Understanding the 97110 CPT Code is the first step to cleaner claims and fewer headaches. You heard it? Every physical therapist, hospital, and billing team knows how one wrong code can wreck an otherwise perfect day. But what does 97110 really mean? How should it be used? And why does it confuse so many practices?
Let’s break it down in plain language. We’ll talk about what the code stands for, how to apply the 8-minute rule, what documentation matters most, and how it stacks up against 97530. When you understand how this single code works, you unlock faster payments and fewer denials across every claim. Because in the world of rehab billing, clarity means cash flow.
What is the 97110 CPT Code?
So what exactly is this code everyone talks about? The 97110 CPT Code, defined by the American Medical Association (AMA), represents Therapeutic Exercise, one or more areas, each 15 minutes. That’s the technical definition, but in practice, it’s much more than a phrase on a claim form. It’s used when you, as a therapist, help a patient perform specific exercises to improve strength, endurance, range of motion, or flexibility. Not random movement. Not passive watching. Actual, skilled engagement.
Think of it as your hands-on role in rebuilding function.
Each 15-minute block counts as one billing unit, but the key is direct one-on-one contact. That’s what separates skilled therapy from simple exercise instruction. CMS also recognizes 97110 as a timed service, which means you get paid for the time you spend actively treating, not just supervising.
So, if you’re right there guiding, cueing, and correcting movement, 97110 is your go-to code.
Detailed Description of the 97110 CPT Code
Let’s dive deeper. What makes this code stand out from others? According to CMS, 97110 covers therapeutic exercises that help restore or maintain muscle function, joint movement, or flexibility. It’s often the bread and butter of outpatient rehab and for good reason.
| Key Element | What It Means | Example |
|---|---|---|
| Purpose | Improve strength, flexibility, or endurance | Resistance band training for shoulder recovery |
| Interaction | Direct contact with the therapist | PT monitors and adjusts patient form |
| Billing Unit | Every 15 minutes of skilled time | 30 minutes = 2 units |
| Common Use | Orthopedic and post-surgical rehab | Knee flexion, balance drills, core stability |
Why It Matters?
Because this code represents the core of physical recovery. It’s where therapy meets measurable improvement. But here’s where many get tripped up: documenting why the exercise was needed. That’s where AMA guidance comes in. Every billed unit must show medical necessity. If you can’t connect the exercise to a functional goal, auditors will question it.
What is the 8 Minute Rule for 97110?
Now, here’s the question everyone asks: What’s the deal with the 8-minute rule? The 8-minute rule, outlined by CMS, and a blog written by Pro-MBS determines how many units you can bill for timed codes like 97110. It’s simple once you see it laid out:
| Direct Time | Billable Units |
|---|---|
| 8–22 minutes | 1 unit |
| 23–37 minutes | 2 units |
| 38–52 minutes | 3 units |
| 53–67 minutes | 4 units |
So if you spent 25 minutes providing direct therapeutic exercise, you’d bill 2 units of 97110. But here’s the catch: every second counts only if you’re actively engaged with the patient. Time spent setting up equipment or chatting doesn’t qualify. Ask yourself: Was I providing skilled instruction the whole time? If yes, count it. If not, don’t.
Auditors love to check this. That’s why your notes must always show clear start and stop times.
Documentation Requirements for the 97110 CPT Code
What’s the best way to document 97110 without missing a detail? Follow the golden rules set by CMS and AMA. Your notes must show:
- The specific exercises performed: Write down exactly what was done, not just “therapeutic exercise.” Was it resisted knee extension? Shoulder abduction with a band? Core stability work on a Swiss ball? Specifics matter because CMS reviewers need to see what you actually did to address the patient’s impairment. The exercise name and setup show the skill behind your care.
- The purpose behind them (strength, mobility, endurance): Explain why you chose those particular exercises. Were they meant to build strength after surgery? Improve balance after a stroke? Restore range of motion after a joint replacement? A simple “for strengthening” is too vague. You must link every activity to a clear therapeutic goal that proves medical necessity as required by the American Medical Association (AMA) and Medicare standards.
- Measurable progress toward functional goals: Describe what changed since the last visit. Maybe the patient increased resistance, achieved greater knee flexion, or could stand for longer without support. Concrete numbers like “ROM improved from 80° to 95°” demonstrate progress and justify ongoing care. CMS expects documentation to show measurable outcomes, not just routine attendance.
- Direct time spent face-to-face: Record how long you were physically engaged in skilled treatment. Start and stop times should be clear. For example, “2:10–2:40 PM, 30 minutes of direct contact.” This proves compliance with the 8-minute rule and supports the number of units billed. Never round up or estimate; accuracy is your best defense in an audit.
- The therapist’s signature and credentials: Always end your note with your full name, professional designation, and date. Example: John Smith, PT, DPT – 10/24/2025. Missing credentials can invalidate the entire note in the eyes of CMS auditors. Your signature confirms that a licensed professional delivered skilled, billable therapy.
Here’s an example of strong documentation: “Patient performed 3 sets of seated knee extensions with 3-lb resistance. Purpose: improve quadriceps strength for stair climbing. Direct time: 30 minutes (2 units).” See how clear that is? No fluff. No gaps. One more question: why do so many clinics still get denied? Simple. They copy and paste templates instead of describing real progress. CMS reviewers can spot that a mile away.
Write what you did. Write why it mattered. That’s what protects you.
What is the Difference Between CPT Code 97110 and 97530?
This one’s a classic confusion point. Both codes deal with movement, but they describe different types of therapy. Many clinicians mix them up because they often appear side by side in a treatment plan. But the intent behind each code is different, and getting it wrong can mean denials or compliance issues.
Let’s compare.
| Code | Focus | Core Purpose | Example |
|---|---|---|---|
| 97110 | Exercise for strength or ROM | Improve muscle performance | Shoulder strengthening post-surgery |
| 97530 | Functional activity | Improve ability to perform real tasks | Lifting, reaching, or stepping tasks |
97110: Focused Exercise
Use 97110 when you’re guiding specific exercises that build capacity: muscles, endurance, range. It’s controlled, structured, and repetitive. Think leg presses, shoulder abductions, balance board drills.
97530: Functional Activity
Use 97530 when the goal is to help the patient do something, like reach overhead, pick up a box, or transfer from bed to chair. It’s about real-world performance, not isolated strength.
Billing Both Codes
Can you bill both in one session? Yes, but be careful. CMS states you can only bill them together if the time and purpose are clearly distinct. That means no overlapping notes and no shared minutes. Ask yourself: Was I training movement or training function? That one question keeps you compliant.
Common Mistakes and Audit Triggers
Even top practices get flagged for errors. It happens more often than most people think. A clinic can have skilled therapists, good systems, and still get caught in billing reviews. Sometimes it’s a missed time entry. Other times it’s a note that looks too routine or a code that doesn’t match the documented activity. These small gaps add up and trigger audits from CMS or private payers. What typically causes trouble isn’t lack of care but lack of clarity. When the paperwork doesn’t reflect the skill behind the service, the code loses its power.
That’s why precision matters more than perfection.
- Billing 97110 with no time recorded: This is one of the biggest red flags for auditors. Every billed unit of 97110 must be supported by exact start and stop times showing face-to-face treatment. Without time documentation, payers assume the service wasn’t provided, and that often leads to denials.
- Copying the same exercise list for every visit: Repetition in notes suggests that the patient isn’t progressing or that skilled care isn’t needed. Each session should reflect updates to resistance, range, or intensity. CMS looks for proof that the therapist modified the plan as the patient improved.
- Using 97110 when 97530 would be more accurate: Therapeutic exercise (97110) focuses on muscle strength and mobility, while therapeutic activity (97530) targets real functional tasks. Using the wrong code can create compliance issues and make documentation appear inconsistent with the care provided.
- Missing therapist signature or credentials: Unsigned notes or missing professional titles make a claim invalid in the eyes of Medicare and commercial insurers. Always include your full name, credentials, and date at the end of every note to verify that a licensed clinician performed the service.
The Medicare Benefit Policy Manual, Chapter 15, clearly says documentation must reflect skilled, medically necessary services. If it looks routine or repetitive, it’s at risk. Want a quick fix? Review your last five therapy notes. If they all read the same, that’s a red flag.
How to Stay Compliant and Get Paid Faster?
So how can your clinic stay ahead of denials? It starts with precision. The following Image will show you the steps to stay full compliant and get paid faster:
Partnering with Pro-MBS for Accurate Coding Audits
The 97110 CPT Code might look simple, but it carries serious weight in physical therapy billing. It defines how skill, precision, and documentation come together to prove medical necessity. For hospitals, clinics, and private practices, mastering this code means cleaner claims and steady cash flow.
That’s where Pro-MBS comes in. Our team specializes in coding audits and compliance support designed for rehab providers. We review your therapy documentation, identify risks before audits happen, and help your billing team apply codes like 97110 and 97530 with total accuracy. Partnering with us means fewer denials, faster reimbursements, and stronger compliance across every claim.
Frequently Asked Questions
Is there a CPT code for physical therapy?
Yes. Physical therapy runs on a precise system of CPT codes that define every skilled act. The 97110 CPT Code covers therapeutic exercise, while the 97530 CPT Code applies to functional activity. These codes tell payers that your care is structured, skilled, and medically necessary—not routine repetition. For complete clarity in your physical therapy billing, let Pro-MBS keep your claims clean and compliant.
Is CPT code 97110 physical therapy?
Absolutely. The 97110 CPT Code stands for Therapeutic Exercise—fifteen minutes of skilled, one-on-one treatment that builds strength, range, and endurance. It’s the backbone of physical therapy billing and one of the most-used codes in rehab care. Every rep counts, every note matters, and precision pays. Partner with Pro-MBS to make every minute of your care billable and defensible.
What is the difference between 97110 and 97530?
The 97110 CPT Code focuses on exercises that rebuild the body—strength, mobility, control. The 97530 CPT Code trains the task itself, guiding patients through functional movements that mirror real life. One code builds capacity, the other builds performance. Get both right, and your claims never stumble. Pro-MBS can help your team master the distinction before payers question it.
Can you code from physical therapy notes?
Yes, but only if your documentation tells the full story. Notes must show what exercises were done, why they were chosen, and how long you worked directly with the patient. 97110 CPT Code billing depends on proof of skilled time, not vague templates. Clean notes mean clean claims. Pro-MBS audits can help you turn documentation into undeniable compliance.
What is the CPT code for PT therapeutic activities?
That’s the 97530 CPT Code—used when therapy focuses on real-world movement. Think lifting, reaching, or balancing to restore daily function. Unlike the 97110 CPT Code, which targets muscle strength, this one trains coordination and task execution. Both are vital, but each has its place. For accurate coding across your PT sessions, work with Pro-MBS, where precision meets payment.
How many units to bill for PT?
Under CMS’s 8-minute rule, the math is strict but simple: 8–22 minutes equals 1 unit, 23–37 equals 2, and so on. Each 97110 CPT Code unit represents fifteen minutes of skilled, face-to-face care—not setup, not idle time. Every second must show purpose. Stay accurate, stay paid. Pro-MBS ensures your time matches your reimbursement.
How to maximize physical therapy billing?
Document like a storyteller, code like a strategist. The 97110 CPT Code and 97530 CPT Code must align with purpose, time, and necessity. The secret isn’t volume—it’s precision. Link every move to measurable progress and every note to compliance. When clarity leads, payment follows. For unmatched billing accuracy, trust Pro-MBS to guide your PT revenue cycle.
What is the rule of 8 physical therapy units?
The 8-minute rule decides how many units you can bill for time-based services like the 97110 CPT Code. Eight minutes earns one unit; more time builds up in 15-minute steps. Simple, yet often mishandled. Miss it once, lose revenue fast. Pro-MBS helps ensure your timing and units always align—because in PT billing, every minute is money.
