CPT Code 97110 Explained: Therapeutic Exercises for Physical Therapy Billing

If you have ever been to physical therapy for back pain or a knee injury, your therapist must have used exercises to help you get better. These exercises are billed under CPT Code 97110, which makes it one of the most commonly used codes in physical therapy. But billing 97110 is not just about adding it to a claim form.

As it is a time-based code, therapists must carefully count the minutes, record the details of the session, and follow payer rules. It is essential to bill CPT Code 97110 correctly to avoid claim denials and ensure fair reimbursement. Therefore, knowing how CPT 97110 works is the key to smooth payments and compliance for therapists, assistants, and billing staff.

This blog explains everything you need to know about CPT Code 97110, one of the most common codes in physical therapy billing.

What is CPT Code 97110?

CPT Code 97110 is a billing code used in physical therapy to describe therapeutic exercises provided to a patient in a one-on-one session. These exercises are designed to improve strength, flexibility, range of motion, and overall physical function. In fact, the code is classified as a timed service, which means that it is billed based on the length of direct patient contact during the session.

Also, CPT 97110 is recognized as a medically necessary treatment when it is part of an established care plan prescribed and supervised by a licensed healthcare provider, such as a physical therapist or occupational therapist.

Who can Bill for CPT 97110?

Only qualified and licensed healthcare professionals are allowed to bill for CPT Code 97110. The following providers are eligible:

• Physical Therapists (PTs)
• Occupational Therapists (OTs)
• Physicians and Non-Physician Practitioners (when appropriate within scope)
• Assistants (PTA/OTA) but only under direct supervision and with payer-specific rules

It is important to note that billing for CPT 97110 must always comply with state practice laws and payer regulations. However, unqualified staff such as therapy aides, technicians, or support personnel are not permitted to bill for this service.

When to Use CPT 97110

CPT Code 97110 should only be used when therapeutic exercises are medically necessary and directly connected to a patient’s treatment plan. It is not for general fitness or wellness activities. Below are the key situations when this code applies:

• Improving Strength: When a patient needs targeted exercises to build muscle strength as part of recovery.
• Enhancing Range of Motion: When exercises are prescribed to increase joint flexibility and mobility.
• Restoring Endurance: When a treatment plan includes exercises to improve physical stamina and tolerance.
• Improving Balance and Coordination: When exercises help patients regain control of movement after injury, surgery, or illness.
• Part of a Prescribed Plan of Care: The exercises must be ordered and documented by a licensed provider as part of an overall treatment plan.
• One-on-One Supervised Therapy: The code applies only when the therapist is working directly and individually with the patient.

CPT 97110 is used when exercises are focused on restoring or improving a patient’s physical abilities for functional recovery, under professional supervision.

Time-Based Billing

Time-based billing ensures that therapists are reimbursed fairly for the actual time they spend providing skilled therapy. The 8-minute rule sets clear guidelines on how much time must be completed to bill a unit to help standardize claims across different payers. It includes:

• Billing in 15-Minute Units:

CPT 97110 is billed in 15-minute blocks, which means the therapist records time in set intervals rather than billing for the entire session as one code. This ensures the claim reflects the actual therapy time provided.

• Direct Supervision Required:

The therapist must be physically present and actively supervising or instructing the patient for the time to count toward billing. But the time spent without supervision, such as a patient exercising alone, cannot be billed under this code.

• The 8-Minute Rule:

Medicare and many other payers follow the 8-minute rule, which allows a therapist to bill for one unit of therapy if at least 8 minutes of direct treatment are provided. It is important to note that less than 8 minutes cannot be billed.

• Multiple Units:

When more time is spent, therapists can bill for additional units. For example, 23 to 37 minutes qualifies for two units. This structured approach ensures that billing accurately reflects longer sessions.

• Accurate Tracking:

Therapists must document the exact time spent with the patient during treatment. It is crucial to remember that keeping detailed records supports compliance with payer rules and reduces the risk of denied claims.

Documentation Essentials

Accurate documentation is one of the most important parts of billing CPT 97110. Proper notes also demonstrate medical necessity to make it easier for payers to approve claims and for providers to track progress over time. It includes:

• Treatment Rationale

Documentation must explain the specific medical reason for using therapeutic exercises. It should link the exercises directly to the patient’s diagnosis, functional limitations, and rehabilitation goals outlined in the treatment plan.

• Details of Exercises

Therapists need to record what exercises were performed, how they were carried out, and which body parts were targeted. This provides evidence that treatment supports recovery and function.

• Time Spent

As CPT 97110 is time-based, recording the exact minutes of direct one-on-one therapy is essential. In fact, accurate timing helps justify billed units and prevents claim denials.

• Patient Progress

Progress notes should highlight how the patient responded to therapy, including improvements, difficulties, or setbacks. This shows whether the plan of care is effective or needs adjustments.

• Therapist’s Signature

Every note must include the therapist’s name, signature, and date. This validates the documentation, confirms accountability, and ensures it is legally and professionally acceptable for payers.

Billing Modifiers

Billing modifiers are short codes added to CPT claims to provide payers with extra information. They explain exceptional circumstances and ensure accurate reimbursement for CPT 97110 services.

• Modifier 59

This modifier shows that therapeutic exercise (97110) is a distinct and separate service from other treatments provided on the same day. It prevents claims from being bundled together.

• Modifier 76

This modifier is used when the same therapeutic exercise service is repeated by the same provider on the same day. It confirms the repetition was medically necessary.

• Modifier 77

This modifier applies if the same therapeutic exercise service is repeated, but by a different provider on the same day. It helps clarify payer records for accurate billing.

• Modifier KX

This modifier is required when therapy services exceed the annual Medicare threshold. In fact, the provider confirms medical necessity for continuing treatment beyond the set limit by adding the modifier KX. 

• Modifier GP/GO

These modifiers identify whether the service was provided under a physical therapy (GP) or occupational therapy (GO) plan of care. They are often mandatory for Medicare claims.

Reimbursement Insights

Medicare usually reimburses CPT 97110 at a rate of about $30 to $40 per unit whereas private insurance companies may pay slightly higher between $35 and $50 per unit. The exact amount is not fixed and can vary depending on the location, the provider's type of practice, and the payer's specific policies. As reimbursement rates are not the same everywhere, it is always important for providers to check directly with the payer to confirm the current payment rates before billing.

Conclusion

CPT Code 97110 may seem straightforward, but any mistake in documentation, timing, or modifier use can quickly turn into claim denials and delayed payments. In fact, this can add unnecessary stress and financial strain for busy physical therapy practices. The good news is that with the right knowledge and systems in place, providers can bill CPT 97110 with confidence and consistency.

Outsourcing physical therapy billing and coding services to 24/7 Medical Billing Services can make the process even easier. Their team stays updated with the latest payer guidelines, manages claims accurately, and reduces denials. This helps practices maximize revenue without worrying about the fine print of coding.

FAQs

Q1.Does Medicare cover CPT Code 97110?

Yes, but coverage depends on medical necessity and proper documentation.

Q2.Is CPT 97110 only used in physical therapy?

No, it can also be used in occupational therapy when therapeutic exercises are performed.

Q3.Is prior authorization required for CPT 97110?

Some insurance plans may require prior authorization, especially for extended therapy.

Q4.Can CPT 97110 be billed for group therapy?

No, group sessions have separate codes like CPT 97150.