What is the difference between CPT 97110 and 97112?
Asked by: Nickolas Mohr | Last update: June 25, 2025Score: 4.9/5 (3 votes)
What is CPT code 97112 used for?
CPT 97112 consists of all the therapeutic interventions that are used to improve body functions. These procedures are used to improve balance, coordination, kinesthetic and proprioceptive sensations. Patients need to be in direct contact with the doctor in order to receive treatment.
Can cpt code 97110 and 97112 be billed together?
You would need the mod-59 on 97112 so that they know it is a different 15-minute time period than the 97110, otherwise they will bundle the codes.
What is the difference between therapeutic exercise and neuromuscular reeducation?
Therapeutic exercise is a lower complexity activity for the patient, whereas neuromuscular reeducation and therapeutic activities is a higher complexity activity and requires the documentation to support it as such.
What is CPT code 97110 used for?
CPT® code 97110 is used for billing therapeutic exercises that are aimed at improving patients' strength, endurance, range of motion, and flexibility, making it a cornerstone of many treatment plans.
CPT Code 97110 vs CPT Code 97530 | Medicare Billing & Documentation
What is an example of 97112?
CPT code 97112 is used to bill skilled therapy interventions that aim to improve motor function through neuromuscular reeducation. It includes interventions such as balance reeducation, movement coordination, and kinesthetic sense training for sitting and standing activities.
What is the medical necessity for 97110?
To bill using the 97110 CPT code, the exercises prescribed must be medically necessary to enhance a patient's mobility and strength, thus increasing participation in daily activities like feeding, dressing, bathing, and various other functional tasks.
How many units of 97112 can you bill?
How many units of CPT code 97112 can you bill? Billing for CPT code 97112 is limited to no more than 4 units per date of service per discipline as stated on the CMS website. CMS notes that treatments should rarely exceed 30-60 minutes, with longer sessions requiring documentation to support a lengthier duration.
What falls under neuromuscular reeducation?
Neuromuscular reeducation deals with retraining the brain and spinal cord in voluntary and reflex motor activities. Basic principles of neuromuscular physiology are applied clinically in the treatment of muscle paresis and paralysis.
What falls under therapeutic exercise?
Introduction. Therapeutic exercise involves movement prescribed to correct impairments, restore muscular and skeletal function and/or maintain a state of well-being. Therapeutic exercise is a type of physical activity used to treat or prevent injuries and improve functional outcomes.
Does 97110 need a modifier for chiropractic?
So if you render and bill for 1-2 regions of CMT (98940) and therapeutic exercise (97110), then the 97110 chiropractic CPT code will receive the GP modifier.
How to document neuromuscular reeducation?
Documentation for neuromuscular reeducation must show impairments which affect the neuromuscular system as listed above, and must contain objective measurements/ratings of loss of motion, strength, balance, coordination, and/or mobility (e.g. degree of motion, strength grades, assist for balance and Policy contains: • ...
What is the correct coding initiative?
The National Correct Coding Initiative (NCCI)
The Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding, with the overall goal of reducing improper payments of Medicare Part B and Medicaid claims.
What modifier goes with 97112?
Modifiers such as 59 or XS should be used when reporting the 97112 CPT code and other procedures, such as chiropractic manipulative treatment (CMT), performed on the same service date and in the same or different body regions.
When to bill therapeutic activities?
The 97530 CPT code may be billed when a patient engages in therapeutic activity. This CPT code for therapeutic activity includes a wide range of rehabilitative procedures that use whole-body movement to gradually improve functional performance—such as bending, lifting, carrying, and reaching.
When to use CPT 97112?
CPT code 97112 refers to the therapeutic procedure of neuromuscular re-education. It involves the use of various techniques and exercises aimed at improving coordination, proprioception, balance, posture, kinesthetic sense, and motor control.
What is an example of a muscle reeducation?
It's where you learn to perform an isolated contraction of a muscle. Usually short, “wake up” exercises for your muscles to increase blood flow. For example squeezing your glutes together to help improve your ability to activate your glutes.
Which is an example of neuromuscular exercise?
These exercises, such as single-leg balance or standing on unstable surfaces, force the body to recruit muscles and activate neural pathways responsible for maintaining balance. Proprioception exercises, which focus on the body's sense of position and movement, further improve coordination and stability.
What is the billing rule for 97110?
CPT® code 97110: Therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes. As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care.
What is the rule of 8 for PT billing?
If there are less than 8 minutes, you cannot bill an extra unit. As an example, a physical therapist provides 15 minutes of therapeutic exercise (97110), 8 minutes of therapeutic activities (97530), and 5 minutes of manual therapy (97140). All services are timed codes.
Can you bill 97112 and 97116 together?
Do not bill for CPT codes 97110, 97112, 97116 or 97530 for the same time period. Ultrasound with electrical stimulation provided concurrently (e.g., Medcosound, Rich-Mar devices), should be billed as ultrasound (97035).
How much does Medicare pay for 97110?
Therapeutic exercise (97110) will drop by an average of 3.3%, going from $31.40 to $30.36. Manual therapy (97140) sees a similar percentage decrease, from $28.87 to $27.91.
What documentation is needed for 97110?
Documentation should include not only measurable indicators such as functional loss of joint motion or muscle strength, but also information on the impact of these limitations on the patient's life and how improvement in one or more of these measures leads to improved function.
When reporting skilled minutes, the time counted is?
The time counted is the time the patient is treated using skilled therapy modalities and procedures, and is recorded in the documentation as “Timed Code Treatment Minutes.” Pre- and post-delivery services are not to be counted when recording the treatment time.