Top 5 Highest Paying Physical Therapy Codes

97161 – Physical Therapy Evaluation

The physical therapy initial evaluation tops the list of top 6 highest paying physical therapy codes in 2022. The physical therapy evaluation code is an untimed code and may only be delivered by a licensed physical therapist.

CGS Medicare Ohio lists CPT Code 97161 reimbursement at $98.60. [3]

Ohio BWC Workers Compensation Rate for CPT code 97161 reimbursement is $138.20 [2]

* The initial evaluation should document the necessity of a course of therapy through objective findings and subjective patient/caregiver self-reporting. Initial evaluations must be completed by the therapist or physician/NPP that will be providing the therapy services. Initial evaluations are completed to determine the medical necessity of initiating rehabilitative therapy or skilled instruction in maintenance activities that the patient and/or caregiver can perform at home. [1]

97530 – Therapeutic Exercise

#2 on the top 5 highest paying physical therapy codes in 2022 is CPT Code 97530 Therapeutic Exercise.

CGS Medicare Ohio lists CPT Code 97530 reimbursement at $36.21.

Ohio BWC Workers Compensation Rate for CPT code 97530 reimbursement is $50.82

* Therapeutic activities are considered reasonable and necessary for patients needing a broad range of rehabilitative techniques that involve movement. Movement activities can be for a specific body part or could involve the entire body. This procedure involves the use of functional activities (e.g., bending, lifting, carrying, reaching, catching, pushing, pinching, grasping, transfers, bed mobility and overhead activities) to restore or maintain functional performance. The activities are usually directed at a loss or restriction of mobility, strength, balance, or coordination. They require the skills of the therapist to design the activities to address a specific functional need of the patient and to instruct the patient in their performance. These dynamic activities must be part of an active treatment plan and must be directed at a specific outcome. [1]

97112 – Neuromuscular ReEducation

#3 on the top 5 highest paying physical therapy codes in 2022 is CPT Code 97112 Neuromuscular ReEducation.

CGS Medicare Ohio lists CPT Code 97112 reimbursement at $33.54.

Ohio BWC Workers Compensation Rate for CPT code 97112 reimbursement is $47.69

* This therapeutic procedure is provided for the purpose of restoring or maintaining balance, coordination, kinesthetic sense, posture, and proprioception (e.g., proprioceptive neuromuscular facilitation (PNF), BAP’s boards, vestibular rehabilitation, desensitization techniques, balance and posture training). [1]

97535 – Self Care / Home Management Training

#4 on the top 5 highest paying physical therapy codes in 2022 is CPT Code 97535 Self Care / Home Management Training.

CGS Medicare Ohio lists CPT Code 97535 reimbursement at $32.13.

Ohio BWC Workers Compensation Rate for CPT code 97535 reimbursement is $45.68

* This procedure is reasonable and necessary only when it requires the skills of a therapist, is designed to address specific needs of the patient, and is part of an active treatment plan directed at a specific outcome.
The patient must have a condition for which self-care/home management training is reasonable and necessary. The training should be focused on a functional limitation(s) that will be meaningful to the patient and the caregiver. The patient and/or caregiver must have the capacity and willingness to learn from instructions. Documentation must relate the training to expected functional goals. [1]

97110 – Therapeutic Exercise and 97116 – Gait Training

#5 Tied for the last place on the top 5 highest paying physical therapy codes in 2022 is CPT Code 97110 Therapeutic Exercise and 97116 Gait Training

CGS Medicare Ohio lists CPT Code 97110 and 97116 reimbursement at $28.97 each.

Ohio BWC Workers Compensation Rate for CPT code 97110 / 97116 reimbursement is $41.18

References:

1. Outpatient Physical and Occupational Therapy Services L34049

2. Ohio BWC Fee Schedule Look Up

3. CGS Medicare Fee Schedule Look Up