Coding for Physical Therapy Services

Translating physical therapy services and patient/client symptoms and diagnoses into data elements that can be collected and analyzed is the basis for procedure and diagnosis coding.  All third party payers in the US use these standardized code sets.

Procedure and Service Coding

HCPCS Level 1 (CPT) Codes

Physical Therapy services are reported using CPT (Current Procedural Terminology) codes.  CPT codes are maintained by the American Medical Association and are updated annually.  You may also hear these codes called HCPCS Level 1 codes.   You should plan to purchase an updated CPT Book annually to avoid claims denial.  In addition, you may wish to buy the Coding and Payment Guide for Physical Therapists and laminated “Fast Finder” code cards.  These are available in the APTA’s Resource Catalogue.

HCPCS Level II Codes

HCPCS Level II codes are used to bill Medicare and Medicaid patients and have been adopted by some private payers as well.  These codes are published annually by the Centers for Medicare and Medicaid Services (CMS).  These codes are supplementary to CPT (Level I) codes.  These codes are used in physical therapy to report Medical and surgical supplies, durable medical equipment, orthotic procedures/devices and prosthetic procedures.  HCPCS Level II codes are also updated annually and a new code book should be purchased annually to avoid claims denial.

ICD-9-CM Codes

ICD-9-CM is the International Classification of Diseases, 9th Edition, Clinical Modification.  This code set is used to classify disease, injuries, symptoms and other reasons for patient encounters.  Revisions to ICD-9-CM codes are also made annually, and code books should be updated to avoid claims denial.