Therapy billing is minute-based and plan-of-care driven, and Medicare adds its own modifiers and thresholds.
Examples of frequently billed services, with billing notes from our coders.
| CPT code | Service | Billing note |
|---|---|---|
| 97161 | PT evaluation, low complexity | Evaluation complexity must be documented |
| 97110 | Therapeutic exercise, 15 minutes | Counts toward timed units |
| 97112 | Neuromuscular re-education, 15 minutes | Document the specific intervention |
| 97140 | Manual therapy, 15 minutes | Often edited with other codes; check modifier rules |
| 97530 | Therapeutic activities, 15 minutes | Direct one-on-one time only |
| 97164 | PT re-evaluation | Needs a clinical reason |
| 97035 | Ultrasound therapy, 15 minutes | Check payer coverage |
Codes shown are common examples and descriptions are simplified in our own words. CPT® is a registered trademark of the American Medical Association. Always confirm against the current AMA CPT codebook, ICD-10-CM and each payer’s policy.
Modifiers tell the payer how and why a service was performed. Missing or wrong ones are a leading cause of denials.
Eligibility, benefits and prior authorization verified before the visit.
Code, modifier and documentation review before claims are submitted.
Denials corrected and appealed, aging claims worked until resolved.
Diagnostic testing, procedures and E/M claims coded correctly for each payer.
View billing detailsBiopsy, lesion removal and Mohs billing, with medical and cosmetic claims kept separate.
View billing detailsColonoscopy, endoscopy and screening claims coded for the right site and payer.
View billing detailsTalk to our team about your practice, hospital or lab. We will review your current billing and show you where revenue is slipping away.