Current Procedural Terminology (CPT) code 97110 is a standardized numerical identifier used in the healthcare system to define and bill for therapeutic exercises. This code covers a therapeutic procedure requiring direct, one-on-one contact between the patient and a qualified healthcare professional, such as a physical or occupational therapist. Its purpose is to secure reimbursement for the skilled application of exercises designed to restore or improve a patient’s physical function.
The Purpose of Therapeutic Exercises
Therapeutic exercises, defined under CPT code 97110, are structured physical activities prescribed to restore foundational physical attributes. These exercises are medically necessary interventions tailored to a patient’s specific impairment or injury, not general fitness routines. The primary goals are to improve four key physical parameters: strength, endurance, range of motion, and flexibility.
Building strength involves using resistance to increase muscle power and stability, such as progressive resistive exercises using weights, bands, or body weight. Endurance training focuses on increasing a patient’s ability to sustain physical activity, often through cardiovascular conditioning on equipment like a treadmill. Range of motion exercises are designed to improve the movement capacity of joints, encompassing active, active-assistive, or passive joint movements.
Flexibility training, such as specific stretching routines, aims to enhance the elasticity of muscles and tendons to reduce stiffness and improve joint mobility. For example, a patient recovering from a rotator cuff repair might perform assisted shoulder movements, while a patient with chronic low back pain might engage in core stabilization drills. The treatment plan must clearly document how these foundational exercises contribute to achieving a patient’s functional, real-world goals.
Billing Rules and Time Requirements
CPT code 97110 is classified as a time-based code, meaning billing is directly tied to the duration of the service provided. Each unit of the code represents 15 minutes of direct therapeutic exercise performed under the supervision of a licensed therapist. The therapist must be in direct, one-on-one contact with the patient throughout the billed time, actively instructing and monitoring the exercises.
To ensure compliance with payer guidelines, the service must adhere to the “8-minute rule” for timed codes, particularly for federal programs like Medicare. This rule stipulates that a therapist must provide a minimum of eight minutes of the service to bill for one full 15-minute unit. For example, 23 to 37 minutes of therapeutic exercise can be billed as two units of 97110.
Accurate and detailed documentation is necessary to justify the use of this code and prevent claim denials. The clinical record must establish medical necessity, demonstrating that the exercises are skilled and goal-oriented. Documentation should specify the type of exercise performed, the targeted body part, the time spent, and objective metrics, such as strength grades or degrees of motion, to track progress.
How 97110 Differs From Related CPT Codes
The distinction between CPT code 97110 and other time-based therapy codes hinges on the specific nature of the activity. Code 97110 focuses on developing foundational physical attributes like strength and flexibility through isolated exercises. In contrast, CPT code 97530, Therapeutic Activities, involves dynamic, functional movements. Therapeutic activities improve functional performance by simulating tasks from daily life, such as bending, lifting, or squatting, requiring coordination of multiple joints and body parts.
CPT code 97112, Neuromuscular Re-education, focuses on retraining the nervous system and muscles. This code is used for activities aimed at improving balance, coordination, posture, and proprioception (the body’s sense of its position in space). Examples include balance training on unstable surfaces or using techniques like Proprioceptive Neuromuscular Facilitation (PNF) patterns.
A single session may involve multiple codes, but the time for each service must be documented separately to avoid billing overlap. For instance, a patient might perform leg presses (97110) to increase strength and then transition to a simulated task like retrieving an object from an overhead shelf (97530). Therapists must carefully select the code that most accurately describes the primary skilled intervention provided during each distinct time block.