Physical Therapy Claims Processing | Most-paid CPT codes
You can increase your profitability by analyzing which physical therapy billing codes result in the most paid claims each month and then set new monthly practice management goals that include the frequent use of these. For example, we took a look at bestPTÂ numbers from 2012 and discovered that only 180 CPT codes were used by our physical therapy billing clients. Even more surprisingly, only a few of those actually resulted in payments from insurance companies. In other words– it might make sense to focus on implementing the patient treatments that do get you paid at the end of the day.
10 CPT codes were reported in 89.9% of the claims and 92.4% of all reported units:
|
| % of Claim | % of Units |
97110 | Therapeutic exercises | 30.1% | 38.1% |
97140 | Manual Therapy (ie. STM, JM) | 22.9% | 21.7% |
97530 | Therapeutic Activities | 7.9% | 12.0% |
97112 | Neuromuscular Re-education | 6.9% | 6.2% |
97010 | Hot or cold packs | 5.1% | 3.3% |
97014 | Electrical stimulation | 4.6% | 2.9% |
97035 | Ultrasound | 4.2% | 2.8% |
G0283 | Electrical Stimulation (Unattended) | 3.2% | 2.0% |
97001 | Physical Therapy Evaluation (1st Appointment only) | 2.8% | 1.8% |
97032 | Application of a modality to one or more areas | 2.2% | 1.4% |
|
| 89.9% | 92.4% |
Top 10 most paid CPT codes generated 92.2% of all collections:
|
| % Paid |
97110 | Therapeutic exercises | 37.4% |
97140 | Manual Therapy (ie. STM, JM) | 21.6% |
97530 | Therapeutic Activities | 13.9% |
97112 | Neuromuscular Re-education | 7.4% |
97001 | Physical Therapy Evaluation (1st Appointment only) | 5.4% |
92507 | Treatment of speech | 1.7% |
97014 | Electrical stimulation | 1.4% |
97035 | Ultrasound | 1.3% |
97032 | Application of a modality to one or more areas | 1.1% |
97113 | Therapeutic procedure | 1.0% |
|
| 92.2% |
It might surprise you that code 97010 (Hot or cold packs) was used in 5.1 percent of all claims, but generated only 0.5 percent of all collections. In stark contrast, the code 97001 (Physical Therapy Evaluation) was used in only 2.8 percent of all claims, but generated a whopping 5.4 percent of all collections.
The average collections of the  top 10 most paid CPT codes amounted to $23.53 per unit although codes 97014 (Electrical stimulation) and 97035 (Ultrasound) generated only of $9.25 and $9.36 respectively. On the high end of the spectrum codes 97001 (Physical Therapy Evaluation) and 92507 (Treatment of speech) generated $58.96 and $66.51 respectively.
As you can see, frequent use of code 97001 is not only resulting higher payments, but even more importantly it indicates healthy practice growth with lots of new patients! In addition, the use of code 97002 shows that referring doctors are trusting you with their patients by prescribing “evaluate and treat” which basically means that you have earned their trust!
