When to use: Apply 97010 for superficial hot or cold pack application. Hot packs increase tissue extensibility and promote muscle relaxation prior to manual therapy or exercise. Cold packs reduce acute inflammation and pain. Document treatment area, duration, and clinical rationale.

DC application: Commonly used before CMT to relax paraspinal musculature. Note: Medicare bundles 97010 — do not bill separately for Medicare patients.

When to use: Apply 97012 for mechanical traction — intermittent or sustained distraction of the cervical or lumbar spine using a mechanical device. Evidence-based for cervical radiculopathy and lumbar disc pathology. Relieves nerve root compression, reduces intradiscal pressure, and promotes joint mobility.

When to use: Apply 97014 when electrical stimulation is applied and the clinician is NOT in constant attendance — the patient is set up with electrodes and the device runs unmonitored. Used for muscle re-education, pain modulation, edema reduction, and muscle strengthening.

When to use: Apply 97016 for pneumatic compression device therapy — sequential compression applied to an extremity to reduce edema, improve lymphatic circulation, and manage lymphedema. Document limb circumference measurements at each session to demonstrate edema reduction.

When to use: Apply 97018 for paraffin bath therapy — deep superficial heating using warm paraffin wax applied to hands, wrists, or feet. Increases tissue temperature, improves joint mobility, reduces morning stiffness, and prepares the hand for exercise. Most commonly used in OT hand therapy for RA, OA, and post-surgical rehab.

When to use: Apply 97022 for whirlpool therapy — partial or full body immersion in agitated warm/cool water for burns, edema reduction, and pain management. Note: pulsed lavage (97602) has largely replaced whirlpool for wound care due to infection control concerns.

When to use: Apply 97024 for diathermy — deep heating using electromagnetic energy (microwave or shortwave). Penetrates deeper than hot packs or ultrasound. Used for deep muscle relaxation, joint stiffness, and tissue extensibility prior to manual therapy. Less commonly used in modern PT practice.

When to use: Apply 97026 for infrared therapy — superficial heating using infrared radiation. Promotes blood flow, reduces muscle spasm, and decreases pain. Used prior to exercise or manual therapy to warm superficial tissues.

Note: Low-level laser therapy (LLLT/photobiomodulation) is NOT billed as 97026 — use 97039 (unlisted modality).

When to use: Apply 97028 for ultraviolet (UV) light therapy — UV-C has bactericidal properties effective against wound biofilm. Used in wound care and burn rehabilitation. Requires specific UV equipment and clinical training in dosimetry.

When to use: Apply 97032 when electrical stimulation requires constant clinician attendance — adjusting parameters, monitoring patient response, or applying FES. Includes NMES for muscle re-education post-stroke, FES for foot drop, and attended TENS with parameter adjustments throughout treatment.

When to use: Apply 97033 for iontophoresis — transdermal delivery of ionized medications using direct electrical current. Most commonly used with dexamethasone for tendinopathies, bursitis, and plantar fasciitis. Acetic acid for calcific tendinitis. Requires a physician order.

When to use: Apply 97034 for contrast bath therapy — alternating immersion of a distal extremity in warm and cold water. Promotes vascular pumping, reduces edema, decreases pain, and improves ROM. Commonly used for CRPS, post-surgical hand/foot edema, and subacute ankle sprains.

When to use: Apply 97035 for therapeutic ultrasound. Continuous mode (thermal): increases tissue temperature, promotes extensibility, reduces pain and spasm. Pulsed mode (non-thermal): promotes tissue healing, reduces acute inflammation. Also used for phonophoresis — transdermal delivery of topical medications via ultrasound.

When to use: Apply 97036 for full-body hydrotherapy — Hubbard tank or therapeutic pool immersion. Used in burn centers and acute rehab for wound care, ROM, and early functional mobility. Buoyancy reduces gravitational stress, allowing movement in patients who cannot tolerate full weight bearing.

Note: 97036 = full-body immersion as a modality. Active therapeutic exercise in water = 97113.

When to use: Apply 97039 for therapeutic modalities without a specific CPT code — including LLLT/photobiomodulation, PEMF, and other emerging modalities. A special report describing the modality, equipment, parameters, and clinical rationale must accompany every claim.

When to use: Apply 97110 for therapeutic exercises developing strength, endurance, ROM, or flexibility. The most commonly billed PT/OT code. Requires one-on-one skilled clinician supervision throughout.

PT application: Resisted strengthening, ROM exercises, stretching, cardiovascular conditioning.

OT application: Upper extremity exercise, fine motor strengthening, hand therapy exercise.

When to use: Apply 97112 for neuromuscular reeducation — interventions targeting movement, balance, coordination, kinesthetic sense, posture, and proprioception. Distinct from 97110 (strength/ROM). Use when the primary goal is neuromotor function: balance retraining post-stroke, proprioception after ankle sprain, PNF patterns.

When to use: Apply 97113 for aquatic therapy — therapeutic exercise in a pool under skilled clinician supervision. Water buoyancy reduces gravitational load, allowing pain-free movement when land-based exercise is not tolerated. Used for OA, post-surgical rehab, fibromyalgia, and neurological conditions.

When to use: Apply 97116 for gait training — skilled instruction and supervision of ambulation with assistive devices, over varied surfaces, and on stairs. Includes pre-gait activities, device fitting/training (walker, cane, crutches), and stair negotiation. One of the most commonly billed PT codes post-acute.

When to use: Apply 97124 for massage — manual soft tissue techniques including effleurage, petrissage, compression, and tapotement. Goals: reduce muscle tension, improve circulation, decrease edema, prepare tissue for exercise. Requires skilled clinical judgment — not a standalone relaxation massage.

When to use: Apply 97129 for therapeutic interventions focused on cognitive function — attention, memory, executive function, problem-solving. Added in 2019. Used for TBI cognitive rehab, stroke cognitive-communication treatment, dementia maintenance, and MCI intervention. PT, OT, and SLP may all bill this code within their scope.

When to use: Apply 97130 for each additional 15-minute block of cognitive rehabilitation beyond the first 15 minutes. Always paired with 97129. Cannot be billed as a standalone code.

When to use: Apply 97139 for physical medicine procedures without a specific CPT code. A special report must accompany every claim describing the procedure, technique, equipment, and clinical rationale.

When to use: Apply 97140 for manual therapy — hands-on techniques directed at joints and soft tissues. The second most commonly billed PT code. Includes joint mobilization/manipulation, myofascial release, IASTM, and neural mobilization. Requires specialized training and direct hands-on contact throughout.

DC application: Use 97140 for extremity joint mobilization only. For spinal chiropractic manipulation, use 98940–98942.

When to use: Apply 97150 when a therapist simultaneously treats 2+ patients. The therapist divides attention among multiple patients. Common in cardiac rehab group exercise, post-surgical class, and lymphedema group education.

When to use: Apply 97161 for low-complexity PT evaluations — 1–2 performance deficits, stable uncomplicated condition, straightforward POC. Examples: isolated ankle sprain, single-joint OA, uncomplicated post-surgical case with no comorbidities affecting the POC.

When to use: Apply 97162 for moderate-complexity PT evaluations — the most common level in outpatient PT. Characterized by 3+ performance deficits and comorbidities that impact the POC. Most post-surgical, neurological, and multijoint presentations qualify as moderate complexity.

When to use: Apply 97163 for high-complexity PT evaluations — multisystem involvement, significant comorbidities, and complex CDM where standard guidelines do not apply. Typical: acute stroke, SCI, complex TBI, multiple trauma, advanced neurological disease.

When to use: Apply 97164 when formal re-evaluation is warranted — new clinical findings requiring a POC change, failure to progress, significant functional change, or return after a treatment gap. Not a routine progress note — it requires formal reassessment that changes the clinical direction.

When to use: Apply 97530 for therapeutic activities — dynamic activities improving functional performance in real-world tasks. Uses functional movements (sit-to-stand, carrying, stair negotiation, dressing simulation) rather than isolated exercise. One of the most commonly billed OT codes.

OT application: ADL training, functional transfers, meal preparation, and task-specific upper extremity training.

When to use: Apply 97545 for work hardening programs — structured, work-specific conditioning for return to work. Uses real or simulated work tasks, progressively graded to match the physical demands of the specific job. Typically 2–4 hour daily sessions over weeks.

97545 + 97546 structure: 97545 = initial 2 hours. 97546 = each additional hour. A 4-hour session = 97545 ×1 + 97546 ×2.

When to use: Apply 97550 when training a caregiver without the patient present. Added 2020 to recognize skilled caregiver education. Use for family training on transfer techniques, positioning, HEP facilitation, dysphagia diet management, or fall prevention — when patient is not in the room.

When to use: Apply 97551 when training a caregiver with the patient present — the most common caregiver training scenario. Typical: caregiver-assisted transfer training, cueing strategies for dementia, dysphagia diet, or positioning techniques practiced with the patient.

When to use: Apply 97597 for selective debridement of open wounds up to 20cm² — removal of devitalized tissue using methods that preserve healthy tissue: sharp debridement, autolytic, or enzymatic. Requires clinical judgment and scope-of-practice compliance.

When to use: Apply 97598 for each additional 20cm² of selective debridement beyond the first 20cm² covered by 97597. Always requires 97597 as the primary code.

When to use: Apply 97602 for non-selective debridement — methods that remove both viable and non-viable tissue without clinical discrimination. Includes wet-to-dry dressings, pulsed lavage with suction, and wound irrigation. Appropriate for heavily contaminated wounds requiring mechanical cleansing.

When to use: Apply 97605 for NPWT using a non-disposable device on wounds ≤50cm². NPWT applies controlled negative pressure to remove exudate, reduce edema, promote granulation tissue, and draw wound edges together. Used for chronic wounds, pressure injuries, diabetic foot ulcers, and post-surgical wounds.

When to use: Apply 97606 for NPWT using a non-disposable device on wounds >50cm². Same clinical application as 97605 but for larger wound areas. Document wound measurements clearly to support the >50cm² area billed.

When to use: Apply 97607 for NPWT using a disposable (single-use) device on wounds ≤50cm². Disposable NPWT devices (e.g., PICO, SNAP) are increasingly common for outpatient and home wound care. The entire device is discarded after use, distinguishing it from 97605 (reusable device).

When to use: Apply 97610 for low-frequency (40 kHz) non-thermal ultrasound — specifically the MIST Therapy System. Delivered via saline mist, it gently debrides the wound surface and promotes cellular healing without contact. Used for chronic non-healing wounds including diabetic foot ulcers, venous leg ulcers, and pressure injuries that have failed conventional wound care.

When to use: Apply 97750 for standardized physical performance testing generating a separate written report. Common: FCE, isokinetic strength testing, formal standardized balance assessments, 6MWT. Not for routine outcome measures in a progress note — requires a formal standalone written report with normative comparisons.

When to use: Apply 97760 for the initial encounter of orthotic management — fitting, checking, and training in orthosis use. Includes device fit evaluation, skin inspection training, donning/doffing instruction, wearing schedule education, and initial function training. Use 97763 for all subsequent sessions.

When to use: Apply 97761 for the initial encounter of prosthetic training — first fitting and functional training with a prosthetic device. PT focus: LE gait training. OT focus: UE prosthesis functional use (terminal device operation, myoelectric control, ADL integration). Requires specialized prosthetic training knowledge.

When to use: Apply 97763 for all subsequent orthotic and prosthetic management after the initial visit (97760 or 97761). Includes progressive gait training with prosthesis, orthotic adjustments, advancing functional activities, problem-solving device issues, and graduating to community-level use.

When to use: Apply 97799 as a last resort for PT/rehab services that cannot be described by any existing CPT code. A special report must accompany every claim. Medicare almost always denies 97799 — use only when no other code applies and the service is medically necessary and well-documented.

When to use: Apply 97165 for low-complexity OT evaluations — fewer than 3 performance areas affected, minimal comorbidities, straightforward intervention. Examples: isolated hand injury, single ADL deficit after minor injury, simple pediatric fine motor concern without comorbidities.

When to use: Apply 97166 for moderate-complexity OT evaluations — the most common level in outpatient OT. Multiple performance areas affected, comorbidities impacting the POC, and moderate CDM required. Most adult neurological, pediatric developmental, and hand therapy cases qualify.

When to use: Apply 97167 for high-complexity OT evaluations — 5+ performance areas affected, significant comorbidities, complex CDM, multiple standardized assessments required. Common: acute stroke with hemiplegia and cognitive deficits, TBI, SCI, severe burns, or complex pediatric with multiple developmental domains affected.

When to use: Apply 97168 when formal OT re-evaluation is warranted — unexpected functional change, new diagnosis affecting occupational performance, plateau requiring POC revision, or return after a significant treatment gap. Not a routine progress note — requires POC modification based on new clinical findings.

When to use: Apply 97533 for sensory integration therapy — structured sensory experiences improving sensory processing and adaptive responses. Used in pediatric OT for ASD, sensory processing disorder, DCD, and ADHD. Involves vestibular, proprioceptive, and tactile activities in a sensory-enriched environment.

When to use: Apply 97535 for self-care and home management training — direct skilled training in ADL and IADL tasks. Includes adaptive equipment instruction, compensatory technique training, energy conservation, and home modification recommendations. The most characteristic OT CPT code — closely aligned with OT's core domain of occupational performance.

When to use: Apply 97537 for community and work reintegration training — skill training for community-level activities including shopping, banking, public transit use, and work simulation tasks. Can be in-clinic (simulated grocery task, cash management) or community outings with the therapist. Documents the transition from clinic to real-world performance.

When to use: Apply 97542 for wheelchair management training — skilled instruction in safe and effective wheelchair use. Includes manual WC propulsion, power WC operation, pressure relief techniques, WC transfers, obstacle navigation, ramp/curb management, and home mobility. Used in SCI, stroke, MS, and neurodegenerative conditions.

When to use: Apply 97755 for assistive technology assessment — formal evaluation for prescription of power wheelchairs, complex seating systems, AAC devices, and other DME requiring clinical justification. Generates a Letter of Medical Necessity (LMN) required for DME authorization and insurance coverage.