Complete Guide to CPT Code 97110

The 97110 CPT code is one of the most frequently used codes in rehabilitation therapy, representing therapeutic exercises designed to help patients recover physical function. According to the American Medical Association (AMA), this code covers “therapeutic procedure, one or more areas, each 15 minutes, therapeutic exercises to develop strength and endurance, range of motion and flexibility” . 

This 97110 CPT code is fundamental to physical therapy, occupational therapy, and other rehabilitation services aimed at restoring patients’ functional abilities.

The importance of properly understanding and applying the 97110 CPT code cannot be overstated. It’s considered a cornerstone of many therapy treatment plans and is one of the most scrutinized codes by insurance auditors . 

Accurate use ensures appropriate reimbursement for services while maintaining compliance with increasingly complex insurance requirements. When used correctly, this code helps therapists document the skilled, medically necessary care they provide to patients recovering from surgery, injury, or neurological events .

97110 CPT Code Description

The official 97110 CPT code description refers to “therapeutic exercises to develop strength, endurance, range of motion and flexibility” . This timed code is billed in 15-minute increments and requires direct one-on-one patient contact by a qualified therapist . The 97110 CPT code description encompasses a wide range of exercises, all focused on improving a patient’s physical capabilities through active participation.

Key Characteristics of the 97110 CPT Code

• Each unit represents 15 minutes of direct therapeutic exercise, following the 8-minute rule for unit calculation 
• Services must require the expertise of a licensed therapist for development, modification, or instruction 
• Patients must actively perform exercises rather than receiving passive treatments 
• Exercises must target specific functional improvements and be documented accordingly 

Common Applications Include:

• Post-surgical rehabilitation (e.g., knee replacement recovery with leg press exercises) 
• Chronic pain management through core stabilization and flexibility exercises 
• Neurological rehabilitation for conditions like stroke or Parkinson’s disease 
• Orthopedic injuries to restore strength and mobility after fractures or soft tissue damage 

It’s crucial to distinguish the 97110 CPT code from other similar therapy codes. The table below clarifies these differences:

Table: Differentiation Between 97110 and Other Common Therapy Codes

Applicable modifiers for CPT code 97110

Modifiers are essential components of accurate therapy billing that provide additional information about the circumstances of service. The 97110 CPT code modifier requirements vary depending on the specific situation and payer guidelines. Using appropriate modifiers correctly can significantly reduce claim denials and ensure proper reimbursement .

Common Modifiers Used with the 97110 CPT Code:

• GP: Indicates services delivered under an outpatient physical therapy plan of care 
• GO: Signifies services provided under an occupational therapy plan of care 
• CQ: Denotes that services were provided in part by a physical therapist assistant (PTA) 
• KX: Signifies that services exceeding therapy caps are medically necessary 

The -59 modifier deserves special attention as it’s commonly required but often misused. This modifier indicates that a procedure or service was distinct or independent from other services performed on the same day . For example, when billing 97110 and 97530 together, modifier -59 should be applied only if these services were performed in distinctly different 15-minute intervals and address separate therapeutic goals .

Proper use of the -59 modifier requires:

• Clear temporal separation: Services should be provided during different time intervals 
• Distinct goals: Each service should address different functional limitations 
• Specific documentation: Clinical notes must justify separate billing by explaining how services targeted different deficits 

Modifier -59 should not be used routinely, as this can trigger audits. According to NCCI edits, the 97110 CPT code will specifically need the -59 modifier if billed with certain other codes such as 36591, 36592, or 96523 .

CPT code 97110 – billing & reimbursement guidelines

Discussed below are the billing and reimbursement guidelines for CPT code 97110:

Unit calculation and the 8-minute rule

The 97110 CPT code is a timed code, meaning reimbursement depends on accurate time tracking and unit calculation according to the 8-minute rule . This rule stipulates that at least 8 minutes of direct service must be provided to bill for one 15-minute unit. The standard calculation is as follows:

• 8-22 minutes = 1 unit 
• 23-37 minutes = 2 units 
• 38-52 minutes = 3 units 
• 53-67 minutes = 4 units 

When providing multiple timed services in one session, therapists must total all timed minutes first to determine total units, then allocate units to specific codes based on time spent on each service . Only direct one-on-one patient time counts toward these calculations—preparation, documentation, or rest periods cannot be included .

Documentation requirements

Proper documentation is critical for both compliance and reimbursement of the 97110 CPT code. Medical reviewers pay close attention to whether records demonstrate medical necessity and skilled intervention . Comprehensive documentation should include:

• Medical necessity justification: Clear explanation of functional deficits and how exercises address them 
• Specific exercise details: Type of exercises, body parts targeted, sets, repetitions, resistance levels 
• Time documentation: Total time spent on 97110 activities with start and stop times when multiple codes are billed 
• Clinical decision-making: Rationale for exercise selection, modifications made, and patient education provided 
• Patient response: Objective measures of performance, tolerance, and progress toward functional goals 

Reimbursement rates

97110 CPT code reimbursement varies significantly by payer, geographic location, and practice setting. While exact figures fluctuate, representative rates from major payers include:

• Medicare: Approximately $30-40 per unit 
• Blue Cross Blue Shield: Around $33.50 per unit 
• UnitedHealthcare: Approximately $36.10 per unit 
• Medicaid: Varies by state, typically $27-30 per unit 

These rates are subject to change, particularly with Medicare’s proposed conversion factor decreases in recent years . Additionally, the Multiple Procedure Payment Reduction (MPPR) policy may reduce payment for subsequent therapy services provided on the same day .

Avoiding common billing errors

• Insufficient documentation: Generic notes like “therapeutic exercises performed” lack necessary detail. Instead, specify “patient completed 3 sets of 10 repetitions of shoulder flexion with 2lb weight to improve overhead reaching for dressing” 
• Billing for non-skilled services: Don’t bill for exercises patients can perform independently without skilled supervision 
• Incorrect time calculations: Avoid rounding up units or including non-billable time like setup or rest periods 
• Mixing codes inappropriately: Ensure you’re using the most appropriate code for each service rather than defaulting to 97110 

Conclusion

The 97110 CPT code is an essential tool for rehabilitation therapists to bill for therapeutic exercises that develop strength, endurance, range of motion, and flexibility. Proper use of this code requires understanding its specific applications, accurate time tracking according to the 8-minute rule, appropriate modifier usage, and thorough documentation that establishes medical necessity.

As audit scrutiny increases, therapists must prioritize specific, objective documentation that clearly justifies each service billed under the 97110 CPT code. By implementing systematic documentation practices, conducting regular internal audits, and staying current with payer policy changes, therapy practices can ensure appropriate reimbursement while maintaining compliance.

Ultimately, mastering the 97110 CPT code enables therapists to focus on what matters most: delivering high-quality, effective care that helps patients achieve their functional goals and improve their quality of life.

Read More CPT Codes Related Articles: