Physical Therapy CPT Codes in 2026: Evaluation, Treatment, and Billing Units

If your billing team is reconciling 97161 versus 97163 on the same stack of evaluations, or debating whether a session goes on 97110 or 97530, this is the reference guide that ends the argument.

Physical therapy CPT codes fall into two billing categories: untimed evaluation codes that bill once regardless of visit length, and timed treatment codes that bill in 15-minute units.

Getting the category right is more important than memorizing the codes themselves, because every timed code error flows directly into unit miscounts and claim denials.

Disclaimer: This article is provided for general educational purposes only. It does not constitute legal, financial, or compliance advice. CPT code descriptions, Medicare reimbursement rates, and payor coverage policies change annually and vary by plan. Confirm current requirements with your payor, compliance officer, or a certified billing professional before submitting claims.

Key Takeaways

• Physical therapy CPT codes are either untimed (evaluation codes 97161 to 97164) or timed treatment codes (97110, 97112, 97116, 97140, 97530). Category determines how you bill.
• Evaluation complexity is set by patient presentation, not time. A 45-minute low-complexity eval is still 97161.¹
• Timed codes bill in 15-minute units under the 8-minute rule. For unit calculation, see our Physical Therapy Billing in 2026 guide.
• 97110 (therapeutic exercise) makes up approximately 42% of all PT billing volume.²
• The 2026 Medicare conversion factor rose for the first time in years. Core timed codes 97110, 97140, 97530, and 97112 were exempted from the efficiency adjustment.³

Physical Therapy Evaluation CPT Codes (Untimed)

Complexity drives selection, not time. The three initial CPT codes evaluation physical therapy are tiered by the patient’s presentation across three components: history, examination, and clinical decision-making. The lowest-qualifying component determines the code, not the highest.¹

Source: CMS MLN Matters Article MM9782; CMS Medicare Coverage Database Article A55367. ^{1 4}

The most common evaluation error across all four physical therapy CPT codes above is defaulting to 97162 regardless of presentation. Overcoding without supporting documentation creates audit exposure. Undercoding on a genuinely complex patient leaves reimbursement on the table.

The physical therapy re evaluation CPT code, 97164, requires a clinical trigger: a documented, significant change in the patient’s condition requiring a formal plan of care revision.

Billing it at routine intervals without that trigger draws contractor scrutiny. CMS Recovery Audit Contractors have 97161 through 97164 on their active review list under proposed topic 0A339, effective January 13, 2026.⁵

Common Timed Physical Therapy CPT Codes

CPT codes for physical therapy treatment split further into those requiring direct one-on-one contact billed in 15-minute timed units, and supervised modalities billed once per session. The six timed codes below account for the majority of daily PT billing volume.²

Source: CMS Medicare Coverage Database Article A56566; APTA Coding for Timed Codes. ^{2 6}

The distinction between 97110 and 97530 trips up more PT billing teams than any other CPT code for physical therapy pair. Therapeutic exercise targets isolated muscle function. Therapeutic activities target functional task performance. The same physical movement billed under the wrong code fails medical necessity review when the documented goal does not match the code’s clinical intent.

97112 and 97110 have a similar problem. Both involve the patient moving. The billing difference is intent: 97112 requires documented neuromuscular deficit and therapist-directed motor retraining. A patient doing balance exercises for strength falls under 97110. A patient retraining proprioception after ACL reconstruction falls under 97112. CGS Medicare has 97112 on its active post-payment review list alongside 97110, 97140, and 97530.⁷

Billing Units for Physical Therapy CPT Codes: The 8-Minute Rule Applied

Timed CPT codes physical therapy providers use most frequently bill in 15-minute units. How many units a session generates depends on total timed minutes across all timed codes for that date of service, not per individual code. Under the Medicare 8-minute rule, one unit requires at least 8 minutes; two units require at least 23 total minutes; three units require at least 38.

Source: CMS Medicare Claims Processing Manual, Chapter 5, Section 20.2.⁸

For detailed worked examples of multi-code sessions, mixed remainders, and the difference between Medicare’s methodology and the AMA Rule of Eights some commercial payors follow, see Physical Therapy Billing in 2026: The 8-Minute Rule, KX Modifiers, and Why Your Claims Keep Getting Rejected.

Medicare Part B Physical Therapy Billing Guidelines in 2026

Three Medicare part b billing guidelines for physical therapy have the most direct impact on whether a correctly coded claim actually pays.⁴

Plan of care certification

A physician or qualified non-physician practitioner must certify the plan of care before PT services begin, or within 30 days of the start of care. Claims submitted after certification lapses deny on a technicality documentation quality cannot fix.

Progress note frequency

CMS requires progress notes at least every 10 visits or 30 days, whichever comes first. The note must document continued medical necessity. Missing or untimely progress notes expose all claims in that period to denial on retrospective review.

Annual therapy thresholds

The CY 2026 KX modifier threshold is $2,480 for PT and SLP services combined. The targeted medical review threshold is $3,000. Claims above $2,480 without the KX modifier are denied automatically. Above $3,000, claims carry heightened audit risk even with KX applied.

Physical therapy billing guidelines from CMS physical therapy billing guidelines documentation emphasize that plan of care goals must be functional, measurable, and tied to the patient’s specific impairment. Vague goals like “improve strength” without a baseline measurement and functional context are the most common documentation deficiency triggering retrospective denial.

Physical Therapy CPT Codes vs Billing Codes and Reimbursement Rates

The CPTcode physical therapy describes the service. The reimbursement rate is what a specific payor pays for that service, and they are not the same number across payors. Physical therapy billing codes and reimbursement rates differ between Medicare, Medicare Advantage, and commercial plans even for the same CPT code.

Under Medicare, every CPT code is assigned relative value units multiplied by the 2026 conversion factor of $33.40 for non-qualifying APM participants.³ The 2026 fee schedule increased rates on core timed codes, with 97140 moving from a negative year-over-year change to positive following APTA advocacy that removed it from the CMS efficiency adjustment list.³

Medicare reimbursement for physical therapy uses national rates adjusted by Geographic Practice Cost Index factors. The same 97110 unit reimburses differently in a high-cost metropolitan market than in a rural area. Practices that benchmark their physical therapy billing codes and reimbursement rates against national averages alone may be underestimating revenue in high-GPCI markets or overbilling contract thresholds in low-GPCI ones.

Commercial and Medicare Advantage rates do not follow the fee schedule automatically. Contract terms set the allowed amount. A practice billing CPT codes for physical therapy under outdated contracts that predate 2026 fee schedule increases is collecting at old rates regardless of what Medicare pays.

When to Stop Managing Physical Therapy CPT Billing Alone

Three patterns confirm a PT billing operation has outgrown in-house management.

1. Clinicians or front desk staff are regularly asking which CPT code for physical therapy applies to a specific session rather than the billing team.
2. Denial patterns cluster around specific code combinations, 97140 and 97530 bundled without modifier 59, 97112 lacking neuromuscular documentation, 97164 billed without a clinical trigger.
3. Annual CMS updates are absorbed reactively, after the first round of denials reveals the change.

The best physical therapy billing services eliminate all three patterns through pre-submission audit:

• Code selection confirmed against documented clinical intent
• Unit calculation verified against minutes
• Modifier requirements mapped per payor before the claim leaves the practice

A3 Medical Billing provides physical therapy medical billing services through AAPC-certified coders with specialty-specific code expertise, no long-term contracts, and a 99% clean claim rate on first submission.

Practices evaluating a physical therapy billing company should confirm the team has active PT coding experience, not just general outpatient billing experience.

Physical Therapy CPT Codes in 2026: The Bottom Line

The codes themselves have not changed in 2026. What changed is the scrutiny behind them:

• CMS RAC auditors have evaluation codes on active review
• CGS has four core treatment codes in post-payment review
• The 2026 fee schedule created reimbursement differences between practices that updated their code mix and those that did not.

A3 Medical Billing is a sought-after medical billing company that USA based PT practices trust for physical therapy billing services, RCM services, and credentialing services with specialty-specific coding expertise and no hidden fees.

If your team is still manually reconciling which physical therapy CPT codes apply to which session, contact A3 for a free PT billing audit and find out where the code selection errors are costing you.

Frequently Asked Questions

What are the evaluation CPT codes for physical therapy?

The four evaluation CPT codes for physical therapy are 97161 (low complexity), 97162 (moderate complexity), 97163 (high complexity), and 97164 (re-evaluation). Complexity is determined by the patient’s presentation across history, examination, and clinical decision-making. A 45-minute session with a simple ankle sprain and no comorbidities is still 97161 regardless of time spent.¹

What is the physical therapy re-evaluation CPT code?

The physical therapy re evaluation CPT code is 97164. It applies when a significant, documented change in the patient’s condition requires a formal revision of the plan of care. It is not a routine progress note code and should not be billed at fixed intervals. CMS Recovery Audit Contractors have 97164 on active review as of January 2026.⁵

Which physical therapy CPT codes are timed versus untimed?

Timed codes bill in 15-minute units and require direct one-on-one contact: 97110, 97112, 97116, 97140, 97530, and 97535. Untimed codes bill once per encounter regardless of duration: 97161, 97162, 97163, and 97164 for evaluations, plus supervised modality codes like 97010 and 97012. Billing a timed code without tracking minutes creates either underbilling or audit exposure.²

What is the difference between CPT 97110 and CPT 97530?

97110 covers therapeutic exercise targeting isolated muscle function such as strength, endurance, range of motion, and flexibility. 97530 covers therapeutic activities targeting functional task performance such as sit-to-stand training, work simulation, and real-world movement patterns. The documentation must reflect the functional goal the activity supports. Billing 97530 with documentation that only describes isolated exercise is an audit flag.²

How do Medicare reimbursement rates apply to PT CPT codes?

Each CPT code physical therapy providers bill is assigned relative value units multiplied by the 2026 Medicare conversion factor of $33.40. Rates are then adjusted by Geographic Practice Cost Index factors that vary by location.³ Core timed codes 97110, 97140, 97530, and 97112 were exempted from the 2026 efficiency adjustment following APTA advocacy, preserving reimbursement on the codes that make up most of a typical clinic’s daily billing volume.