CPT Codes for Physical Therapy: Medicare Guide (2026)

Physical therapy is billed with an untimed evaluation code (97161, 97162 or 97163, or 97164 for a re-evaluation) plus 15-minute timed treatment codes such as 97110, 97112, 97140 and 97530, each with the GP modifier. Medicare turns the day's timed minutes into units with the 8-minute rule, then cuts practice-expense payment on every unit after the first.

Physical therapy billing at a glance

Every PT page on FeeBase, by the question it answers:

Physical therapy evaluation codes: 97161–97164

The initial evaluation is reported once, at one of three complexity levels. The level reflects how much the patient's history, body systems, clinical presentation and decision-making demand of the therapist, not the minutes spent.

All four components have to support the level you bill, so the weakest one sets it. Medicare gives the three levels identical RVUs, so they pay the same; other payers may not. The PT evaluation codes guide walks through each component and the NCCI limits on evaluation days.

A re-evaluation (97164) is separately payable when the therapist's assessment shows a significant improvement, decline or other change in the patient's condition or function that the plan of care didn't anticipate (Benefit Policy Manual, ch. 15, §220). Routine reassessment during treatment isn't a re-evaluation, and NCCI doesn't allow an evaluation and a re-evaluation on the same day.

Timed physical therapy CPT codes

These are the codes billed most often in outpatient PT. Each is reported in 15-minute units of direct, one-on-one time.

Choosing between similar timed codes

Most coding errors in PT are a choice between two timed codes that use the same equipment. The documented purpose of the work decides, never the rate:

• 97110 vs 97530. Therapeutic exercise builds one capacity (strength, range of motion, endurance); therapeutic activities practice a functional task such as a sit-to-stand or a lift. A squat in sets for quadriceps strength is 97110; practicing getting up from the patient's own chair is 97530.
• 97110 vs 97112. Neuromuscular re-education retrains balance, coordination and proprioception for a documented deficit. Strengthening done standing on foam is still 97110.
• 97140 vs 97530. Manual therapy is the therapist's hands on joints and tissue; therapeutic activities are the patient moving. The NCCI edit between them ended December 31, 2019, so the pair no longer needs 59. 97140 with massage (97124) is never paid together.

Two timed codes on the same day are billed for their own minutes; NCCI says one 15-minute interval is one service, except for supervised modalities (NCCI Policy Manual, ch. XI, §P.2). There's no current NCCI edit among 97110, 97112, 97140 and 97530. Where an edit does pair two timed codes delivered in separate, unmingled blocks, such as 97140 with 97750, CMS allows modifier 59 or an X modifier (MLN1783722). See modifier 25 vs 59.

Timed vs untimed codes and the 8-minute rule

Untimed codes (evaluations, re-evaluations, unattended modalities) are billed as one unit per day. For timed codes, Medicare adds up all timed minutes for the day and converts the total into units (Claims Processing Manual, ch. 5, §20.2):

Assign the units to the codes with the most minutes. Drag the minutes below to see how a 41-minute visit splits:

Here 41 minutes supports only 3 units for four blocks of time. 97110 earns one unit for its first full 15 minutes, 97140's 10 minutes beat the 8 left over on 97110 and 97530, and the last unit goes to one of those two tied codes; the other's minutes are documented but not billed. Commercial payers that follow the AMA's per-code rule may count differently. Use the 8-minute rule calculator for any combination.

Untimed modalities: 97010, 97014 and G0283

• 97010 (hot or cold packs) has a bundled status on the Medicare fee schedule. It isn't paid separately; payment is included in other services that day.
• 97014 (unattended electrical stimulation) has status I: not valid for Medicare claims.
• G0283 is the HCPCS code Medicare uses instead, for unattended electrical stimulation other than wound care as part of a therapy plan of care. It's untimed: one unit per day.

Wound-care stimulation, attended e-stim (97032) and the NCCI edits between them are in G0283 vs 97014.

The modifiers every PT claim needs

GP. CMS requires GN, GO or GP on every "always therapy" service, and only one of them per line. GP marks services under a physical therapy plan of care.

CQ. When a physical therapist assistant furnishes a service "in whole or in part," the line also carries CQ (always paired with GP) and Medicare's payment is reduced by 15% for dates of service from January 1, 2022 (42 CFR 410.60(a)(4)). The allowed amount and the patient's 20% coinsurance are unchanged: on a $100 allowed amount, coinsurance is $20 and Medicare pays $68 instead of $80 (Transmittal R11129CP). "In part" means the assistant's minutes exceed 10% of the service's total. One exception: for the last 15-minute unit of the day, if the therapist personally provided 8 or more minutes, no CQ is needed. The 15% reduction is taken last, after the MPPR (Claims Processing Manual, ch. 5, §20).

CQ applies to therapists in private practice and to institutional providers paid at PFS rates. It doesn't apply to therapy billed by or incident to a physician or NPP, and it doesn't apply to critical access hospitals. In private practice, a PTA may work under the PT's general supervision (42 CFR 410.60(c)(2)).

KX. Once a patient's incurred therapy expenses for the year pass the threshold, add KX to attest that continued care is medically necessary and documented. For 2026 the thresholds are $2,480 for PT and speech-language pathology combined and $2,480 for occupational therapy (MLN Matters MM14315). Lines over the threshold without KX are denied.

Multiple procedure payment reduction

Medicare pays the full practice-expense amount only for the unit or procedure with the highest PE payment that day. Every other unit, including second and third units of the same code, gets 50% of its practice-expense payment. Work and malpractice are always paid in full. The reduction applies across PT, OT and SLP on the same day (Claims Processing Manual, ch. 5, §10.7).

Run your own visit through the therapy MPPR calculator.

Why Medicare PT rates matter for every payer

Clinics look up Medicare's PT rates even for patients who aren't on Medicare, because most other PT pricing is anchored to them. Commercial contracts are often written as a percentage of the Medicare fee schedule, and many state workers' compensation schedules are built on Medicare's RVUs and payment rules: Texas applies Medicare payment policies with its own conversion factor (28 TAC §134.203), and California's official fee schedule for physician and practitioner services is based on the Medicare RBRVS (Labor Code §5307.1). When CMS changes the conversion factor or a code's RVUs, those contracts move with it.

That makes the Medicare amount the number to check first when a commercial offer arrives or a workers' comp payment looks short. Download the PT codes for your ZIP from the Medicare physical therapy fee schedule, then compare the payer's rates line by line with the contract check.

Plan of care and certification

1. Evaluate and write the plan. The plan of care sets goals, the type, amount, frequency and duration of treatment.
2. Get it certified. A physician or NPP signs and dates the plan within 30 days of the first treatment day, evaluation included. A verbal certification must be signed within 14 days (Benefit Policy Manual, ch. 15, §220.1.3).
3. Use the written-order exception when it applies. If the record has a written order or referral and you can show the plan was sent to the ordering practitioner within 30 days of the evaluation, no signature is needed for the initial certification (42 CFR 424.24(c)(5)).
4. Recertify at least every 90 days if treatment continues, with documentation of the continuing need.

Pricing a whole PT code list for your locality? A fee sheet does it in one pass.

FAQ

What are the CPT billing codes for physical therapy?

Evaluations 97161, 97162 and 97163 (low, moderate and high complexity), re-evaluation 97164, and timed treatment codes such as 97110 (therapeutic exercise), 97112 (neuromuscular re-education), 97116 (gait training), 97140 (manual therapy), 97530 (therapeutic activities) and 97535 (self-care training). Medicare adds GP to each line.

Is CPT 97530 OT or PT?

Both. 97530 and most other 97xxx treatment codes can be billed by physical or occupational therapists. The modifier shows whose plan of care the service falls under: GP for PT, GO for OT.

Is CPT 97110 PT or OT?

Both, like 97530. Use GP when it's furnished under a PT plan of care and GO under an OT plan.

Can 97110 and 97530 be billed together?

Yes, when both services were performed and the day's total timed minutes support the units. There's no NCCI edit between them, so no modifier is needed. Document the purpose of each so the note shows they were different services; see 97110 vs 97530.

Does Medicare pay more for a high-complexity PT evaluation?

No. 97161, 97162 and 97163 have identical RVUs on the Medicare fee schedule, so they pay the same. Bill the level all four components support; see PT evaluation codes.

Is CPT 97140 PT or OT?

Either discipline can bill 97140 when it's within their scope under state law. It's a 15-minute timed code like the others.

How many units can I bill for 45 minutes of therapy?

Three. 38 to 52 total timed minutes supports 3 units under Medicare's rule. Assign them to the codes with the most minutes.

Keep reading

• Code comparisons: 97110 vs 97530, 97110 vs 97112, 97140 vs 97530, PT evaluation codes 97161–97163 and G0283 vs 97014.
• 8-minute rule calculator: minutes to units for any mix of timed codes.
• Therapy MPPR calculator: payment after the practice-expense reduction.
• Medicare physical therapy fee schedule: every PT code for your ZIP as CSV or PDF.
• Incident-to billing: when therapy in a physician's office is billed under the physician.
• Modifier 25 vs 59: when 59 belongs on therapy lines, and why CMS sources split between XE and XU.
• What is an RVU?: why practice expense drives the MPPR.
• Modifiers: GP, KX, CQ, 59, XE, XU.
• Codes in this guide: 97161 97162 97163 97164 97110 97112 97116 97140 97530 97535 97010 97014 G0283 97032

Sources: Medicare Claims Processing Manual, Pub. 100-04, ch. 5, §10.7, §20.1 and §20.2; Medicare Benefit Policy Manual, Pub. 100-02, ch. 15, §220.1.3 and §220.3; 42 CFR 410.60 and 424.24(c) (eCFR, current Oct 1, 2026); MLN Matters MM14315, CY 2026 PFS final rule summary; MLN1783722 (April 2026); Medicare NCCI Policy Manual (2026), ch. XI, §P.2; CMS NCCI practitioner PTP edits v32.3 (October 1, 2026); 28 Tex. Admin. Code §134.203; Cal. Labor Code §5307.1; status indicators from CMS RVU26D. Verified October 7, 2026.