Covered Codes for Physical Therapy Providers

Code  Description  Session Limit  Other Instructions
Covered Codes for Physical Therapists (PT) – Use modifier “GP” when billing these codes.
97001 Physical therapy initial evaluation 1 unit Limited to 1 evaluation per provider, per
condition, per calendar year.
97002 Physical therapy re-evaluation 1 unit Limited to once every 3 months.
97010 Application of a modality to one or more areas: hot
or cold packs
4 units
97012 Application of a modality to one or more areas;
traction, mechanical
4 units
97014 Application of a modality to one or more areas;
electrical stimulation (unattended)
4 units
97016 Application of a modality to one or more areas:
vasopneumatic devices
4 units
97018 Application of a modality to one or more areas:
paraffin bath
4 units
97022 Application of a modality to one or more areas;
whirlpool
4 units
97024 Application of a modality to one or more areas;
diathermy
4 units
97026 Application of a modality to one or more areas;
infrared
4 units
97028 Application of a modality to one or more areas;
ultraviolet
4 units
97032 Application of a modality to one or more areas;
electrical stimulation (manual), each 15 min.
4 units
97033 Application of a modality to one or more areas;
iontophoresis, each 15 min.
4 units
97034 Application of a modality to one or more areas;
contrast baths, each 15 min.
4 units
97035 Application of a modality to one or more areas;
ultrasound, each 15 min.
4 units
97036 Application of a modality to one or more areas;
Hubbard tank, each 15 min.
4 units
97110 Therapeutic procedure, one or more areas, each
15 min.; therapeutic exercises
4 units Prior authorization is required when used
with code 97140. See “Other Instructions”
for code 97140.
97112 Therapeutic procedure, one or more areas, each
15 min.; neuromuscular reeducation
4 units
97113 Therapeutic procedure, one or more areas, each
15 min.; aquatic therapy with therapeutic
exercises
4 units
97116 Therapeutic procedure, one or more areas, each 15
min.; gait training
4 units
97124 Therapeutic procedure, one or more areas, each
15 min.; massage, including effleurage,
pertrissage and/or tapotement
4 units See “Other Instructions” for 92507.
97140 Manual therapy techniques (e.g.,
mobilization/manipulation, manual lymphatic
drainage, manual traction) one or more regions,
each 15 min.
6 units of code
97140
OR
6 combined
units of codes
97140, 97110
and/or 97535
Prior authorization is always required. One
prior authorization is issued for ICD-9 codes
457.0, 457.1 and 757.0 for use with a
combination of codes 97140, 97110 and/or
97535 for a maximum of 15 sessions (6
units per session) for a total of 90 units to be
completed in approximately 3 weeks.
97150 Therapeutic procedure(s), group
(A group is 2 or more individuals.)
1 unit Bill 1 unit for each recipient in the group.
97530 Therapeutic activities, direct (one-on-one) patient
contact by the provider (use of dynamic activities
to improve functional performance), each 15 min.
4 units
97532 Development of cognitive skills to improve
attention, memory, problem solving (includes
compensatory training), direct (one-on-one)
patient contact by the provider, each 15 min.
4 units See “Other Instructions” for 92507.
97533 Sensory integrative techniques to enhance sensory
processing and promote adaptive responses to
environmental demands, direct (one-on-one)
contact by the provider, each 15 min.
4 units See “Other Instructions” for 92507.
97535 Self-care/home management training (e.g., ADLs)
direct (one-on-one) contact by provider, each 15
min.
4 units Prior authorization is required when used
with code 97140. See “Other Instructions”
for code 97140.
97542 Wheelchair management/ propulsion training,
each 15 min.
4 units
97760 Orthotic(s) fitting and training, upper
extremity(ies), lower extremity(ies), and/or trunk,
each 15 min.
4 units
97761 Prosthetic training, upper and/or lower
extremities, each 15 min
4 units
97762 Checkout for orthotic/prosthetic use, established
patient, each 15 min.
4 units