CPT code 97110 & 97112: Coding Guide for Coders

Basics of CPT code 97110 & 97112

The CPT code 97112 procedure requires direct one- on -one patient contact by a physician or therapist. The descriptor for this procedure reflects 15-minute intervals. If a procedure lasts more than 15 minutes, the CPT code can be reported for each 15-minute interval. CPT code 97112 Neuromuscular Re-education includes activities that facilitate re-education of movement, balance, posture, coordination, and proprioception/kinesthetic sense. You would include time spent kinesiotaping in this category as well as performing stabilization exercises, facilitation or inhibition, desensitization, ergonomic training, improving motor control, and plyometrics. While CPT code 97110 Therapeutic Exercise includes exercises for strengthening, ROM, endurance, and flexibility and must be direct contact time with the patient. Ambulation for endurance training would be included in this category (not gait training!).

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Description of CPT code 97110 & 97112

97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

97112   Therapeutic procedure, 1 or more areas, each 15 minutes;  neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

The health care provider and/or patient perform therapeutic exercises to one or more body areas to develop strength, endurance, and flexibility. This code requires direct contact with a health care provider and may be billed in 15-minute units.

In order to report code 97110, a minimum of eight minutes of therapeutic exercises need to be performed. Services of less than eight minutes would not be reported.

The eight-minute rule helps you count how many units of a time-based service you can bill for Medicare. The rule states that you must perform the service for at least eight minutes in order to count for one full unit.

CPT code 97110 is officially defined as “therapeutic exercises to develop strength, endurance, range of motion, and flexibility.” It can be applied to single or multiple body parts and requires direct contact with a qualified medical professional.

Therapeutic exercises include:

• Strengthening Exercises— Biceps Curls, Shoulder Press, Bent over row, squats, bridging
• Endurance Exercises— Treadmill, Cycle Ergometer
• ROM—- Passive, Active Assistive, Active
• Flexibility Exercises—- Forward lunges, Side lunges, Knees to chest

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Related Procedures for CPT code 97110 & 97112

97113 Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises

97116 ; gait training (includes stair climbing)

97124 ; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)

97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes

97150 Therapeutic procedure(s), group (2 or more individuals)

97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes

When you’re billing for gait training (97116), mechanical traction (97012), or manual therapy (97140), the therapeutic intent is pretty cut and dried. However, the movement intervention codes (think 97110, 97112, and 97530) are a bit trickier. 

List of exercises or activities included for reporting the above codes.

• active, active assistive, or passive range of motion to improve joint motion
• active, resistive exercises to increase muscle strength and endurance (include whether it’s isometric, isokinetic, or isotonic)
• stretches to improve flexibility (indicate type of stretch such as active, ballistic, pre-contraction, etc.)
• exercise to improve cardio-pulmonary endurance, such as walking on treadmill, using upper extremity ergometer
• specific exercises or activities performed and for what purpose,
• neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, and/or posture
• proprioception for sitting and/or standing activities.

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Example of CPT code 97110

A 26-year-old male presents with a complete spinal cord lesion resulting in paraplegia. The patient presents with paralysis of the lower extremities and bilateral upper-extremity (UE) weakness secondary to prolonged immobility, as well as decreased core strength and postural control. Therapeutic exercises focused on restoring and increasing UE strength for compensatory strategies would be reported with CPT code 97110, Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility, with modifier 97 appended because the procedure is rehabilitative in nature.

Therapeutic activities focused on skill acquisition for wheelchair management and mobility, including transferring to and from the wheelchair, would be reported with CPT code 97530, Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes, with modifier 96 appended because these services are habilitative in nature.

For CPT 97110 documentation, it is necessary to provide information about the volume and validation of the exercise. This means recording the number of sets and repetitions, the amount of resistance (weight, force, or torque) used during each set, and the duration of the hold. The technique for determining resistance in this instance should also be mentioned. One common approach is to use a percentage of the patient’s one-rep max or their maximum voluntary isometric contraction.

The therapist spends time directly with the patient administering the therapy services.

Modifiers GP(Outpatient Physical Therapy),

GO (Outpatient Occupational Therapy),
GN (Outpatient Speech-Language Pathology),
CO (Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially)),
CQ (Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially)), can be used for CPT code 97110.

The 97110 CPT code can be used for physical and occupational therapy, as well as chiropractic services. The Modifier 52 should never be used with the 97110 CPT code if the therapy service time is less than 8 minutes.

Example of CPT code 97112

Example 1: Open-chain right shoulder exercises; 3×10 with eyes closed. Manual cues provided to facilitate proper scapulohumeral rhythm and position sense. 

Report CPT code 97112  for Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and/or proprioception

NCCI edits for CPT code 97110 & 97112