If you're a physical therapist, clinic manager, or billing specialist, you already know that CPT (Common Physical Therapy) codes are the heartbeat of your billing process. Without the right codes, you don’t get paid. It’s that simple.

These codes aren’t just numbers—they tell insurance companies what kind of service was performed, for how long and sometimes even how complex the work was. And with CPT codes updating regularly, keeping up is not optional. It’s essential.

Let’s break it all down—what’s new in physical therapy CPT codes for 2025, how to use them properly and what you need to avoid if you want those claims approved fast and paid in full

Why Physical Therapy CPT Codes Matter (A Lot)

Think of CPT codes like the “language” that connects your clinic with insurance companies. CPT stands for Current Procedural Terminology, and it’s maintained by the American Medical Association (AMA).

When you submit a bill for services, the CPT code tells the insurer what was done. Wrong code? You might get underpaid—or worse—denied.

About 30% of denied claims are caused by outdated or incorrect CPT codes. That’s revenue lost for stuff you did. Ouch.

Many CPT codes also relate to services that assess or improve a patient’s range of motion

Why Staying Updated Is a Must

CPT codes aren’t static. Every year, new ones get added, old ones get revised and some get tossed out altogether. Physical therapy CPT codes especially need regular updates to keep your billing accurate.

If you’re using last year’s codes, you’re already behind. And that could:

●      Delay your reimbursements

●      Trigger audits

●      Lead to rejected claims

●      Make documentation non-compliant

Sound familiar? Yeah, not fun

New CPT Code Changes for Physical Therapy in 2025

The 2025 updates bring more clarity to evaluation codes, tweak some treatment descriptions and refine how we bill dynamic and manual therapy.

Let’s walk through the key changes that matter.

Evaluation Codes: Understanding Complexity

Physical therapy evaluations are now broken down by complexity level—this helps align services with patient needs. The CPT code for physical therapy evaluation changes based on the patient’s needs.

1. Low Complexity Evaluation

●      New CPT Code: 97161

●      Used for straightforward cases

●      Patient has 1-2 problems, stable condition

●      Takes about 20 minutes

2. Moderate Complexity Evaluation

●      CPT Code: 97162

●      Multiple body systems affected

●      May include comorbidities

●      Treatment options vary

3. High Complexity Evaluation

●      CPT Code: 97163

●      Highly complex presentation

●      Unstable conditions and multiple factors

●      Longer clinical decision-making time

Pro Tip: Always document clinical reasoning clearly to justify the level of complexity.

Treatment CPT Codes You Should Know

Now onto the hands-on stuff—these are the CPT codes for physical therapy treatment that you’ll likely use daily.

1. 97110 – Therapeutic Exercises

●      Targets strength, endurance and flexibility

●      Billed in 15-minute units

●      Super common—and often audited

●      CPT code 97110 covers exercises aimed at improving how the body works.

2. 97112 – Neuromuscular Re-Education

●      Works on balance, coordination and posture

●      Great for neuro patients

●      Also billed per 15 minutes

3. 97140 – Manual Therapy Techniques

●      Includes joint mobilization and soft tissue work

●      One-on-one contact required

●      You’re not allowed to bill 97110 and this for the same spot in one session.

●      Manual therapy with code 97140 involves one-on-one treatment.

4. 97530 – Therapeutic Activities

●      Think lifting, squatting, pushing—dynamic activities

●      CPT requires specificity in documentation

●      Companies look closely at this one

5. 97535 – Self-care/Home Management Training

●      Includes ADLs, safety and energy conservation

●      Especially useful for post-op or elderly clients

How Billing Works: The 15-Minute Rule

Most time-based therapy CPT codes are billed in 15-minute increments. That means if you do 25 minutes of therapeutic exercises, you can only bill 1 unit, not 2.

Here's a quick reference:

●      8–22 minutes = 1 unit

●      23–37 minutes = 2 units

●      38–52 minutes = 3 units

●      And so on…

Always track time accurately and total up the one-on-one time spent, not just the session length.

Common Billing Scenarios (With Examples)

Let’s say a patient comes in for:

●      20 mins of therapeutic exercise (97110)

●      15 mins of manual therapy (97140)

●      10 mins of neuromuscular re-education (97112)

Total billable units: 3 units
But remember, if two services are for the same issue (say, both manual and exercise for low back pain), you can’t bill them both.

Document clearly what was done, why, and where (as in body part).

Documentation Best Practices for CPT Billing

Want to reduce denials? Nail your documentation. Here’s what insurers are looking for:

●      Specific body parts treated

●      Clinical rationale for each service performed

●      Exact time spent per activity

●      Progress notes tied to treatment goals

The golden rule: If it’s not documented, it didn’t happen.

Common Billing Errors to Avoid

Let’s not sugarcoat it—mistakes are costly. Here are a few big ones to steer clear of:

●      Using outdated codes

●      Billing two codes for the same activity/body area

●      Overestimating treatment time

●      Under-documenting the complexity level

●      Forgetting to update the plan of care

And yes, copy-pasting old notes without editing them can also get you flagged.

What Insurance Companies Are Looking For

From the payer’s side, accuracy and necessity are everything. Insurance reviewers want:

●      CPT codes that match the diagnosis

●      Services that are medically necessary

●      Clean and legible documentation

●      Proper coding combinations (no duplicates)

They aren’t just being picky—they’re trying to spot upcoding and fraud. The more aligned your coding is with AMA and payer guidelines, the faster you'll get paid.

Quick Checklist for CPT Code Compliance

Here’s a cheat sheet you can tape to your clinic wall:

·       Use the most current CPT code list (2025 edition)

·       Document each service with time and rationale

·       Assign each CPT code to its proper treatment area

·       Follow the 8-minute rule for billing units

·       Avoid billing conflicting codes together

·       Keep up with payer policy updates

·       Review claims before submitting

Conclusion

Sure, CPT coding feels like paperwork. But honestly? It’s one of the biggest factors in how your clinic performs financially.

Think of it like this—your hands do the healing, but your codes open the door to getting paid for it. So, take it seriously.

Stay current, stay accurate and you’ll see fewer denials and faster payments. Plus, you’ll avoid the dreaded audit letter (nobody wants that).

Got a team? Make sure everyone’s trained on the latest updates. One weak link in coding can mess up the whole flow.

Check your most recent claims. Are you billing with the 2025 physical therapy CPT codes? If not, now’s the time to update. Trust me—it’s worth the effort.

Need help navigating the latest CPT code changes and improving your billing accuracy? SysMD specializes in physical therapy medical billing services that keep your clinic compliant, efficient, and profitable. With our expert team staying ahead of yearly updates and payer requirements, we help reduce denials, streamline reimbursements, and let you focus on what matters most—your patients. Let SysMD handle the billing while you deliver the care.