Covered Codes for Physical Therapy Providers
Code | Description | Session Limit | Other Instructions | |
Covered Codes for Physical Therapists (PT) – Use modifier “GP” when billing these codes. | ||||
97001 | Physical therapy initial evaluation | 1 unit | Limited to 1 evaluation per provider, per condition, per calendar year. |
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97002 | Physical therapy re-evaluation | 1 unit | Limited to once every 3 months. | |
97010 | Application of a modality to one or more areas: hot or cold packs |
4 units | ||
97012 | Application of a modality to one or more areas; traction, mechanical |
4 units | ||
97014 | Application of a modality to one or more areas; electrical stimulation (unattended) |
4 units | ||
97016 | Application of a modality to one or more areas: vasopneumatic devices |
4 units | ||
97018 | Application of a modality to one or more areas: paraffin bath |
4 units | ||
97022 | Application of a modality to one or more areas; whirlpool |
4 units | ||
97024 | Application of a modality to one or more areas; diathermy |
4 units | ||
97026 | Application of a modality to one or more areas; infrared |
4 units | ||
97028 | Application of a modality to one or more areas; ultraviolet |
4 units | ||
97032 | Application of a modality to one or more areas; electrical stimulation (manual), each 15 min. |
4 units | ||
97033 | Application of a modality to one or more areas; iontophoresis, each 15 min. |
4 units | ||
97034 | Application of a modality to one or more areas; contrast baths, each 15 min. |
4 units | ||
97035 | Application of a modality to one or more areas; ultrasound, each 15 min. |
4 units | ||
97036 | Application of a modality to one or more areas; Hubbard tank, each 15 min. |
4 units | ||
97110 | Therapeutic procedure, one or more areas, each 15 min.; therapeutic exercises |
4 units | Prior authorization is required when used with code 97140. See “Other Instructions” for code 97140. |
|
97112 | Therapeutic procedure, one or more areas, each 15 min.; neuromuscular reeducation |
4 units | ||
97113 | Therapeutic procedure, one or more areas, each 15 min.; aquatic therapy with therapeutic exercises |
4 units | ||
97116 | Therapeutic procedure, one or more areas, each 15 min.; gait training |
4 units | ||
97124 | Therapeutic procedure, one or more areas, each 15 min.; massage, including effleurage, pertrissage and/or tapotement |
4 units | See “Other Instructions” for 92507. | |
97140 | Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction) one or more regions, each 15 min. |
6 units of code 97140 OR 6 combined units of codes 97140, 97110 and/or 97535 |
Prior authorization is always required. One prior authorization is issued for ICD-9 codes 457.0, 457.1 and 757.0 for use with a combination of codes 97140, 97110 and/or 97535 for a maximum of 15 sessions (6 units per session) for a total of 90 units to be completed in approximately 3 weeks. |
|
97150 | Therapeutic procedure(s), group (A group is 2 or more individuals.) |
1 unit | Bill 1 unit for each recipient in the group. | |
97530 | Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 min. |
4 units | ||
97532 | Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 min. |
4 units | See “Other Instructions” for 92507. | |
97533 | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) contact by the provider, each 15 min. |
4 units | See “Other Instructions” for 92507. | |
97535 | Self-care/home management training (e.g., ADLs) direct (one-on-one) contact by provider, each 15 min. |
4 units | Prior authorization is required when used with code 97140. See “Other Instructions” for code 97140. |
|
97542 | Wheelchair management/ propulsion training, each 15 min. |
4 units | ||
97760 | Orthotic(s) fitting and training, upper extremity(ies), lower extremity(ies), and/or trunk, each 15 min. |
4 units | ||
97761 | Prosthetic training, upper and/or lower extremities, each 15 min |
4 units | ||
97762 | Checkout for orthotic/prosthetic use, established patient, each 15 min. |
4 units |