Improve revenue collection with comprehensive knowledge of coding procedures.
Current Procedural Terminology codes, more commonly called CPT codes, standardize medical tracking and billing for diagnostic, medical, and surgical procedures. Every task conducted by a health care practitioner has a unique five-digit number. Insurers review the submitted codes to determine the correct provider reimbursement for a patient’s visit.
CPT codes were created and copyrighted by the American Medical Association (AMA). The organization updates and maintains these codes as new treatments become available and older modalities become obsolete. Comprehensive knowledge of CPT codes and how they work can help physical therapists, speech-language pathologists, and occupational therapists ensure prompt, accurate billing for their services.
Currently, CPT codes fall into four main areas of classification:
- PLA codes: lab testing
- Category I: vaccines, medications, devices, services, treatments, and procedures
- Category II: quality of care and performance metrics
- Category III: procedures and services that use new modalities
Some CPT codes, commonly called bundled services, cover several different related procedures or treatments.
When the insurance company reviews the CPT codes for a patient visit, the company reimburses the provider based on the rates in the agreement with that practice. In other words, therapists from different practices do not necessarily receive the same insurance payments even when providing identical services.
Top 10 CPT Codes Billed for Physical Therapists in 2021
Access our full list of top 25 CPT codes for physical therapists, plus modifier and billing tips, on our resource center.
| Code | Short Descriptor |
|---|---|
| 97110 | Therapeutic exercises |
| 97140 | Manual therapy |
| 97112 | Neuromuscular re-education |
| 97530 | Therapeutic activities |
| 97014 | Electrical stimulation (unattended) |
| G0283 | Electrical stimulation, Medicare non-wound (unattended) |
| 97161 | PT evaluation: low complexity |
| 97010 | Hot/cold packs |
| 99072 | Additional supplies, materials, and staff time that exceeds usual visit or non-facility services performed during a public health emergency (new AMA CPT as of Sept. 8, 2020) |
| 97116 | Gait training |
Top 10 CPT Codes Billed for Occupational Therapists in 2021
Access our full list of top 25 CPT codes for occupational therapists, plus modifier and billing tips, on our resource center.
| Code | Short Descriptor |
|---|---|
| 97530 | Therapeutic activities |
| 97110 | Therapeutic exercises |
| 97140 | Manual therapy |
| 97112 | Neuromuscular re-education |
| 97535 | Self-care or home-management training |
| 97035 | Ultrasound / Phonophoresis |
| 99072 | Additional supplies, materials, and staff time that exceeds usual visit or non-facility services performed during a public health emergency (new AMA CPT as of Sept. 8, 2020) |
| 97018 | Hot wax treatment / Paraffin bath |
| 97165 | OT evaluation: low complexity |
| 97014 | Electrical stimulation (unattended) |
Top 10 CPT Codes Billed for Speech-Language Pathologists in 2021
Access our list of top 10 CPT codes for speech therapists, plus modifier and billing tips, on our resource center.
| Code | Short Descriptor |
|---|---|
| 92507 | SLP treatment, individual |
| 92526 | Treatment of swallowing dysfunction and/or oral function for feeding |
| 92523 | Evaluation of speech sound production with language comprehension and expression |
| 92610 | Evaluation of oral pharyngeal swallowing function |
| 97129 | Therapeutic intervention of cognitive function and compensatory strategies to manage performance of an activity, direct, initial 15 mins |
| 97130 | Therapeutic intervention of cognitive function and compensatory strategies to manage performance of an activity, direct, each additional 15 mins |
| 99072 | Additional supplies, materials, and staff time that exceeds usual visit or non-facility services performed during a public health emergency (new AMA CPT as of Sept. 8, 2020) |
| 92522 | Evaluation of speech sound production |
| 92609 | Therapeutic services for use of speech-generating device, including programming and modification |
| 92611 | Motion fluoroscopic evaluation of swallowing function by cine or video recording |
Frequently asked questions about CPT codes
Here are answers to some of the most common inquiries SLP, OT, and PT professionals have about CPT codes. If you’re curious about CPT code billing for telehealth during the public health emergency, check out our telehealth and CTBS billing code resource for more information.
What’s the difference between CPT codes and ICD-10?
ICD-10, or the tenth revision to the International Classification of Diseases, is a diagnostic coding system created by the World Health Organization. The American Medical Association creates CPT codes, which represent procedures rather than diagnoses.
Let’s use an example of a physical therapist seeing a patient with a dislocated shoulder. The therapist would notate the injury using the ICD-10 code S43 (dislocation and sprain of joints and ligaments of the shoulder girdle) along with the appropriate sequence relevant to the encounter and injury location, like S43.003A (unspecified subluxation of unspecified shoulder joint, initial encounter).
However, to treat the patient, the therapist would notate the procedures performed using CPT codes. If they performed a moderately complex evaluation, they’d use CPT code 97162, along with any other procedure codes and modifiers relevant to the patient’s visit and services rendered.
What Is the difference between CPT codes and HCPCS codes?
HCPCS, sometimes pronounced “hicks-picks,” stands for the Healthcare Common Procedure Coding System. HCPCS codes were developed by the Centers for Medicare and Medicaid Services (CMS) and are based on the AMA’s CPT codes. Most of the codes between CPT and HCPCS are the same, but when billing solely for Medicare and Medicaid services, clinics should only use HCPCS codes. Some third-party insurance providers also mandate HCPCS over CPT codes for billing, so be sure to check with payers which coding set they prefer prior to submitting claims.
Like CPT codes, there are a couple of classifications for HCPCS codes.
- Level I: These codes share an identical CPT code and are numeric.
- Level II: These alphanumeric codes cover non-physician products or supplies and some additional procedures that are not included in CPT codes.
What Is the difference between timed and untimed CPT codes?
Timed codes are just as they sound—codes used for variable, timed services, typically in increments of 15 minutes. Untimed codes are service-based codes that do not report time spent with patients. Practitioners use untimed CPT codes for a single treatment with a predetermined flat fee. You should report this billing code each time you perform a treatment for a patient.
Timed CPT codes, used only for skilled intervention, are based on the amount of time you spend with the patient. You may use multiple units of a single timed code for a single session with a patient, depending on the duration of the therapy in question.
What is the 8-minute rule?
Practitioners who bill for their services must understand the 8-minute rule. Billing protocol varies for insurance companies that use CMS guidelines, including Medicare and Medicaid plans, and those that use AMA guidelines. Ideally, practices can customize their EMR system’s settings to bill patient services accurately depending on the insurer.
CMS guidelines
CMS requires practitioners to perform a service for at least 8 minutes to bill a single unit of the appropriate timed CPT code. When you use a timed CPT code to provide services to a client who has Medicare, Medicaid, or another plan that follows CPT guidelines, you bill in 15-minute increments. To determine how many times to use the code when billing for that session, divide the total length of the session in minutes by 15. When the remainder is eight or more, you can bill for another code unit.
Let’s look at a brief example. A therapist spends 48 minutes providing skilled physical therapy services to a client. To calculate their units, divide 48 by 15 to get three as the remainder. As a result, the therapist will only bill three code units rather than four. However, if the next session with the same client lasted 56 minutes, the therapist would bill for four timed codes. The 8-minute rule does not apply to untimed codes.
AMA guidelines
Unlike CMS, AMA does not consider the total treatment session time when practitioners use timed codes. Instead, they must bill by units that last at least 8 minutes. Let’s say you provide two different services for 8 minutes each to a client covered by an AMA insurer. Under AMA, you would bill each code as a single unit for a total of two units for that appointment.
In contrast, CMS would divide the total length of the session (16 minutes) by 15 and get 1 billing unit with a remainder of 1. Because the remainder is less than eight, you would bill only a single unit.
What modifiers are needed to bill for physical, occupational, or speech therapy services?
CPT code modifiers provide additional information about your billing code to insurance providers. These details help the payer reimburse appropriately and correctly for your services. Here are some of the most common code modifiers you will use when billing for physical, occupational, and speech therapy services:
- Modifier GP designates services provided by a physical therapist.
- Modifier GO designates services provided by an occupational therapist.
- Modifier GN designates services provided by a speech-language pathologist.
- Modifier 95 is used by SLP, OT, and PT providers to designate telehealth services. Some payers prefer the modifier GT.
- Modifier 52 designates an abbreviated procedure.
- Modifier 59, used to designate a “distinct procedural service,” is both the most widely used and one of the most commonly misused billing codes. You should use modifier 59 when you perform at least two procedures on at least two different sites on the body during the same visit. You can also use this code if no other modifier describes the proper relationship between the two procedure codes. However, providers should not use modifier 59 to keep insurers from bundling services together.
- Modifier XE indicates that a service was billed separately because it occurred during a separate patient visit or encounter.
- Modifier XP indicates that a different practitioner performed a service during the same patient encounter.
- Modifier KX indicates that the practitioner confirmed the medical necessity of a procedure and met the criteria for coverage of the code in question, despite surpassing the “therapy threshold.”
- Modifier CQ indicates services provided by a physical therapy assistant.
- Modifier CO indicates services provided by an occupational therapy assistant.
What CPT codes are used for physical therapy?
Most of the CPT codes for physical therapy appear in the 97000 section, Physical Medicine and Rehabilitation, of the AMA’s CPT code book. Codes can range from exercises performed for assessment to group activities to timed assessments or treatment.
Below is a small sampling of CPT codes that physical therapists may use to bill for services performed:
- 97012 Mechanical Traction
- 97110 Therapeutic Exercise
- 97112 Neuromuscular Re-Education
- 97113 Aquatic Therapy/Exercise
- 97116 Gait Training
- 97124 Massage Therapy
- 97140 Manual Therapy
- 97161 PT Evaluation: Low Complexity
- 97162 PT Evaluation: Moderate Complexity
- 97163 PT Evaluation: High Complexity
- 97164 PT Re-Evaluation
- 97530 Therapeutic Activities
- 97535 Self-Care/Home Management Training
- 97542 Wheelchair Management
- 97750 Physical Performance Test or Measurement
How do you bill for physical therapy telehealth procedures?
Physical therapists have increasingly provided telehealth services since 2020. If your PT practice offers these services, you can bill for virtual care that falls under CPT codes 97161 – 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, and 97761.
According to the American Physical Therapy Association (APTA), you should use these codes with both the GP modifier and the 95 modifier to indicate telehealth. Our CPT code telehealth cheat sheet for PT lays out some of the most important details about billing for remote services.
What CPT codes are used for occupational therapy?
Most of the CPT codes for occupational therapy appear in the 9700 section (Physical Medicine and Rehabilitation) of the AMA’s CPT code book, and share many of the same codes with physical therapists. However, OTs may also use codes in the 9600 section for behavioral health assessments or treatment. Codes can range from assessing coordination and balance to wheelchair management to group or individual therapy assessments and treatment.
According to the American Occupational Therapy Association (AOTA), here’s a sampling of CPT codes you may use for occupational therapy billing:
- 96110 Developmental screening with a standardized instrument
- 96112 Developmental test administration
- 96127 Emotional/behavioral assessment with a standardized instrument
- 97110 Therapeutic exercises for flexibility, range of motion, and endurance
- 97150 Group therapeutic procedures
- 97165 Low-complexity OT evaluation
- 97166 Moderate-complexity OT evaluation
- 97167 High-complexity OT evaluation
- 97168 OT re-evaluation
- 97530 One-on-one therapeutic activities
- 97535 Self-care/home management assistance
- 97542 Wheelchair management, training, and assessment
- 97755 Assistive technology assessment
- 97760 Orthotic management and training
- 97761 Prosthetic training for an extremity
How do you bill for occupational therapy telehealth procedures?
Occupational therapists can bill for telehealth procedures using an approved list of codes, which can be found on our OT telehealth cheat sheet. When appropriate, codes should include a modifier 95 to designate telehealth care and GO to designate services provided by an OT.
Additionally, condition code DR and modifier CR should be used when billing to Medicare during the public health emergency, as explained by CMS. For place of service, use the code for the place where the patient would have received in-person services, either home or clinic setting.
What CPT codes are used for speech therapy?
Most of the CPT codes for speech therapy appear in the 9200 section of the AMA’s CPT code book, but SLPs can also use physical therapy codes in the 9700 section with some exceptions. Codes can range from assessing swallowing function to language comprehension to group or individual therapy assessments and treatment.
Below is a sampling of CPT codes that speech-language pathologists may use to bill for their services:
- 92507 Individual treatment for disorder of communication, voice, language, speech, or auditory processing
- 92508 Group treatment for disorder of communication, voice, language, speech, or auditory processing
- 92521 Evaluation of speech fluency
- 92522 Evaluation of sound production during speech
- 92523 Evaluation of sound production along with language expression and comprehension
- 92524 Qualitative and behavioral resonance and voice analysis
- 92526 Feeding or swallowing dysfunction treatment
- 92607 Alternative communication device evaluation
- 92609 Alternative communication device management and therapy
- 92610 Swallowing function evaluation
- 92626 Surgically implanted auditory device evaluation
- 96105 Aphasia assessment
- 96125 Cognitive testing with a standardized instrument
- 97125 Cognitive function interventions
- 97129 Therapeutic intervention of cognitive function and compensatory strategies to manage performance of an activity (timed code, initial 15 mins)
How do you bill for speech-language pathology telehealth procedures?
According to the American Speech-Language-Hearing Association (ASHA), Medicare will only allow speech-language pathologists to bill for telehealth services during the federal pandemic emergency. The Biden administration renewed the public health emergency declaration in April 2021. However, private insurance companies have their own rules about telehealth billing for SLPs.
SLPs may use the codes above along with modifier 95 to indicate telehealth services and GN to designate services provided by an SLP. They should also use the place of service code for the setting where the patient received services prior to the pandemic (11 for office, 12 for home-based care). Our downloadable cheat sheet for telehealth SLP services provides easy access to the telehealth codes you need, plus tips on billing correctly for telehealth services.
How often do CPT codes change?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates that CPT codes are updated annually, effective January 1 of each year. The AMA provides clinics a little extra time to get adjusted to the new CPT codes, and will typically release the new codes in the fall before the changes take effect.
Having the right EMR and billing integration can make a world of difference for clinics when it comes to staying on top of updates. For example, Clinicient’s Insight Platform offers an easy auto-fill option for procedure codes, including auto-calculating timed units, and will automatically update every time new procedure codes, NCCI edits, or new ICD-10 codes are released. And with customizable payer rules, clinics can have even more control over how their system automates billing. To learn more, schedule a free, no-obligation demo today.
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