What this is, in plain language
A physical therapy session focused on therapeutic exercise to improve strength, range of motion, flexibility, or function. Billed in 15-minute units.
Why a clinician orders it
Recovery from injury or surgery, chronic pain management, or to address functional limitations.
Medical necessity — what insurers usually look at
Plans usually cover a number of visits per condition or per year. Medicare and many plans require updated documentation of progress and goals to continue beyond initial visits (the 'KX modifier' threshold for Medicare).
Documentation to ask about
- ✓PT evaluation and plan of care
- ✓Measurable goals and progress notes
- ✓Visit count used vs. plan allowance
Questions for your provider
- ?How many PT visits does my plan allow per year?
- ?Will the therapist send progress notes for continued visits?
Why this code is in our seed set
#5 on the CMS Top 200 Level I CPT Codes Ranked by Services (~44 million allowed services).
Validated against
- •CMS Top 200 Level I CPT Codes Ranked by Services
- •CMS Outpatient Therapy Threshold (KX modifier) policy
- •AMA CPT code 97110 descriptor
Terms you'll see
Medical NecessityRead more →
The insurer is reviewing whether the service is clinically appropriate for your situation.
Important: AuraCode is an educational tool. It does not provide medical, legal, or insurance advice, claims decisions, or approval guarantees. Final coverage depends on your specific plan, eligibility, diagnosis, submitted documentation, and your insurer's review.