Surgical · General

Therapeutic exercise billed per 15-minute unit, targeting strength, endurance, range of motion, or flexibility with direct one-on-one patient contact.

Verified May 8, 2026 · 8 sources ↓

Medicare: $29.06
Total RVUs: 0.87
Global, days
Region: General

Drawn from CMSBrelliumBtetechnologiesAssociationdatabase

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 8 cited references ↓

Specific exercise names, not generic descriptors — 'seated knee extensions 3x15 at 10 lb' not 'leg exercises'
Objective baseline measurements of strength or ROM with comparison to the uninvolved side
Sets, reps, resistance level, hold times, and any progressions made during the session
Patient response to each exercise, including quality of movement, compensations, or difficulty
Functional goal tied to each exercise — connect the deficit to a meaningful activity limitation
Home exercise program (HEP) documentation showing progression toward independent exercise
Pain rating, location, and effect on function if pain is the primary indication
Therapist name, credential, signature, and date on every note
Progress update at minimum every 10 visits per LCD L33631 requirements
Justification for continued treatment beyond 12–18 visits with functional outcome data

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

59 Distinct service 76 Repeat, same physician 77 Repeat, another physician KX Documentation on file XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 97110 covers skilled therapeutic exercise delivered directly to a patient, one-on-one, in 15-minute increments. Each unit must represent active, provider-directed exercise aimed at a documented impairment — strength deficit, limited ROM, poor endurance, or reduced flexibility. Passive-only programs should not drive ongoing 97110 billing beyond 2–4 visits; documentation must show the patient is actively engaged and progressing toward functional goals. Taping time (e.g., McConnell taping) used to facilitate a strengthening intervention counts toward the 97110 unit.

This code frequently pairs with 97140 (manual therapy) and 97112 (neuromuscular reeducation) on the same date. NCCI edits govern those combinations — modifier 59 (or an X-modifier) is required when services are genuinely distinct and separately documented. Per CMS, 97110 and 97530 can be billed together when each maps to a separate, documented therapeutic goal; private payers vary, and some require modifier 59 regardless.

For Medicare, once cumulative therapy charges cross the annual threshold, modifier KX is mandatory on every claim and documentation must affirmatively establish continued medical necessity. Claims above the threshold without KX face automatic denial. Beyond 12–18 visits, the notes must make an explicit case for why continued skilled therapeutic exercise is required — incremental ROM gains alone typically won't hold up under audit.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.45
Practice expense RVU	0.41
Malpractice RVU	0.01
Total RVU	0.87
Medicare national rate	$29.06
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$29.06

Common denial reasons

The recurring reasons claims for CPT 97110 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Vague exercise descriptions ('strengthening exercises performed') without specifics on parameters or body part
Missing KX modifier when billing exceeds the annual Medicare therapy threshold
Lack of documented medical necessity for visits beyond 12–18 — notes show minimal functional gains
Billing 97110 alongside 97140 or 97112 without modifier 59 when payer requires it for separate services
Time documentation insufficient to support the number of 15-minute units billed
Passive-only exercise program billed beyond the initial 2–4 training visits without skilled justification

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01How many units of 97110 can be billed per session?

There's no hard AMA cap on units, but medical necessity must justify every 15-minute increment billed. Medicare's 8-minute rule governs timed codes — a service must be performed for at least 8 minutes to count as one unit. Payers scrutinize high unit counts closely, so document total treatment time and time spent on each service.

02Can 97110 and 97530 be billed together?

Yes, per CMS guidance. Each code must map to a distinct therapeutic goal documented in the plan of care. 97110 targets impairment-level deficits (strength, ROM, flexibility); 97530 covers functional task training involving multiple parameters simultaneously (lifting, carrying, reaching). Private payers sometimes require modifier 59 — check each payer's policy.

03When is modifier KX required on a 97110 claim?

Modifier KX is required for Medicare once cumulative therapy charges in the calendar year exceed the annual threshold. It certifies that services are medically necessary and that documentation supports continued treatment. Claims above the threshold without KX are automatically denied.

04Does McConnell taping time count toward 97110?

Yes. Per CMS billing and coding guidance, time spent on taping applied to facilitate a strengthening intervention — such as McConnell taping — is counted under 97110, not billed separately.

05What's the difference between 97110 and 97112?

97110 targets strength, endurance, ROM, and flexibility through structured exercise. 97112 (neuromuscular reeducation) addresses movement pattern dysfunction, balance, coordination, and proprioception. When both are clinically indicated and separately documented, they can be billed on the same date with modifier 59 if required by the payer.

06How often does documentation need to be updated to support ongoing 97110 billing?

LCD L33631 requires supportive documentation — objective measurements, progress toward functional goals, and HEP updates — at minimum every 10 visits. Beyond 12–18 visits, notes must explicitly justify why continued skilled therapeutic exercise is necessary, not just show that the patient is still attending.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures exercise names, targeted body regions, sets, reps, resistance levels, and hold times directly from dictation — plus the therapist's stated rationale and the patient's response. That specificity is what separates a billable 97110 note from a generic narrative that auditors flag as unskilled or medically unnecessary.

See how Mira captures CPT 97110 documentation