CATEGORY
physical medicine and rehabilitation therapeutic procedures
CODE TYPE
Timed-based code
billed in 15 mins increment
ADD-ON CODE
No add-on code
THERAPEUTIC PROCEDURE
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.
Types of Exercises that are included:
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.
» Proprioceptive neuromuscular facilitation (PNF) techniques:
- Hold Relax
- Contract Relax
- Hold Relax with agonist contraction
» Postural reeducation
» EMG feedback
» Desensitizing techniques
» Balance exercises
» Stability Exercises
» Kinesthetic training
» Movement Reeducation
These procedures are reasonable and necessary for disabilities that affect the body’s neuromuscular system.
CODING GUIDELINES
» Require the professional skills of qualified healthcare professionals that includes:
- Physical Therapist
- Occupational Therapist
- Chiropractors
- Physical Therapist Assistant
- Occupational Therapy Assistant
» Billed in 15 minutes increment
» Requires a therapy modifier (GP, GN, GO, CO, CQ)
» CMS 8-minute rule and AMA rule of Eights are applied
CMS 8-Minute Rule:
A minimum of 8 minutes of direct contact with the patient must be provided for a single unit of 97112 to be billed:
| Units | Number of Minutes |
|---|---|
| 1 unit | ≥ 08 minutes through 22 minutes |
| 2 units | ≥ 23 minutes through 37 minutes |
| 3 units | ≥ 38 minutes through 52 minutes |
| 4 units | ≥ 53 minutes through 67 minutes |
| 5 units | ≥ 68 minutes through 82 minutes |
| 6 units | ≥ 83 minutes through 97 minutes |
| 7 units | ≥ 98 minutes through 112 minutes |
| 8 units | ≥ 113 minutes through 127 minutes |
The pattern remains the same for treatment times of more than 2 hours.
AMA Rule of Eights:
“AMA guidelines state that incremental intervals of treatment performed on the same session may be added together when determining total time in direct contact of a qualified healthcare provider with the patient is necessary. Each unique timed service is counted separately instead of combining the time from multiple units”
Physical Therapy Modifiers
Below mentioned modifiers are used when services are provided for the respective plan of care:
| MODIFIERS | PLAN OF CARE |
|---|---|
| GP | Outpatient Physical Therapy |
| GO | Outpatient Occupational Therapy |
| GN | Outpatient Speech-Language Pathology |
| CQ | Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially) |
| CO | Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially) |
TOTAL NO. OF BILLABLE UNITS
04 units are allowed per date of service by CMS but more units can be billed if justified by medical notes.
REIMBURSEMENT GUIDELINES
For reimbursement of these CPTs following elements must be documented in the Physical Therapy Notes:
- Loss of deep tendon refluxes and vibration sense in combination with paresthesia .
- Nerve palsy such as ulnar nerve palsy, peroneal nerve injury .
- Weakness or flaccidity due to neurological disease or injury .
