If you run a therapy clinic or work as a physical therapist, you have most likely come across the 97535 CPT code on a regular basis. However, even though this is the accepted code for invoicing therapeutic activities, many providers still struggle with billing it accurately.
Therefore, it’s crucial to understand the proper billing guidelines. Moreover, accurate billing not only ensures timely reimbursement but also helps avoid costly claim denials. So, are you confident that you’re billing 97535 correctly? Let’s explore how to master this code together.
Working with a trusted medical billing company can make all the difference in maximizing your reimbursements and minimizing denials. we will walk you through what CPT 97535 covers, explain when to apply it, and show you how to properly document and bill for it.
By following these steps, you can ensure your practice remains strong and financially healthy. Furthermore, understanding these details will help you avoid common billing pitfalls and maximize your reimbursements.
What Is CPT Code 97535?
CPT 97535 refers to therapeutic activities designed to improve functional performance. These are active, dynamic activities that challenge balance, coordination, strength, and endurance.
Common examples include:
- Reaching and bending exercises
- Functional mobility tasks like transferring or stepping
- Activities targeting upper and lower extremity function
This code is typically billed in 15-minute increments, so accurate timing and documentation are critical.
When to Use 97535:
- When a therapist actively guides the patient through functional movement exercises
- For patients recovering from injury or surgery to regain physical function
- As part of a broader physical therapy plan focusing on daily living skills
Key Documentation and Billing Tips for 97535 cpt code
Proper documentation is your strongest ally in successful billing. Without it, claims for 97535 can get rejected or delayed.
What Should You Document?
- Specific activities performed: Describe the type of therapeutic activity and the goals
- Patient participation: Confirm that the patient is actively engaged in exercises
- Time spent: Note the actual face-to-face time spent on therapeutic activities
- Progress notes: Record improvements or barriers to progress
Collaborating with professional credential services ensures your providers’ qualifications align with payer requirements. This alignment helps reduce claim denials related to provider eligibility.
How to Bill 97535 cpt code Correctly
Understanding payer guidelines is essential because insurance companies vary in their requirements.
General Billing Rules:
- Bill in 15-minute units using time-based billing
- Use appropriate modifiers if multiple services are delivered in a session
- Ensure the service is medically necessary and part of a documented treatment plan
Common Mistakes to Avoid:
- Billing for total session time instead of the actual 97535 time
- Using 97535 interchangeably with other therapy codes like 97110 (therapeutic exercises)
- Lacking detailed documentation of the activities performed
Working closely with your medical billing company can help audit your claims and catch such errors before submission.
Integrating 97535 with Other Physical Therapy Codes
Often, 97535 is billed alongside codes like 97110, 97112, and 97140. It’s important to:
- Keep documentation separate and specific for each code
- Avoid double billing the same time for multiple codes (use time-based modifiers carefully)
- Understand payer policies on bundling and reimbursable units
Proper coding coordination improves your chances of full reimbursement and prevents costly audits.
The Role of Billing and Coding in Therapy Practices
Physical therapists depend critically on accurate medical billing and coding. It’s not only about selecting the correct code; it also guarantees flawless alignment of all administrative elements.
Benefits of Expert Billing and Coding:
- Faster claims processing
- Fewer denials and appeals
- Increased revenue flow
- Compliance with federal and payer regulations
If you’re handling billing in-house, consider training or outsourcing to specialists to stay current with CPT updates and payer rules.
Conclusion
Mastering the 97535 CPT code is vital for any physical therapy practice. By focusing on accurate documentation, understanding payer rules, and aligning with professional credential services, you can optimize your billing and reimbursement processes.
Remember, working with a reliable medical billing company or enhancing your in-house billing capabilities ensures you get paid for the valuable care you provide.
FAQs
Q1: How long is one unit of CPT 97535?
One unit represents 15 minutes of face-to-face therapeutic activity.
Q2: Can CPT 97535 be billed with other therapy codes?
Yes, but make sure documentation supports the time spent on each service separately.
Q3: What documentation is required for 97535 billing?
Detailed notes on the type of activities, patient participation, time spent, and progress are essential.
Q4: Does 97535 require provider credentialing?
Yes, providers must be properly credentialed, which supports claim approvals.
