Rehab therapists specialize in analyzing movement and creatively using movement to restore patient function. Unfortunately, most therapists struggle to select the correct CPT codes to document and bill for these movement interventions. Choosing the correct movement intervention codes requires understanding the subtle differences in each code and how they apply to each intervention.
What are the movement intervention codes?
Before we dig into the codes, there are a couple of points that require clarification. First, there is some confusion among therapists about what determines when a CPT code is a one-on-one service. The one-on-one nature of codes is established by their CPT definitions, not by the type of payer. The interplay of state practice acts, regulations, and payer policies determines who can deliver billable one-on-one codes.
The movement intervention codes are represented by three services; the descriptions are courtesy of the Current Procedural Terminology (CPT) 2023 Professional Edition:
- CPT code 97530: Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes®
- CPT code 97112: Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting and standing activities®
- CPT code 97110: Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength, endurance, range of motion, and flexibility®
Understanding the subtle differences in the definitions of these movement intervention codes is very important, as these 15-minute codes make up the bulk of the charges for therapists’ services. Because the definitions of each of the three services differ, the values of these CPT codes are different. Depending on the payer’s fee schedules, the spread can be as much as $10—as illustrated by the example Medicare fee schedule table below:
2023 Medicare Fee Schedule for the Atlanta area + PE RVU is where the MPPR discount is applied.
All three of the codes require the therapist to have direct (one-on-one) patient contact. They all are 15-minute codes, and each has its differentiating documentation requirements. These three codes are the appropriate codes to use for instructing patients in their home exercise program. Intent is the key to selecting the correct code for a specific movement intervention.
It’s also important to note that you can perform each of these services continuously or intermittently during the treatment time during a visit. When performing these interventions, record the dosage (exercise prescription) the patient performs each day for each exercise. Once exercises can be performed without the active input of a therapist or assistant, they are no longer considered “skilled” and should be replaced by more challenging exercises.
With that out of the way, let’s look at the three movement intervention codes, courtesy of the CPT 2023 Professional Edition.
What are therapeutic activities (97530)?
Therapeutic activities are the overloading of everyday movements by adding or changing the speed of movement, weight, or isokinetic resistance, time, distance, and other factors. This code usually requires some equipment for those purposes, but equipment is not required.
Therapeutic activities also requires dynamic activities or movements, like:
- hopping, or
You may notice from the above list a common trend: every example ended in an “-ing.” And with each of these examples, they address a functional activity. With therapeutic activities, you’re improving functional performance by overloading these everyday activities.
What is neuromuscular reeducation (97112)?
In the case of neuromuscular reeducation, you’re emphasizing your specific feedback to the patient about the quality or specificity of a particular movement. Neuromuscular reeducation also includes instruction in movement, mechanics, posture, and balance, the facilitation and inhibition techniques for increasing or decreasing muscle tone, and proprioceptive and desensitization training techniques.
The feedback you’re providing to the patient on the quality of movement can take on many forms, such as:
What are therapeutic procedures (97110)?
The vague definition attached to this code has long tempted therapists to document all movement interventions with this code—which has led to its historical overuse by PTs. That’s why we must clarify the circumstances under which you should use this code and not the other two.
When coding for movement interventions, if your intent with that intervention matches either therapeutic activities or neuromuscular reeducation, do not code it as therapeutic exercise. As a rule, you should always code for intent and match your intent closely to the code definition that best describes the intervention.
For therapeutic exercises, remember that they are not “normal” functional activities performed in everyday life. They are often open-chain lower extremity exercises and closed-chain upper extremity exercises. Therapeutic exercises include manual resistance to elbow flexion or knee flexion, or other single joint resistive exercises, prolonged static stretch to increase ROM (as opposed to decrease muscle tone), and other similar activities. It should also be noted that therapeutic exercises never include instruction or coaching, except in establishing home exercises.
Choosing the right movement intervention codes when documenting treatment requires understanding what you’re trying to accomplish with that patient and the intent behind each prescribed activity. It also requires a better understanding of which activities are meant to fall under which code so that you can choose the most accurate and descriptive CPT code for your documentation. And as I’ve said many times before, documenting accurately and defensibly is your best defense against denied claims—or potential audits.