Quick Answer

The most commonly used physical therapy CPT codes are 97110 (therapeutic exercise), 97530 (therapeutic activities), 97140 (manual therapy), 97161–97163 (PT evaluations by complexity level), and 97112 (neuromuscular re-education). The 2026 Medicare conversion factor is $33.40 per RVU for non-APM clinicians (most PTs) — up 3.26% from $32.35 in 2025, the first increase to the fee schedule in five years. The annual therapy threshold that triggers the KX modifier also rose, to $2,480 combined for PT and speech-language pathology. One correction worth knowing before you build a billing strategy around it: CMS reimburses evaluation codes 97161, 97162, and 97163 at the same national rate regardless of complexity tier, so in 2026 accurate evaluation coding is mainly a documentation and audit-defense issue — not a per-claim revenue lever. Treatment code mix (97530 vs. 97110 vs. 97140) is where code selection still meaningfully changes what a session pays.

Physical therapy CPT codes determine how much your clinic gets paid. Choose the wrong code, miss a required modifier, or submit a claim your documentation doesn't support, and you risk a denial, a down-code, or a post-payment audit recovery. CMS and its Medicare Administrative Contractors continue to focus review activity on PT evaluation-complexity coding and modifier use, so getting codes right mostly protects revenue you've already earned rather than manufacturing new revenue.

This guide covers what you need to code correctly in 2026: the CPT codes used most in outpatient PT, how to select the right evaluation level (and what Medicare actually pays for each tier), which treatment codes reimburse the most, how billing and telehealth modifiers work, and what documentation each code needs to survive an audit.

What Are Physical Therapy CPT Codes and Why Do They Matter?

Definition: CPT Code

A CPT (Current Procedural Terminology) code is a 5-digit numeric identifier maintained by the American Medical Association (AMA) that describes a specific medical service or procedure for billing and insurance reimbursement. CPT codes describe the treatment provided — not the patient's diagnosis. Diagnoses use a separate system, ICD-10 codes, and CMS updates that code set on its own annual cycle (most recently the FY2027 ICD-10-CM updates effective October 1, 2026).

Every service a physical therapist provides in a clinical setting maps to one or more CPT codes. Those codes are submitted on a claim to the insurance payer, who uses them to determine what — and whether — to reimburse. Using the wrong code, an outdated modifier, or a code your documentation doesn't support results in a denied or reduced claim.

Three things make 2026 coding discipline matter more than usual. First, the AMA's CPT 2026 code set (effective January 1, 2026) made no changes to the core PT/rehab 97xxx evaluation and treatment codes — the activity that year was concentrated in Remote Therapeutic Monitoring (RTM), where CMS added new codes 98979, 98984, and 98985 and revised the day-range descriptors for 98976 and 98977. That stability is good news for PT billers, but it also means any 97xxx code change you hear about is likely a rate change, not a definition change. Second, CMS raised the 2026 Medicare conversion factor to $33.40 per RVU (a 3.26% increase, the first bump in five years) but simultaneously applied a -2.5% "efficiency adjustment" to many non-time-based codes; the core timed treatment codes (97110, 97112, 97140, 97530) were exempted from that cut, so the net effect varies by code. Third, CMS and MACs continue active audit scrutiny of high-complexity evaluation coding, so documentation quality matters even where the complexity tier doesn't change what Medicare pays. Billing software built for rehab — SPRY's PT billing platform, for example — can flag mismatched codes and missing modifiers before a claim goes out, which is where most of these errors are actually caught in practice.

The codes in this guide are organized the way you actually use them: evaluations first, then treatment codes ranked by 2026 reimbursement, then modifiers, then documentation requirements.

Understand the difference between timed and untimed CPT codes to bill accurately and avoid claim issues.

Top Physical Therapy CPT Codes Used Most in 2026

The codes below account for the majority of outpatient PT billing volume. Rates are the 2026 Medicare national non-facility average, unadjusted for local Geographic Practice Cost Index (GPCI) — your actual payment will vary by location. Private payer rates commonly exceed Medicare's, though the premium varies widely by payer and contract, so treat these as a baseline, not a quote.

*National, non-facility, unadjusted for locality. Source: 2026 Medicare Physician Fee Schedule, calculated from published relative value units at the $33.4009 conversion factor for non-qualifying APM participants.

Which PT Evaluation CPT Code Should You Use: 97161, 97162, or 97163?

Since January 2017, physical therapists select from three complexity-tiered evaluation codes for new patients, replacing the old 97001/97002 system. The right code depends on the complexity of the patient's clinical presentation — not the time spent or the number of visits planned.

Important 2026 update: CMS assigns 97161, 97162, and 97163 the same work RVU (1.54) and the same total RVU, so all three tiers reimburse at the identical national Medicare rate — roughly $98 in 2026. That has been true since the three-tier system replaced 97001/97002 in 2017; CMS has not acted on APTA's repeated requests to differentiate payment by complexity. This means choosing the right tier in 2026 doesn't change your Medicare check for that claim — but it still matters. Billing a complexity level your documentation doesn't support is a documented audit trigger, and some private payers and value-based contracts do weight complexity coding in performance or capitation calculations.

CPT 97161 — Low Complexity Evaluation

Use 97161 for patients with stable, straightforward presentations where 1–2 personal factors are influencing care. Typical examples include an acute ankle sprain, routine post-surgical recovery on a standard protocol, or simple mechanical low back pain with no complicating factors.

Documentation requirements are the minimum threshold for all evaluation codes: a history review covering medical and surgical background, a physical examination of the relevant body systems, objective testing appropriate to the presentation, clinical decision-making, and a basic plan of care. The key to 97161 is demonstrating why the case is straightforward — vague documentation gets flagged on audit even when the clinical picture genuinely was simple.

CPT 97162 — Moderate Complexity Evaluation

Use 97162 when a patient presents with moderate clinical complexity — typically three or more personal factors affecting care, multiple body regions requiring assessment, or a condition requiring standardized outcome measures to track progress. Common presentations include chronic conditions with more than one contributing impairment, patients with moderate functional limitations across multiple domains, or vestibular disorders requiring multi-system assessment.

Documentation must include a comprehensive history covering medical, surgical, and social background; a review of multiple body systems; and at least one validated standardized outcome measure — SPRY's functional outcome measure library is built to capture exactly this. Clinical reasoning should explicitly reflect the complexity of the decisions being made — not just the complexity of the patient's diagnosis.

Compliance tip

Because 97161, 97162, and 97163 pay the same Medicare rate, there's no financial incentive to inflate the tier — and every incentive not to. Code the tier your documentation actually supports: count the personal factors, document the systems reviewed, and let your notes reflect what happened in the evaluation. Under-coding costs you nothing in Medicare reimbursement but can still misrepresent the acuity of your caseload for quality reporting and payer contracting purposes.

CPT 97163 — High Complexity Evaluation

Reserve 97163 for patients with genuinely complex, unstable, or medically complicated presentations. This means an unstable clinical picture, three or more personal factors with significant functional impact, a complex medical history requiring extensive intake and analysis, and a case requiring multiple standardized testing protocols to adequately characterize the patient's impairments and function.

Documentation at this level is substantial: a complete history spanning medical, surgical, psychological, and social factors; comprehensive review of multiple body systems; multiple validated assessment tools; high-level clinical reasoning documented in detail; and a comprehensive plan of care that accounts for contingencies. As above, 97163 does not currently pay more than 97161 under Medicare — the value of coding it correctly is compliance and case-mix accuracy, not a per-claim payment increase.

CPT 97164 — Re-Evaluation

97164 is appropriate when a patient's clinical status changes significantly enough to warrant a formal reassessment — not just a progress note. This includes new complications, a major change in the patient's condition, a change in diagnosis, or a required periodic review under certain payer contracts. Documentation must justify why a full re-evaluation was needed rather than a routine progress update, include updated objective measures, and present a revised plan of care. The 2026 national Medicare rate for 97164 is approximately $67.

Common audit trigger

Billing 97164 at regular intervals without documented clinical justification is a known audit red flag. Re-evaluation should be triggered by a specific clinical event, not calendar scheduling. Every 97164 claim should clearly state what changed and why that change warranted formal re-evaluation.

Physical Therapy Treatment CPT Codes: Ranked by 2026 Reimbursement

Treatment codes are billed in 15-minute timed units. A standard 60-minute treatment session generates up to 4 billable units, and the combination of codes you use for those units determines your reimbursement. Unlike the evaluation codes, treatment code selection has a real, verifiable effect on what a session pays — the table below ranks the four highest-volume timed treatment codes by their 2026 national Medicare rate.

*National, non-facility, unadjusted for locality; 2026 Medicare Physician Fee Schedule. All four codes were exempted from CMS's 2026 -2.5% efficiency adjustment, so this ranking held steady rather than compressing this year.

CPT 97530 — Therapeutic Activities

97530 is the highest-reimbursing timed treatment code in physical therapy and one of the most commonly under-used. It covers dynamic activities performed to improve functional performance — meaning real-world movements tied to what patients actually need to do in their daily lives, not isolated exercises in controlled positions.

Billable activities under 97530 include sit-to-stand training for functional transfers, bed mobility training, car transfer training, stair negotiation with balance challenges, lifting and carrying tasks for return to work, and sport-specific functional movement patterns. The defining criterion is a direct connection between the activity and a functional goal in the patient's plan of care.

CPT 97110 — Therapeutic Exercise

97110 is the most frequently billed PT code in the country, covering individualized exercise programs targeting strength, endurance, range of motion, and flexibility. It applies to structured, controlled exercises where the therapist designs and directly supervises the program — straight leg raises, resistance training, stretching protocols, and similar interventions.

97530 vs 97110 — What's the Difference and When to Use Each

97530 reimburses roughly 21% more than 97110 nationally in 2026 ($35.07 vs. $29.06 per unit), reflecting its higher clinical-skill requirement. But the two codes aren't interchangeable based on rate alone — documentation must explicitly link 97530 to a stated functional goal, not just describe a harder exercise.

CPT 97112 — Neuromuscular Re-education

97112 covers interventions targeting the neuromuscular system — balance training, coordination exercises, proprioceptive training, and re-education of movement patterns disrupted by injury or neurological involvement. It is appropriate for post-stroke rehabilitation, vestibular rehabilitation, patients with proprioceptive deficits after joint reconstruction, and anyone whose primary impairment is a motor control or coordination problem rather than simply weakness or limited range.

CPT 97140 — Manual Therapy

97140 covers hands-on techniques performed directly by the therapist: joint mobilization, joint manipulation, soft tissue mobilization, manual lymphatic drainage, and similar interventions. It is a skilled service that requires the physical presence and active participation of the PT throughout the timed unit. 97140 cannot be billed when a student or aide is providing the hands-on component.

Modifiers and Telehealth Rules PT Billers Need in 2026

A correct code paired with a missing or wrong modifier still gets denied. The table below covers the modifiers PT claims use most.

On telehealth specifically: after a lapse tied to the federal government funding fight in late 2025, Congress's FY2026 funding legislation extended major Medicare telehealth flexibilities — including for PTs, OTs, and SLPs — through December 31, 2027, per APTA's February 2026 update. Practices billing telehealth visits should confirm their service location is enrolled in PECOS and continue using modifier 95 with POS 10 or 02. See SPRY's telehealth billing guide for the full code-by-code breakdown of what qualifies.

Documentation Requirements for PT CPT Codes: What Survives an Audit

CPT codes are only as strong as the documentation behind them. A frequent reason for PT claim denial and audit recovery isn't wrong code selection — it's documentation that doesn't support the code selected. Here is what each category of service requires.

Evaluation Code Documentation (97161, 97162, 97163)

All three evaluation codes share the same core documentation structure, with escalating requirements at each complexity level:

• History: Medical and surgical history relevant to the presenting condition. Moderate and high complexity require social and psychological factors as well.
• Systems review: Examination of body systems relevant to the PT diagnosis. High complexity requires multiple systems with detailed analysis.
• Tests and measures: Objective testing appropriate to the presentation. Moderate and high complexity require validated standardized outcome measures.
• Clinical decision-making: Documentation of the reasoning behind your clinical decisions — not just what you found, but what it means and why it influenced your plan.
• Plan of care: Goals, frequency, duration, and treatment approach. High complexity requires contingency planning documented in the POC.
• Personal factors: The number of personal factors influencing care must be explicitly stated — 1–2 for low, 3+ for moderate and high.

Treatment Code Documentation (97110, 97530, 97140, 97112)

Timed treatment codes must document start and end times for each unit billed, or use a cumulative time statement covering all timed services in the visit. Beyond time, each code requires specific content:

• 97110: Exercise mode, frequency, sets, repetitions, resistance level, and active therapist involvement throughout.
• 97530: The specific functional activity performed, the functional goal it addresses, and why skilled PT involvement was required for the activity.
• 97140: Technique used (e.g., joint mobilization grade and direction, soft tissue technique), body region treated, and clinical rationale.
• 97112: Specific neuromuscular impairment addressed, technique used, and patient response or progression.

Documentation tip

The 8-minute rule governs time-based codes: a single unit requires at least 8 minutes of direct, skilled service, and each unit after the first opens at a further 15-minute mark (8, 23, 38, 53, 68…). To bill 4 units in a 60-minute session, you need between 53 and 67 minutes of timed service. Document total timed minutes at the end of every note, and use a tool like SPRY's 8-minute rule calculator when a session mixes several timed codes and the unit math gets tight.

Coding Accurately in 2026 Is a Compliance Strategy — and, for Treatment Codes, a Revenue One

The 2026 conversion factor increase is genuinely good news for PT practices after five flat-or-declining years — but its benefit is uneven across your fee schedule, since the paired -2.5% efficiency adjustment hit many non-time-based codes even as it spared the core timed treatment codes. The difference between a clinic that defaults to 97110 for every treatment and one that correctly identifies and documents 97530, 97112, and 97140 where they apply is a real revenue distinction on the treatment side, often measured in thousands of dollars annually at meaningful patient volume.

Evaluation coding is a different story in 2026: because Medicare pays 97161, 97162, and 97163 identically, defaulting to 97161 for every new patient doesn't cost you Medicare revenue the way it once might have. It does still matter for compliance — billing a tier your notes don't support is an audit finding whether or not the payment differs — and it matters for private payers and value-based arrangements that may weight complexity differently than Medicare does.

The strategies in this guide — selecting the evaluation tier your documentation supports, using high-value treatment code combinations, applying modifiers correctly, and documenting to the standard each code requires — are how PT clinics stay compliant while capturing the treatment-code revenue that's actually available to them.

Your Next Steps

1. Audit your last 30 evaluation claims against the criteria above. Even though Medicare pays the tiers identically, confirm your documentation would hold up if a MAC asked you to justify the tier billed.
2. Review your treatment code mix. What percentage of your timed units are 97530 versus 97110? If it's well under 20% 97530, your documentation may not be capturing the functional work actually happening in sessions.
3. Verify that GP is appearing on every Medicare claim line, and that KX is triggering once a patient's combined PT/SLP allowed charges cross the 2026 threshold of $2,480.
4. Train clinical staff on the 8-minute rule and time documentation. Inconsistent time documentation is one of the most common reasons clean claims get questioned.
5. If your practice offers telehealth, confirm your billing team is applying modifier 95 with the correct place-of-service code and that your service locations are enrolled in PECOS — flexibilities are extended through December 31, 2027, but the paperwork requirements didn't go away.

Disclaimer: This guide reflects the CY2026 Medicare Physician Fee Schedule final rule, the CPT 2026 code set, and CMS telehealth guidance as of September 2026. Reimbursement rates vary by geographic location and payer contract. Always verify current rates with CMS and consult a qualified billing professional before implementing coding changes.

Frequently Asked Questions

What is the most commonly billed CPT code in physical therapy?

CPT 97110 (therapeutic exercise) is the most frequently billed PT code in the United States. It covers individualized exercise programs targeting strength, endurance, range of motion, and flexibility, billed in 15-minute units. The 2026 Medicare national non-facility rate is approximately $29.06 per unit.

What CPT code is used for a physical therapy initial evaluation?

PT initial evaluations are billed using CPT 97161 (low complexity), CPT 97162 (moderate complexity), or CPT 97163 (high complexity). The correct tier depends on the number of personal factors affecting care, the clinical complexity of the presentation, and the scope of history-taking and testing required — not on reimbursement, since Medicare pays all three tiers the same national rate (roughly $98 in 2026). These codes replaced the old 97001/97002 system in January 2017.

What is the difference between CPT 97530 and CPT 97110?

CPT 97530 (therapeutic activities) covers functional, real-world movement tasks tied to a patient's daily activities — such as sit-to-stand training, car transfers, stair negotiation, or job simulation. CPT 97110 (therapeutic exercise) covers isolated, structured exercises like straight leg raises or resistance training. In 2026, 97530 reimburses about 21% more per unit nationally ($35.07 vs. $29.06), but documentation must explicitly link the activity to a stated functional goal, not just describe more difficult exercise.

What is the 2026 Medicare conversion factor for physical therapy?

The 2026 Medicare conversion factor is $33.40 per relative value unit (RVU) for non-qualifying APM participants, which includes most physical therapists — up 3.26% from $32.35 in 2025, the first increase to the fee schedule in five years. CMS also applied a separate -2.5% "efficiency adjustment" to many non-time-based codes, though core timed PT treatment codes (97110, 97112, 97140, 97530) were exempted from it.

When should a physical therapist use CPT 97164 vs 97162 or 97163?

CPT 97164 (re-evaluation) is used when a patient's clinical status changes significantly enough to require a formal reassessment — such as a new complication, a meaningful change in diagnosis, or failure to progress as expected. It should not be billed at regular calendar intervals. 97162 and 97163 are initial evaluation codes for new patients or new diagnoses — they are not appropriate for an existing patient whose status has changed mid-episode.

Can a PT bill both 97140 (manual therapy) and 97110 (therapeutic exercise) on the same visit?

Yes, with proper documentation. When two timed codes are provided on the same date and are clinically distinct services (different therapeutic purposes, different anatomical areas, or different time periods), they can be billed together. If the combination triggers a CCI edit, Modifier 59 or an X-modifier (XS for separate structure, XE for separate encounter) is required to override the bundle. Document the distinct purpose and time for each service clearly.

Is physical therapy telehealth still covered by Medicare in 2026?

Yes. After a lapse tied to the 2025 government funding fight, Congress's FY2026 funding legislation extended major Medicare telehealth flexibilities — including coverage for PTs, OTs, and SLPs — through December 31, 2027. Claims should use modifier 95 for interactive audio-video telehealth with place-of-service code 10 (patient at home) or 02, and the billing service location must be enrolled in PECOS.