Current Procedural Terminology, or CPT, codes serve as a standardized language for reporting medical services and procedures to payers like insurance companies and government programs. CPT 97110, specifically, is a time-based code used frequently within the rehabilitation disciplines, particularly physical and occupational therapy. This overview clarifies the nature of CPT 97110, the professionals who use it, and the specific rules governing its billing.
The Core Definition of Therapeutic Exercise
The American Medical Association (AMA) defines CPT 97110 as a therapeutic procedure involving exercises designed to develop strength, endurance, range of motion (ROM), and flexibility in one or more areas of the body. This code is explicitly for exercises that are goal-oriented and medically necessary, meaning they are required to enhance a patient’s mobility and ability to perform daily functional tasks. The exercises are intended to address specific impairments such as muscle weakness, joint stiffness, or restricted movement stemming from an illness or injury. Examples of activities billed under this code include resistance training using weights or bands, stretching for post-surgical joint restrictions, and cardiovascular conditioning with a stationary bike to build physical tolerance. The primary distinction is that these are not general fitness or maintenance activities; they require the skilled intervention of a clinician to guide, modify, and monitor the patient’s performance to achieve a therapeutic outcome.
Who Utilizes and Receives This Service
Licensed healthcare providers authorized to bill for CPT 97110 typically include Physical Therapists (PTs) and Occupational Therapists (OTs). Physicians and non-physician practitioners may also utilize the code when appropriate within their scope of practice, and assistants (PTAs/OTAs) can provide the service under direct supervision, subject to payer-specific rules. These professionals administer the services as part of a documented, individualized plan of care that establishes the medical necessity of the exercise regimen. The patient population requiring therapeutic exercise is diverse, encompassing individuals with orthopedic injuries, post-surgical recovery needs, chronic pain, or those recovering from neurological events such as a stroke. For the procedure to be billable, the exercises must be directly connected to a diagnosis and aimed at a measurable functional goal, supported by accurate documentation of the patient’s specific physical impairment.
Calculating the Time: The 15-Minute Unit Rule
CPT 97110 is a time-based code, meaning reimbursement is directly tied to the duration of the service provided in a session, billed in 15-minute increments. To bill this code, the provider must be in direct, one-on-one contact with the patient, actively guiding and monitoring the exercise performance. Time spent on activities without the provider’s direct instruction, such as charting or resting, does not count toward the billable time. The actual calculation of units often follows the Medicare “8-Minute Rule,” a standard used by many payers to determine unit allocation for timed services. This rule stipulates that to bill for one full unit of a 15-minute time-based code, the service must be performed for a minimum of eight minutes. For example, a treatment session lasting 8 to 22 minutes qualifies for a single unit of CPT 97110, while a session of 23 to 37 minutes would allow for two units.