Most Common CPT Codes for Manual Therapy

Introduction

Manual therapy is a hands-on treatment approach used by healthcare professionals to address various musculoskeletal conditions. Accurate coding and billing are essential for proper reimbursement. This comprehensive guide details the most common CPT codes for manual therapy, providing clear descriptions, applications, and important considerations for healthcare providers in the USA. Understanding these codes ensures accurate documentation, streamlines billing processes, and maximizes revenue.

What is Manual Therapy?

Before diving into the CPT codes, it’s important to define what manual therapy encompasses. Manual therapy involves skilled hand movements, including:

• Mobilization: Gentle, passive movements of joints to restore range of motion and reduce pain.
• Manipulation: Applying a controlled thrust to a joint, often beyond its normal range of motion.
• Soft Tissue Mobilization: Techniques targeting muscles, fascia, and other soft tissues to release tension and improve function.

Most Common CPT Codes for Manual Therapy

It’s crucial to consult the most recent CPT code manual for the most up-to-date information. The codes listed below were accurate as of November 2023 but are subject to change.

CPT Code 97110

• Code Description: Therapeutic Procedure(s), one or more areas; each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility.
• This code covers therapeutic exercises designed to improve strength, endurance, range of motion, and flexibility. While not strictly manual therapy itself, it is often used in conjunction with manual therapy techniques. It should not be used when only manual therapy is performed.
• Applications: Post-surgical rehabilitation, muscle strains, joint sprains, and other conditions affecting movement and strength.

CPT Code 97112

• Code Description: Neuromuscular reeducation, one or more areas, each 15 minutes
• This code reports manual techniques used to improve muscle performance, coordination, proprioception, and balance.
• Applications: Stroke recovery, balance disorders, post-injury rehabilitation, and conditions affecting motor control.

CPT Code 97116

• Code Description: Gait training (includes stair climbing); each 15 minutes
• This code covers manual techniques and exercises focused on improving gait (walking pattern), balance, and coordination.
• Applications: Post-stroke rehabilitation, neurological conditions affecting gait, and post-surgical recovery.

CPT Code 97140

• Code Description: Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes
• This is the primary code for reporting various manual therapy techniques, including joint mobilization and manipulation, soft tissue mobilization, and manual traction.
• Applications: Joint pain, muscle tension, soft tissue restrictions, and spinal conditions.

CPT Code 97530

• Code Description: Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes
• This code is used when dynamic activities are used to improve functional performance. This may include activities like lifting, pushing, pulling, bending, etc.
• Applications: Functional training, activities of daily living (ADLs), and work conditioning.

CPT Code 97535

• Code Description: Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices), each 15 minutes.
• This code reports patient education and training on self-care, home management, and the use of assistive devices.
• Applications: Post-surgical recovery, chronic condition management, and patient empowerment.

Important Considerations for Billing Manual Therapy

• Time-Based Coding: Many manual therapy codes are time-based, billed in 15-minute increments. Accurate time tracking is crucial for proper billing.
• Documentation: Detailed documentation is essential, including the specific techniques used, the body regions treated, and the patient’s response to treatment.
• Medical Necessity: Services must be medically necessary to be reimbursed. Clear documentation of the patient’s condition and the rationale for manual therapy is crucial.
• Modifiers: Appropriate modifiers should be used when necessary, such as the “-25” modifier for Evaluation and Management (E/M) services performed on the same day as a procedure.

CPT codes are subject to annual updates. Always refer to the current edition of the CPT code manual for the most accurate and up-to-date information. You can obtain this from the American Medical Association (AMA).

FAQs

1: Can I bill 97140 for massage therapy?

Yes, 97140 can be used for massage therapy when it’s performed as a manual therapy technique for a specific therapeutic purpose, such as addressing musculoskeletal dysfunction. However, it should not be used for general relaxation massage.

2: How do I document manual therapy services?

Documentation should include the specific techniques used (e.g., joint mobilization, soft tissue mobilization), the body regions treated, the time spent on each technique, and the patient’s response to treatment.

3: What is the difference between mobilization and manipulation?

Mobilization involves gentle, passive movements of a joint within its normal range of motion. Manipulation involves a controlled thrust to a joint, often beyond its normal range of motion.

4: Are there any specific guidelines for billing manual therapy for Medicare patients?

Yes, Medicare has specific guidelines for billing therapy services, including manual therapy. It’s essential to be familiar with these guidelines to ensure proper reimbursement.

5: How often are CPT codes updated?

The American Medical Association (AMA) typically updates CPT codes annually.

About PrimeCare MBS

PrimeCare MBS is a reputable medical billing company that specializes in providing top-quality billing services for physical therapy practices. With our extensive expertise and industry knowledge, we offer reliable and efficient solutions to streamline the billing process and maximize revenue for physical therapy providers. Our commitment to delivering exceptional service, attention to detail, and adherence to compliance regulations make us a trusted partner for physical therapy billing needs. Contact us today to learn more about our physical therapy billing services.

The American Medical Association (AMA) owns the copyright for the Current Procedural Terminology (CPT) coding system. The AMA developed and maintains the CPT code set, regularly updating it to reflect changes in medical practices, technology, and healthcare regulations.