97110 CPT Code: Documentation and Coding Tips

Proper medical billing and coding are essential to the success of any healthcare practice. Among the many CPT codes in use today, 97110 CPT Code is one of the most commonly billed services, especially in physical and occupational therapy. However, accurately documenting and coding this procedure is critical not only for reimbursement but also for avoiding denials and audits.

This comprehensive guide covers everything you need to know about the 97110 CPT Code, including what it entails, documentation best practices, common billing pitfalls, appropriate use of modifiers, and the importance of streamlining processes whether you’re doing it in-house or by outsourcing medical billing services.

What Is the 97110 CPT Code?

The 97110 CPT Code represents “Therapeutic exercises to develop strength and endurance, range of motion and flexibility.” This service typically involves direct one-on-one contact with the patient by the provider or therapist and is billed per 15-minute unit.

It is frequently used in outpatient rehab settings and is fundamental in treatments involving physical therapy, occupational therapy, and chiropractic care. Examples of therapeutic exercises may include stretching, strengthening routines, treadmill exercises, and resistance band work, among others.

When Should You Use the 97110 CPT Code?

The 97110 CPT Code should be used when the following conditions are met:

• The therapy provided is active and focuses on improving physical functions such as strength or flexibility.

• The patient requires a therapist’s direct and continuous attention.

• The service is provided in 15-minute increments.

• There is a clear plan of care (POC) indicating the need for therapeutic exercises.

The key term here is “direct one-on-one contact.” If the service was provided in a group setting or without direct involvement, 97110 is not the appropriate code to use.

Common Examples of 97110 CPT Code in Use

Let’s explore some common situations where 97110 may be applied:

1. A patient recovering from knee surgery performs strength exercises with a physical therapist using leg presses and squats.

2. A stroke patient working on restoring range of motion through resistance training.

3. A person with shoulder tendinitis undergoing flexibility training through active-assisted range of motion exercises.

In each case, the exercises are purposeful, and the therapist is actively engaged with the patient.

Documentation Requirements for 97110 CPT Code

Documentation is everything when it comes to billing for the 97110 CPT Code. Medicare and commercial payers require precise and thorough records to justify the necessity of the service rendered. Failure to document correctly can result in denials or payment delays.

Key Elements to Include:

1. Diagnosis and Medical Necessity:
   The patient’s diagnosis should support the need for therapeutic exercises. You must clearly link the diagnosis to the interventions provided.

2. Functional Limitations and Goals:
   Identify what the patient cannot do (e.g., limited range of motion) and what the goals are (e.g., improve ROM from 30° to 90°).

3. Treatment Description:
   Document the specific therapeutic exercises performed, equipment used, number of repetitions, and levels of resistance.

4. Time Spent:
   97110 is a time-based code, so it is essential to record exactly how many minutes were spent in direct patient contact.

5. Progress Notes:
   Show patient improvement or changes in condition over time to validate the continuation of services.

Example of Proper Documentation:

Date: 07/22/2025
Time Spent: 30 minutes (2 units)
Treatment Provided: Therapeutic exercises for right knee post-ACL surgery, including resistance band extensions, quad sets, and hamstring curls.
Goal: Improve knee flexion to 120°.
Outcome: Increased range of motion from 90° to 100°.

Coding Tips for 97110 CPT Code

Getting paid appropriately for services starts with correct coding. Here are some helpful coding tips specific to the 97110 CPT Code:

1. Understand Timed Coding Rules

The 97110 CPT Code is a timed service. According to CMS guidelines, you must follow the 8-minute rule:

• 8 to 22 minutes = 1 unit

• 23 to 37 minutes = 2 units

• 38 to 52 minutes = 3 units

• and so on.

Don’t round up or down arbitrarily. Documentation must support the time billed.

2. Don’t Mix and Match Timed and Untimed Codes

Avoid billing 97110 along with untimed codes (like 97140) without clear documentation differentiating the services. Each must be distinctly documented and medically necessary.

3. Be Specific About Exercise Type

It’s not enough to say “therapeutic exercise.” Clarify whether the exercise is for range of motion, strength, or flexibility. This adds credibility and supports medical necessity.

4. Know Your Payers’ Guidelines

Different insurance payers may have different coverage policies. Some might only pay for 97110 under certain diagnoses or with prior authorization.

Using Modifiers with 97110

Modifiers help convey important information to the payer and can be the key to avoiding denials.

Commonly Used Modifiers:

• Modifier 59 – Distinct procedural service
  Use when 97110 is provided with another therapy service and documentation supports that they were separate and not overlapping.

• Modifier GP – Services delivered under an outpatient physical therapy plan of care
  Required by Medicare and many commercial payers.

• Modifier KX – Requirements specified in the medical policy have been met
  Use this when services exceed therapy caps but are still medically necessary.

Now, while Modifier 26 is generally reserved for the professional component of services like radiology or diagnostic testing, it’s worth mentioning here because confusion often arises. Providers must ensure they’re not mistakenly attaching Modifier 26 to the 97110 CPT Code, which does not have a technical vs. professional split.

Understanding the proper use of Modifier 26 and outsourcing medical billing services can dramatically reduce these types of errors. A knowledgeable billing service ensures that modifiers are used correctly and compliantly, helping you avoid unnecessary denials and delays in payment.

Benefits of Outsourcing Medical Billing Services for 97110

Many practices, especially smaller clinics, struggle with keeping up with the ever-changing coding regulations and payer requirements. That’s where outsourcing medical billing services comes in as a game-changer.

Here’s why outsourcing can be particularly beneficial when billing codes like 97110:

1. Expertise in Therapy Billing

Medical billing companies often specialize in certain areas, including physical and occupational therapy. They are well-versed in documentation guidelines, CPT rules, and payer policies.

2. Reduced Claim Denials

With thorough knowledge of coding rules and modifier usage, billing services can help minimize rejections and ensure cleaner claim submissions.

3. Increased Revenue Collection

Professional billers can track claims, manage denials, and ensure timely follow-ups leading to faster reimbursement and fewer write-offs.

4. Regulatory Compliance

Outsourcing ensures your practice stays up to date with HIPAA regulations, CMS rules, and annual CPT code updates.

Auditing and Compliance for 97110

Audits are an unfortunate reality in healthcare, and physical therapy services like 97110 CPT Code are frequently targeted. Insurers want to confirm that services are not only rendered but also appropriately documented and coded.

To stay compliant:

• Conduct internal audits quarterly

• Use audit checklists to verify correct coding and documentation

• Train staff routinely on new guidelines

• Consider using EHR alerts to ensure time tracking for time-based codes

Documentation that lacks detail, fails to show progression, or doesn’t link the diagnosis to treatment can lead to recoupments and penalties.

Denial Reasons Related to 97110 CPT Code

Here are the top reasons why 97110 claims are denied and how to avoid them:

Best Practices for Billing 97110 CPT Code

To wrap up, here are some actionable best practices for successfully billing the 97110 CPT Code:

1. Always Document Time and Specific Exercises

2. Clearly Link Exercises to Medical Necessity

3. Use Appropriate Modifiers and Know When Not to Use Them

4. Double-Check Payer-Specific Rules

5. Train Therapists on Proper Documentation

6. Leverage Outsourcing Medical Billing Services if Needed

A streamlined workflow and accurate documentation don’t just protect you they also enhance the patient experience by reducing billing delays and confusion.

Summary

The 97110 CPT Code plays a vital role in therapy and rehabilitation settings. Its successful use hinges on detailed documentation, proper modifier application, and an understanding of payer-specific requirements. By implementing the tips outlined in this guide, providers can reduce claim denials, remain compliant, and improve their revenue cycle.

If managing all of this seems overwhelming, outsourcing medical billing services could be a strategic move especially for practices where coding errors can have major financial impacts. And always keep in mind that coding is not just about billing it’s about telling the patient’s story in a language insurers understand.

Mastering the 97110 CPT Code can be the difference between a healthy practice and one bogged down by billing challenges. Get it right, and you’ll pave the way for better financial and clinical outcomes alike.