Can 97140 and 97110 Be Billed Together?

CPT codes 97140 and 97110 are frequently used in physical and occupational therapy to describe specific interventions. Code 97140 represents manual therapy techniques, while 97110 denotes therapeutic exercises. This guide clarifies when these codes can be billed together for the same patient on the same day. Understanding the distinct nature of each service, along with specific billing guidelines and proper documentation, is essential for accurate claims submission and appropriate reimbursement.

Understanding Therapeutic Modalities

CPT code 97140 covers manual therapy techniques applied to one or more body regions. These hands-on interventions, performed by a therapist, include mobilization, manipulation, manual lymphatic drainage, and manual traction. Manual therapy aims to enhance functional performance, reduce pain, and increase mobility.

CPT code 97110 describes therapeutic exercises designed to develop or improve strength, endurance, range of motion, and flexibility. Examples include resistance training, range-of-motion stretches, and cardiovascular conditioning. Therapeutic exercises address issues like muscle weakness, stiffness, or restricted movement, enhancing a patient’s mobility and ability to participate in daily activities.

Both 97140 and 97110 are time-based codes, billed in 15-minute increments of direct, one-on-one patient contact.

Conditions for Concurrent Billing

CPT codes 97140 and 97110 can be billed together on the same day for the same patient if each service is distinct and medically necessary. Services must be separate procedures, not overlapping in time or purpose, addressing different aspects of the patient’s condition or applied to different areas.

One common scenario for concurrent billing is when services are performed on different body regions. For example, manual therapy (97140) might improve cervical spine mobility, while therapeutic exercises (97110) strengthen lower extremities after surgery. Each intervention targets a unique anatomical area with a specific therapeutic objective, justifying billing both codes.

Even on the same body region, these codes can be billed together if they address entirely different therapeutic goals. A therapist might perform manual therapy on a patient’s shoulder to release soft tissue restrictions and improve joint glide. Following this, therapeutic exercises are administered to the same shoulder to build strength and endurance once mobility improves. Manual therapy restores passive mobility, while exercises focus on active strengthening, representing two separate goals for the same area.

Both services must be medically necessary and contribute directly to the patient’s established plan of care. Medical necessity means the billed procedure is essential for the patient’s condition and directly relates to enhancing function or managing pain. Documentation must clearly articulate why both manual therapy and therapeutic exercises are needed to achieve rehabilitation goals. Interventions should not be considered interchangeable or redundant.

Applying Billing Modifiers

Proper claims submission for concurrent billing of CPT codes 97140 and 97110 typically involves the use of Modifier -59. This modifier signifies a “Distinct Procedural Service,” indicating a service was distinct or independent from other services performed on the same day. Its application signals to the payer that despite being typically bundled or considered inclusive, the services were indeed separate and warrant individual reimbursement.

When billing 97140 and 97110 together, Modifier -59 is generally appended to the code that would otherwise be considered inclusive or subject to National Correct Coding Initiative (NCCI) edits. For example, if manual therapy (97140) and therapeutic exercises (97110) are provided in the same session and considered a linked pair by NCCI, Modifier -59 would typically be appended to CPT code 97140 to indicate its distinctness. This clearly communicates that the manual therapy was performed independently from the therapeutic exercise, either in a different anatomical area, at a different time, or for a different purpose.

It is crucial to verify payer-specific rules and guidelines, as some insurance companies may have their own preferred modifiers or specific bundling edits. While Medicare generally provides guidance through NCCI edits, private payers often establish their own policies. Adherence to these specific payer requirements helps prevent claim denials and ensures appropriate reimbursement for distinct services. The -59 modifier should only be used when no other, more specific modifier is available to describe the distinct circumstances.

Essential Documentation for Reimbursement

Comprehensive documentation is paramount for justifying billing CPT codes 97140 and 97110 on the same day. Each service requires clear and specific details recorded in the patient’s medical record, including the exact type of manual therapy techniques performed (e.g., joint mobilization, soft tissue mobilization) and the specific therapeutic exercises administered (e.g., resistance band exercises, range of motion stretches).

Documentation must explicitly identify the specific body region or regions treated for each service. For instance, if manual therapy was applied to the cervical spine and therapeutic exercises to the lower extremities, this distinction should be clearly noted. This helps to establish the “distinctness” of the services, supporting claims where both codes are billed. Separately identifying the therapeutic goals for each intervention is also critical. The rationale for why manual therapy contributes to one set of goals (e.g., improving joint mobility) and therapeutic exercise to another (e.g., increasing muscle strength) should be evident.

Crucially, start and end times for each timed service must be recorded to demonstrate that the services were non-overlapping and performed in distinct time blocks. This supports the use of Modifier -59 by proving that the treatments were not simultaneous. A clear rationale explaining why both services were medically necessary and how they integrated into the patient’s overall plan of care for that specific day is also required. Documenting the patient’s response to each intervention, including any changes in their condition or progress toward goals, provides further justification for the services provided. This detailed record-keeping ensures compliance with billing regulations and supports the medical necessity of all billed procedures.