Physical Therapy Billing Cheat Sheet (2026)
Physical therapy gets paid by the minute, and the minute has to be on the chart. Timed codes are paid in units set by the 8-minute rule, the KX modifier carries you past the therapy threshold, and the plan of care has to be certified or the whole episode is at risk.
Quick reference for physical therapy billers. Last updated .
Top Physical Therapy CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 97161 | Physical therapy evaluation, low complexity | $97.86 | $97.86 | 2.93 |
| 97162 | Physical therapy evaluation, moderate complexity | $97.86 | $97.86 | 2.93 |
| 97163 | Physical therapy evaluation, high complexity | $97.86 | $97.86 | 2.93 |
| 97164 | Physical therapy re-evaluation | $67.47 | $67.47 | 2.02 |
| 97110 | Therapeutic exercise, 15 minutes | $29.06 | $29.06 | 0.87 |
| 97140 | Manual therapy techniques, 15 minutes | $27.72 | $27.72 | 0.83 |
| 97112 | Neuromuscular reeducation, 15 minutes | $32.73 | $32.73 | 0.98 |
| 97530 | Therapeutic activities, 15 minutes | $35.07 | $35.07 | 1.05 |
| 97035 | Ultrasound therapy, 15 minutes | $14.36 | $14.36 | 0.43 |
| 97014 | Electrical stimulation, unattended | $12.69 | $12.69 | 0.38 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the Physical Therapy billing services page.
Modifiers That Prevent Physical Therapy Denials
Services delivered under a physical therapy plan of care, required by Medicare and many payers on every PT line.
Medically necessary services above the annual therapy threshold, attesting the documentation supports continued care.
A distinct timed service unbundled from another, such as manual therapy (97140) with therapeutic activities (97530) when separately and distinctly performed.
Services furnished in whole or part by a physical therapist assistant, required for the PTA payment differential.
An ABN is on file for services likely to exceed coverage or be denied as not medically necessary.
Habilitative (96) versus rehabilitative (97) intent where the payer differentiates the benefit.
Top Physical Therapy Denials → Quick Fix
Apply the 8-minute rule: total timed minutes divided into 15-minute units. Document start and stop or total minutes per timed code; the math has to support the units billed.
Append modifier KX with documentation of continued medical necessity once the annual therapy threshold is reached. Without it the service is denied above the cap.
When 97140 is distinct from the other service, append modifier 59 or XP and document the separate body region or distinct time block.
Maintain a plan of care certified by the referring provider within the required window. An uncertified plan puts the whole episode at risk.
Document the history, exam elements, and clinical decision-making that support 97161, 97162, or 97163. Defaulting to one level is a coding-accuracy denial.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 97161 | 0213T | Misuse of Column Two code with Column One code |
| 97161 | 0216T | Misuse of Column Two code with Column One code |
| 97162 | 0213T | Misuse of Column Two code with Column One code |
| 97162 | 0216T | Misuse of Column Two code with Column One code |
| 97163 | 0213T | Misuse of Column Two code with Column One code |
| 97163 | 0216T | Misuse of Column Two code with Column One code |
| 97164 | 0213T | Misuse of Column Two code with Column One code |
| 97164 | 0216T | Misuse of Column Two code with Column One code |
Documentation That Holds Up on Appeal
Total minutes per timed code, since the 8-minute rule converts minutes into billable units.
History, number of exam elements, and clinical decision complexity establishing the level.
Continued medical necessity supporting the KX attestation.
Certification by the referring provider within the payer's required window and periodic recertification.
The PTA involvement supporting the CQ modifier and the payment differential.
Revenue Physical Therapy Practices Leave on the Table
Billing unit counts the documented minutes do not support, which fails on audit and claws back paid claims.
Stopping at the therapy threshold instead of appending KX with the necessity documentation that supports continued care.
Collapsing distinct timed services because of bundling fear instead of using modifier 59 with documentation.
Letting plan-of-care certification lapse and putting the entire episode's payment at risk.
Physical Therapy Billing FAQ
How does the 8-minute rule work?
Total the timed-code minutes for the visit and divide by 15. One unit needs at least 8 minutes, two units at least 23, and so on. Each timed code's minutes have to be documented to support the units billed.
What is the KX modifier for?
It attests that services above the annual therapy threshold are medically necessary and the documentation proves it. Without KX, claims above the threshold are denied.
When can I bill 97140 with another timed code?
When manual therapy is distinct from the other service by region or a separate time block. Append modifier 59 or XP and document the distinction, or the codes bundle.
Why do evaluations get down-coded?
Because the note does not document the history, exam elements, and decision-making that support the chosen complexity (97161 to 97163). The level has to be earned in the chart.
Stop Losing Physical Therapy Revenue to Preventable Denials
Our AAPC-certified physical therapy coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.