Coding for Interventions (CPT-4)

When billing most third parties for services provided by a physical therapist, it is necessary to utilize CPT-4 codes to describe the services that were rendered. Although CPT is not an exact descriptor of physical therapists' interventions, it does provide a reasonable framework for billing.

Most of the CPT codes that are available to physical therapists are located in the 97000 series called "Physical Medicine and Rehabilitation." However, CPT recognizes that a provider can bill any code as long as the provider can legally render that service according to state licensure laws. Therefore, it is necessary for physical therapists to become familiar with codes outside of the 97000 series as many codes appropriately describe services provided by physical therapists.

The CPT codes that are typically utilized by physical therapists have undergone significant revisions in the last ten years and the editorial process is ongoing. APTA is very involved in the CPT coding process, both on the editorial side as well as the relative value side. Staff and member advisors attend multiple meetings each year to participate in the code development and revision process.

It is important to understand the difference between CPT coding and payment policy. Just because a code exists and is utilized by a provider does not mean that a payer will reimburse for that code. Payment policy is determined by each individual payer and is determined by the employer benefit package language. The American Medical Association (AMA) owns the copyright of the CPT-4 codes.

The AMA Web site explains the entire process of CPT code development: how codes are suggested, how they become part of the CPT book, who is involved in the process, how you can submit suggestions for new codes, etc. Go to the AMA Web site for an extensive review of the process.

Learning Resources for CPT

Coding and Payment Guide for the Physical Therapist
Ingenix has customized a payment guide for physical therapists. This book must be ordered from the publisher.

CSM 2016