A vital part of ROM exercises, particularly post-injury or surgery.

CPT Code 97110 and Time-Based Billing

Understanding Time-Based Billing for CPT Code 97110

CPT 97110 is time-based, meaning it’s billed in 15-minute increments of direct, one-on-one therapy. Each unit billed corresponds to at least 8 minute rule of direct therapy time, and it can be billed in multiple units depending on how long the therapy session lasts.

How to Calculate Units and Time for CPT Code 97110

For accurate billing:

8–22 minutes = 1 unit
23–37 minutes = 2 units
38–52 minutes = 3 units, and so on.

Always track the time dedicated to direct patient contact and ensure no time overlaps between different CPT codes.

Bill Correctly: 15-Minute Increments and the 8-Minute Rule

To comply with billing regulations:

Ensure that each CPT 97110 session is calculated in 15-minute increments.
Use the 8-minute rule to ensure you’re billing only for time spent actively working with the patient.

CPT 97110 for Specific Medical Conditions

CPT 97110 for Orthopedic and Musculoskeletal Conditions

For orthopedic conditions like sprains, fractures, or arthritis, CPT 97110 can be used to:

Improve strength post-fracture or surgery.
Increase flexibility in joints affected by conditions like arthritis.
Build endurance to support mobility and prevent further injury.

How CPT 97110 Applies to Neurological Conditions and Recovery

For patients recovering from neurological conditions such as stroke or multiple sclerosis, CPT 97110 can be used to:

Improve muscle strength and range of motion.
Restore mobility through functional strengthening exercises.
Enhance coordination and balance.

Using CPT 97110 for Post-Surgical Rehabilitation

In post-surgical rehabilitation, CPT 97110 is essential to restore strength and mobility in patients who have undergone surgeries such as:

Hip replacements
Knee reconstructions
Rotator cuff repairs

Why One-on-One Patient Contact is Crucial for CPT 97110

The Role of Direct One-on-One Contact in CPT 97110

Direct, one-on-one therapy is a critical component of CPT 97110 billing. Unlike supervised modalities, this code requires the therapist to be actively involved in guiding and assisting the patient throughout the exercise session. This ensures that the patient is performing the exercises correctly and safely, directly influencing their recovery progress.

How One-on-One Therapy Affects Reimbursement for CPT 97110

Since CPT 97110 requires direct contact:

Proper billing depends on accurate time tracking of one-on-one sessions.
If you bill incorrectly or do not maintain direct contact, the insurer may deny the claim or request a refund.

Conclusion

Wrap-Up: Why CPT Code 97110 is Essential for Your Therapy Practice

CPT code 97110 is indispensable for physical and occupational therapists working to improve patients’ strength, endurance, range of motion, and flexibility. It is vital for accurate billing, documentation, and ensuring proper reimbursement for the therapeutic exercises provided.

Best Practices for Using CPT Code 97110 Efficiently

Use clear documentation to justify each exercise and its purpose.
Follow payer guidelines to avoid errors.
Track time accurately to ensure that billing is correct and compliant.

By using CPT code 97110 effectively and following the best practices outlined in this guide, therapists can provide high-quality care while ensuring proper financial reimbursement.