How and when to use the 97110 and 97530 CPT codes

You don’t have to be a pro athlete to know there are two primary components to training for a sport. First, there’s a daily regimen of exercises designed to condition and strengthen the muscles, providing a strong foundation. Second is an extensive amount of practice with the specific movements the game requires. This analogy can help us make sense of when to use each of the two most common occupational therapy CPT codes: 97110 and 97530.  

The 97110 CPT code describes therapeutic exercises that a patient participates in during an OT therapy session. These exercises help build strength or endurance to support a return to normal functioning. The 97530 CPT code describes therapeutic activities that are practiced during a session to improve functioning. These activities often include practicing real-life skills like transferring from a chair or bed. In this post, we’ll examine both codes in-depth, explain when to use them, and identify the billing documentation needed for each.

What is the 97110 CPT code?

The 97110 CPT code describes foundational occupational therapy exercises that are designed to improve a patient’s strength, range of motion, endurance, or flexibility. They address issues with muscle weakness, stiffness, or a decreased range of motion. 

In order to bill, the exercises prescribed must be medically necessary to improve a patient’s strength and mobility to increase participation in activities of daily living, like bathing, dressing, feeding, and a range of other functional activities. You work with the client to complete these exercises, either actively, active-assisted, or passively.

Another requirement to bill using the 97110 CPT code is that you must be actively working with the client one-on-one during the entire session. It’s a timed code, with each unit lasting 15 minutes. The 97110 CPT code describes exercises that address one deficit area across one or more areas of the body.

Read Understanding Occupational Therapy Billing Units to learn how to calculate billing units for timed codes.

When to use the 97110 CPT code

You’ll use this code when you’re working with a patient to complete sets of specially designed exercises that restore flexibility, strength, endurance, or range of motion.

Examples of exercises that would typically carry this billing code include using free weights to increase arm strength or walking on a treadmill to build endurance.

Other examples may include overhead stretches with a TheraBand to increase range of motion in an injured shoulder or using TheraPutty to build up hand strength after a stroke.

Required documentation for the 97110 CPT code

Documentation helps you provide better care to clients and, importantly for billing, justifies your services to insurers if you receive a claims rejection or undergo an audit. The documentation for billing 97110 typically identifies a single deficit area you’re targeting for treatment. It makes a clear connection as to how that deficit is negatively impacting the patient’s quality of life. Decreases in flexibility, range of motion, strength, and endurance are all examples of commonly used deficit areas. 

You should record an objective measure of the deficit area before beginning to work with the patient and update it as they progress through the course of treatment. Your documentation should include the area of the body you’re working on and the type, quantity, and purpose of exercises performed during your occupational therapy sessions. 

As the patient progresses, document any changes you made to their exercise program, including any new exercises added. You’ll want to clearly show that the client is making objective, measurable improvements and that there is a clear, planned progression towards an eventual transition to a home exercise program. For complex patients who require a higher level of care, billing for more than one unit can certainly be appropriate.

What is the 97530 CPT code?

The 97530 CPT code is used to document therapeutic activities intended to improve a patient’s functional performance due to lost or restricted mobility, coordination, balance, flexibility, or strength. What differentiates the 97530 CPT code from the 97110 CPT code is that it involves functional activities, not exercises. These activities provide very specific training for the activities of daily life that have been compromised. To use this code, you must be present with the patient for the entire session, working one-on-one with them in an active, active-assisted, or passive role. The 97530 CPT code is also a timed code, with each unit lasting 15 minutes, and it describes a therapy session that addresses multiple deficits through participation in a functional activity. 

When to use the 97530 CPT code

The 97530 CPT code is often the best choice when the session focuses on training that involves a functional activity. One example would include having a patient stand on a balance board while bending down or reaching up for objects at varying heights. Another might include having a client complete a fine motor task while they’re wearing cuff weights. 

Required documentation for the 97530 CPT code

Where the 97110 CPT code typically addresses just one deficit area being targeted by treatment, the 97530 CPT code most frequently focuses on two or more areas. These expected outcomes include things like improving balance, flexibility, strength, or other functional activities. Your documentation should include the areas you targeted for improvement and a detailed description of those activities. Explain why you chose these activities to remediate the deficit areas. Make a clear connection between the activity and its role in restoring a function of daily life. Include the level of assistance you needed to provide the patient during the activity. 

Read SOAP Notes for Occupational Therapy to take better documentation notes and speed up your process. 

Wrapping up

At first glance, the 97110 and 97530 CPT codes look very much alike. Although they have similarities, there are some significant differences in how the occupational therapy is provided and the documentation required for each. Knowing when and how to use each will decrease your number of rejected claims and can simplify potential audits from insurers.

Check out our Complete Guide to Occupational Therapy Billing to learn more about how to simplify and improve your billing processes.