CPT code 97112 is used for neuromuscular reeducation, and it’s one of the most misunderstood billing codes in therapy. Getting it wrong means denials. Getting it right means clean claims and defensible documentation when auditors come knocking.
Here’s the reality: Medicare contractors are actively targeting 97112 in Targeted Probe and Educate (TPE) reviews. Documentation that passed two years ago won’t cut it anymore. The rules haven’t changed, but enforcement has.
This guide covers everything physical therapists, occupational therapists, and physicians need to bill 97112 correctly in 2026. You’ll find the updated KX threshold ($2,480), January 2026 NCCI edits, and current reimbursement rates. We’ve also included a TPE-ready documentation template that actually survives audits.
No fluff. No outdated information. Just the practical guidance you need to bill correctly and protect your revenue when Medicare comes looking.
What is CPT Code 97112? — Definition, Purpose & Clinical Application
Official AMA CPT Code 97112 Definition
CPT 97112 Definition: “Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.”
— American Medical Association, CPT® 2026
That’s the official 97112 cpt code description. It covers a lot of ground, but what it really means is this: you’re retraining how the patient moves, not just what they can do.
What Neuromuscular Reeducation Means Clinically
Neuromuscular reeducation is about restoring the brain-body connection. The nervous system talks to the muscles, and the muscles send feedback back to the brain. When injury, surgery, or neurological damage disrupts that loop, movement quality suffers.
Reeducation means you’re retraining proper motor control. You’re teaching the body to move correctly again through skilled intervention. Balance improves. Coordination comes back. Proprioception gets sharper.
Here’s what separates neuromuscular reeducation from therapeutic exercise: 97112 focuses on how the body moves. Quality matters more than capacity. A patient doing resistance exercises to build quad strength? That’s 97110. A patient retraining weight shift patterns to stop compensating after a stroke? That’s 97112.
The clinical goal is restoring functional movement patterns through targeted neuromotor training.
What CPT 97112 IS (Common Appropriate Uses)
| Clinical Application | Example Interventions |
| Balance / postural control retraining | Altered base of support, perturbation training |
| Proprioceptive training | Eyes-closed exercises, unstable surfaces |
| Motor control retraining | Trunk-pelvis dissociation, scapular control |
| Coordination / timing retraining | Rhythmic stabilization, PNF techniques |
| Movement pattern re-education | Weight shifting, postural awareness cueing |
These interventions require skilled therapist facilitation. You’re cueing, correcting, and progressing based on patient response. That’s what makes it billable as 97112.
What CPT 97112 is NOT (Common Billing Mistakes)
| If the Primary Goal Is… | Use This Code Instead | Why NOT 97112 |
| Strengthening or flexibility | 97110 (Therapeutic Exercise) | Focus is physical capacity, not neuromotor control |
| Functional tasks (lifting, transfers) | 97530 (Therapeutic Activities) | Focus is task performance, not movement quality |
| Gait training specifically | 97116 (Gait Training) | Gait is the primary skilled intervention |
| Manual joint mobilization | 97140 (Manual Therapy) | Different procedure category |
What is CPT code 97112 comes down to this: if you’re retraining movement quality through balance, coordination, or proprioception work, you’re in the right code. If you’re building strength, improving ROM, or working on functional tasks as the primary goal, you’re not.
Payers deny 97112 claims when documentation doesn’t clearly distinguish neuromuscular reeducation from therapeutic exercise. The interventions might look similar on paper, but the clinical intent is different.
2026 Medicare Updates for CPT Code 97112 — What Providers Must Know
2026 KX Modifier Threshold—The New $2,480 Rule
For Calendar Year 2026, the KX modifier threshold is $2,480:
- $2,480 for PT + SLP combined
- $2,480 for OT (separate bucket)
When therapy charges exceed this threshold, claims must include the KX modifier to indicate medical necessity is documented in the record. Without KX, claims over $2,480 will be denied.
Here’s what changed. The old hard therapy cap is gone, but Medicare didn’t eliminate oversight completely. They replaced it with a threshold system that requires the KX modifier once your charges hit $2,480 in a calendar year.
Physical therapy and speech-language pathology share one $2,480 bucket. Occupational therapy gets its own separate $2,480 threshold. That means a patient could receive up to $4,960 in therapy services before hitting both thresholds.
The KX modifier doesn’t require prior authorization. It’s an attestation. You’re telling Medicare that medical necessity is documented in the patient’s record and you can justify continued treatment if audited. Skip the KX modifier above the threshold, and your claim denies automatically.
There’s also a second threshold at $3,000 called the Targeted Medical Review threshold. Claims above this amount face higher audit probability, but they still process as long as KX is appended and documentation supports medical necessity.
2026 Medicare Reimbursement Rate for 97112
| Setting | 2026 National Average Rate* | Total RVUs |
| Non-Facility (Private Practice) | ~$33.07 per unit | ~0.99 |
| Facility (Hospital Outpatient) | ~$26.00 per unit | ~0.99 |
*Rates vary by geographic locality (GPCI). Verify with your MAC for exact rates.
The 97112 reimbursement rate for 2026 sits at approximately $33.07 per unit in non-facility settings. Facility rates drop to around $26.00 because Medicare assumes lower overhead in hospital outpatient departments. Your actual 97112 cpt code reimbursement depends on your geographic locality’s practice expense adjustment.
2026 Medicare Conversion Factors
| Provider Status | 2026 Conversion Factor |
| Qualifying APM Participant (QP) | $33.5675 |
| Non-QP | $33.4009 |
Effective January 1, 2026 per CMS MPFS final rule.
Providers participating in qualifying Alternative Payment Models get a slightly higher conversion factor in 2026. The difference is small, but it applies to every service you bill.
January 2026 NCCI Edits Update
CMS posted the January 1, 2026 NCCI Procedure-to-Procedure edits on December 1, 2025. These edits control which codes can be billed together on the same date of service.
When you bill code pairs that trigger an NCCI edit, the Column 2 code denies unless you append modifier 59 or an X-modifier and your documentation proves the services were clinically distinct. Same body part, same session, different techniques? That requires clear documentation showing separate therapeutic intent.
NCCI edits for 2026 affect how 97112 pairs with other therapy codes. Check the current edit tables before submitting claims with multiple timed codes.
Is CPT Code 97112 a Timed Code? — Units & the 8-Minute Rule
Yes, CPT 97112 is a Timed Code
Yes, CPT code 97112 is a timed code. It is billed in 15-minute increments based on total time spent providing direct, one-on-one skilled intervention. Medicare’s 8-minute rule applies: you must provide at least 8 minutes of treatment to bill 1 unit.
That’s the quick answer. Now here’s how it works in practice.
CPT 97112 gets billed by the unit, and each unit represents 15 minutes of direct treatment time. You’re tracking actual minutes spent on neuromuscular reeducation, not the total appointment time. Patient was there for 45 minutes but you only spent 20 minutes on balance training? You bill based on that 20 minutes.
The 8-Minute Rule for CPT Code 97112
The 8-minute rule determines how many 97112 units you can bill based on total timed treatment minutes. Here’s the breakdown:
| Units Billed | Total Treatment Time Required |
| 1 unit | 8 to 22 minutes |
| 2 units | 23 to 37 minutes |
| 3 units | 38 to 52 minutes |
| 4 units | 53 to 67 minutes |
| 5 units | 68 to 82 minutes |
| 6 units | 83 to 97 minutes |
You need at least 8 minutes to bill one unit. Provide seven minutes of treatment? You can’t bill anything. That’s why accurate time tracking matters.
The 8-minute rule 97112 applies to all timed therapy codes, not just neuromuscular reeducation. When you’re billing multiple timed codes in one session, total up all the timed minutes first, then allocate units across the codes.
Multi-Code Unit Calculation Examples
Calculating 97112 units gets tricky when you’re mixing codes. Here’s how to handle it:
Example 1:
You provide 24 minutes of 97112 and 23 minutes of 97110. Total timed minutes: 47. That equals three billable units. The code with more minutes gets the extra unit, so bill two units of 97112 and one unit of 97110.
Example 2:
You provide 20 minutes of 97112 and 20 minutes of 97110. Total: 40 minutes, which equals three units. Minutes are equal, so you can split them two and one between either code based on clinical emphasis.
Maximum Units Per Session
CMS allows up to four units of CPT code 97112 per date of service as standard practice. You can bill more than four units if medical necessity supports it and documentation justifies the extended treatment time. Payers scrutinize anything beyond four units, so your notes better be rock solid.
CPT Code 97112 vs. 97110 vs. 97530 — Complete Comparison
What is the Difference Between CPT 97110 and 97112?
CPT 97110 (Therapeutic Exercise) focuses on improving physical capacity: strength, endurance, range of motion, and flexibility through repetitive exercises.
CPT 97112 (Neuromuscular Reeducation) focuses on improving movement quality by retraining the brain-body connection, including balance, coordination, proprioception, and motor control.
Key Difference: 97110 is about what the body can do (capacity). 97112 is about how the body moves (quality and control).
The difference between 97110 and 97112 comes down to treatment intent. You’re either building physical capacity or retraining motor control. Same patient, same session, different goals.
A patient doing resistance band exercises to strengthen their rotator cuff? That’s CPT 97110. Same patient working on scapular stabilization patterns with therapist cueing during arm elevation? That’s 97112.
Payers look for this distinction in documentation. If your notes don’t clearly explain why you chose 97112 over therapeutic exercise, expect denials.
Complete CPT Code Comparison Table
| Factor | 97110 – Therapeutic Exercise | 97112 – Neuromuscular Reeducation | 97530 – Therapeutic Activities |
| Primary Focus | Physical capacity (strength, ROM) | Movement quality & motor control | Functional task performance |
| Treatment Goal | Single measurable outcome | Coordination, balance, proprioception | Multiple functional outcomes |
| Movement Type | Repetitive, isolated exercises | Targeted brain-body retraining | Dynamic, functional tasks |
| Examples | Leg press, stretching, resistance | Balance training, PNF, postural work | Lifting, reaching, squatting |
| 2026 Medicare Rate | ~$30.14 | ~$33.07 | ~$40.12 |
| Code Type | Timed (15 min) | Timed (15 min) | Timed (15 min) |
CPT 97530 differs from both codes. Therapeutic activities involve dynamic functional movements that combine multiple components. You’re working on actual tasks the patient needs to perform, not isolated exercises or movement patterns.
When to Use 97112 Instead of 97110
Choose 97112 when treatment targets:
- Balance or postural control improvements
- Movement pattern retraining after neurological injury
- Proprioceptive awareness enhancement
- Coordination deficit correction
- Motor control facilitation (not strength alone)
Choose 97110 when treatment targets:
- Muscle strength increases
- Range of motion improvements
- Cardiovascular endurance building
- Flexibility enhancement
The clinical goal determines the code. Don’t pick based on reimbursement rates.
Can 97110 and 97112 Be Billed Together?
Yes, CPT codes 97110 and 97112 can be billed together on the same date of service when:
- Both services are medically necessary
- Treatment times are distinct (not overlapping)
- Documentation supports different clinical goals
- Modifier 59 (or X-modifiers) is appended
You can bill 97110 and 97112 together, but your documentation needs to prove they were separate interventions addressing different deficits. Spent 15 minutes on resistance exercises for quad strengthening, then 15 minutes on balance training with perturbations? That works. Just make sure your notes clearly differentiate the two.
Missing modifier 59 when billing both codes together? The claim bundles, and you lose reimbursement for one service.
CPT Code 97112 Examples — Techniques, Conditions & Clinical Scenarios
Neuromuscular Reeducation Techniques Covered Under 97112
| Technique | Description | Clinical Application |
| PNF (Proprioceptive Neuromuscular Facilitation) | Hold-relax, contract-relax, rhythmic stabilization | Movement pattern retraining |
| Balance Training | Single-leg stance, tandem walking, perturbations | Postural stability improvement |
| Proprioceptive Training | Unstable surfaces, eyes-closed exercises | Position sense restoration |
| Postural Reeducation | Alignment correction, postural cueing | Dysfunctional posture correction |
| Motor Control Exercises | Core stabilization, movement sequencing | Controlled movement enhancement |
| Desensitization Techniques | Sensory stimulation, texture discrimination | Hypersensitivity treatment |
| Feldenkrais Method | Movement awareness, efficiency training | Movement quality improvement |
| Bobath / NDT | Facilitation and inhibition techniques | Neurological rehabilitation |
These are the 97112 examples you’ll see most often in therapy practices. PNF techniques and balance training dominate, but any intervention targeting motor control qualifies as long as documentation supports it.
Conditions Commonly Treated with 97112
| Condition Category | Specific Conditions | Key 97112 Interventions |
| Neurological | Stroke/CVA, Parkinson’s disease, Multiple Sclerosis (MS), Traumatic Brain Injury (TBI), Spinal Cord Injury | PNF, weight shifting, postural training, LSVT BIG |
| Vestibular | BPPV (post-repositioning), Vestibular neuritis, Concussion | Gaze stabilization, VOR exercises, balance progression |
| Orthopedic | Post-ACL reconstruction, Total Knee Replacement (TKR), Total Hip Replacement (THR), Chronic ankle instability | Proprioceptive training, landing mechanics, perturbations |
Stroke and Parkinson’s are the most common neurological diagnoses billed with 97112. Vestibular conditions are straightforward because the entire treatment plan revolves around balance and coordination. Orthopedic cases require more careful documentation to distinguish neuromuscular reeducation from standard therapeutic exercise.
Clinical Scenario Examples
Example 1: Stroke Recovery
A 65-year-old patient, six weeks post-CVA with left hemiparesis, receives neuromuscular reeducation to trunk and bilateral lower extremities for 15 minutes. Interventions include weight-shifting with tactile cueing, rhythmic stabilization for trunk control, and single-leg stance progression.
Documentation: “NMR to trunk/BLE x 15 min for postural control retraining to improve weight transfer during sit-to-stand. Patient demonstrated improved ability to shift weight to L side with decreased loss of balance (3/5 trials to 1/5 trials).”
Example 2: Post-ACL Reconstruction (Orthopedic Application)
A 28-year-old athlete, eight weeks post-ACL reconstruction, demonstrates proprioceptive deficits. Interventions include single-leg balance on BOSU, perturbation training, and eyes-closed proprioception exercises.
Documentation: “NMR to R LE x 15 min focusing on proprioceptive training and dynamic stability for return to sport. Single-leg stance time improved from 12 to 22 seconds on unstable surface.”
Both 97112 examples show quantifiable progress. That’s what auditors want to see.
Using 97112 for Non-Neurological Diagnoses
Here’s where practices get into trouble. CPT 97112 isn’t exclusive to neurological conditions, but payers scrutinize orthopedic claims more heavily. You can bill 97112 for a post-surgical knee, but documentation must clearly describe the neuromuscular deficit and explain how your intervention addresses motor control, not just strength.
If your notes sound like you’re doing therapeutic exercise with balance work added as an afterthought, expect denials. The neuromuscular component needs to be the primary focus.
CPT Code 97112 Modifiers—When & How to Use Them
Required Modifiers for CPT Code 97112
| Modifier | Description | When to Use |
| GP | Physical Therapy services | Required for ALL PT-billed 97112 Medicare claims |
| GO | Occupational Therapy services | Required for ALL OT-billed 97112 Medicare claims |
| GN | Speech-Language Pathology services | Required when SLP bills 97112 (rare) |
| 59 | Distinct Procedural Service | When billing 97112 with other therapy codes on the same day |
| XE / XS / XP / XU | X-modifier alternatives to 59 | Used for specific, well-defined distinct service scenarios |
| CQ | PTA / COTA Services | When the service is provided by a therapy assistant |
| KX | Threshold Exceeded | Required when charges exceed the $2,480 therapy threshold (2026) |
Every 97112 cpt code modifier matters. Miss one, and you’re looking at a denial or reduced payment. The discipline modifiers (GP, GO, GN) aren’t optional for Medicare claims. Skip modifier GP on a PT claim, and it denies automatically.
The KX modifier becomes critical once your patient’s therapy charges exceed $2,480 for the calendar year. You’re attesting that medical necessity documentation exists in the record. Without it, claims above threshold get rejected.
Does CPT Code 97112 Need Modifier 59?
Modifier 59 is required when billing CPT code 97112 alongside other therapy codes (97110, 97140, 97530) on the same date of service. This indicates the procedures are distinct and separate.
Without Modifier 59: Claims may be bundled or denied due to NCCI edits.
For Chiropractors: When billing 97112 with CMT on the same date, you MUST append modifier 59. Some payers (BCBSNC, NC State Health Plan, MedCost/Zelis) require BOTH 59 AND GP.
Here’s where practices mess up: they forget modifier 59 when billing multiple therapy codes together. NCCI edits trigger, and the second code bundles into the first. You did two separate services but only got paid for one.
The X-modifiers (XE, XS, XP, XU) work as alternatives to modifier 59 when you need to be more specific about why services are distinct. XE means separate encounter. XS means separate structure. Most payers accept either 59 or X-modifiers, but some prefer the specificity.
Does 97112 need a modifier? Always. The question is which ones apply to your specific situation.
CPT Code 97112 Bundling Rules—NCCI Edits & Code Pairing
2026 NCCI Edits Affecting 97112
January 2026 Update: CMS posted the January 1, 2026 NCCI PTP edits on December 1, 2025. These edits determine which code pairs can be billed together.
NCCI edits exist to prevent improper payment for services that shouldn’t be billed separately. When two codes trigger an edit, the Column 2 code denies unless you append the right modifier and your documentation backs it up.
The January 2026 update didn’t dramatically change bundling rules for 97112, but you should still verify current edit tables before submitting claims with multiple therapy codes. CMS updates these quarterly, and what worked last month might not work today.
CPT 97112 Bundling Quick Reference
| Code Pair | Can Bill Together? | Modifier Required | Documentation Requirement |
| 97112 + 97110 | ✅ Yes | 59 or X-modifier | Distinct goals and separate timed minutes |
| 97112 + 97140 | ✅ Yes | 59 or X-modifier | Separate treatment focus and techniques |
| 97112 + 97530 | ⚠️ Limited | 59 | Clearly different functional goals required |
| 97112 + 97116 | ✅ Yes | 59 or X-modifier | Different primary treatment focus |
| 97112 + CMT | ✅ Yes | 59 + GP | Different spinal regions (chiropractic vs PT) |
When 97110 and 97112 are billed together, payers want to see clearly different treatment goals. Balance training for motor control is 97112. Resistance exercises for quad strength is 97110. Same patient, same session, different purposes.
Can You Bill 97112 and 97140 Together?
Yes, CPT codes 97112 and 97140 can be billed together on the same date of service. Use Modifier 59 to indicate the manual therapy (97140) was distinct from neuromuscular reeducation (97112). Treatment times must not overlap, and documentation must support different clinical purposes.
The 97140 and 97112 billed together scenario is common in therapy practices. You might perform soft tissue mobilization to address tissue restrictions, then follow with balance training to improve motor control. Both services are appropriate when documented correctly.
What gets claims denied? Vague notes that don’t explain why both services were necessary. Your documentation should make it obvious these were separate interventions targeting different problems.
CPT Code 97112 Documentation Requirements — TPE Audit Survival Guide
Why 97112 Documentation Matters More Than Ever
Audit Alert: Medicare contractors have specifically targeted CPT 97112 in Targeted Probe and Educate (TPE) reviews. First Coast and Palmetto GBA have published TPE results showing top denial drivers for 97112:
- Medical necessity not established
- Insufficient documentation
- Skilled intervention not demonstrated
TPE audits aren’t random. Medicare contractors identify providers with high denial rates or unusual billing patterns, then pull claims for review. If your 97112 documentation requirements aren’t met, you’ll fail the probe and face additional scrutiny.
The stakes are real. Fail three TPE rounds, and you’re referred to CMS for additional action. That can mean extrapolation, repayment demands, or referral to the Office of Inspector General.
Essential Documentation Elements (TPE Audit Checklist)
Every 97112 note must include these elements to survive a TPE audit:
Why neuromuscular reeducation is needed:
- Document the specific motor control, balance, or proprioceptive impairment
- Connect that impairment to a functional limitation the patient experiences
Skilled nature of the intervention:
- Explain why the therapist’s cueing, facilitation, or graded progression is required
- Describe why the patient can’t perform this independently
What you actually did:
- Name the specific intervention type with parameters
- Include progression variables like surface type, vision status, dual-tasking, or perturbations
Time documentation:
- Record total timed minutes clearly
- Provide enough detail to support unit calculations across multiple codes
Patient response and progress:
- Include objective or observable changes
- Note improvements in movement quality, balance reactions, or motor control
Plan for next session:
- State what you’ll progress next visit
- Explain why continued treatment remains medically necessary, especially once KX is required
TPE-Ready Documentation Template for 97112
Here’s a copy-ready SOAP format that meets 97112 documentation requirements:
text
S: Patient reports [functional difficulty related to balance/coordination/movement].
O: Neuromuscular reeducation to [specific body parts] x [XX] minutes.
INTERVENTION: [Specific technique] with [parameters]:
– [Technique 1]: [surface/vision/resistance/progression level]
– [Technique 2]: [specific details]
SKILLED RATIONALE: Skilled therapist intervention required for [cueing type/manual facilitation/graded progression] due to [patient’s specific deficit].
RESPONSE: [Objective measure or observable change]. Patient demonstrated [specific improvement] compared to [baseline/prior session].
A: Patient [progressing toward/meeting/not yet meeting] goal of [specific functional goal]. Continued skilled neuromuscular reeducation indicated to [achieve goal].
P: Continue NMR [frequency] x [duration]. Progress [specific parameter] next session. [If applicable: KX modifier applied; medical necessity documented above threshold.]
Common Documentation Errors That Cause TPE Denials
| Error | Why It Fails | Solution |
| “NMR × 15 min” only | No skilled rationale provided | Describe specific techniques used and why skilled care is required |
| No functional connection | Technique listed but not linked to ADL/IADL limitations | Always connect interventions to the patient’s activity restrictions |
| Missing objective measures | Progress cannot be demonstrated | Use standardized tests (e.g., Berg Balance Scale, TUG) or quantified observations |
| Repetitive notes | Appears cloned across visits | Individualize notes with progression details and patient response |
| No time documentation | Units cannot be validated | Record exact minutes per intervention to support billed units |
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Frequently Asked Questions About CPT Code 97112
What does CPT code 97112 mean?
CPT code 97112 is the billing code for neuromuscular reeducation. It covers skilled interventions targeting balance, coordination, posture, and proprioception. This timed, one-on-one therapy helps patients regain functional movement through neural pathway stimulation and motor control retraining. The code applies to sitting and standing activities and bills in 15-minute increments.
What is the difference between CPT 97110 and 97112?
CPT 97110 (Therapeutic Exercise) focuses on physical capacity: strength, endurance, and range of motion. CPT 97112 (Neuromuscular Reeducation) focuses on movement quality: balance, coordination, and proprioception. The key difference is intent. 97110 addresses what the body can do. 97112 addresses how the body moves and controls that movement.
Is CPT code 97112 a timed code?
Yes, CPT code 97112 is a timed code billed in 15-minute increments. The 8-minute rule applies, meaning you must provide at least 8 minutes of direct, one-on-one intervention to bill one unit. Document exact treatment minutes to support your unit calculations.
Does CPT code 97112 need a modifier?
Yes. Medicare requires GP (physical therapy), GO (occupational therapy), or GN (speech therapy) modifiers on all 97112 claims. When billing 97112 with other therapy codes on the same date, append Modifier 59 to indicate distinct services. In 2026, add KX when charges exceed $2,480.
How much does Medicare pay for 97112 in 2026?
Medicare reimburses approximately $33.07 per unit for CPT code 97112 in non-facility settings based on 2026 national averages. Facility rates run around $26.00 per unit. Your actual reimbursement depends on geographic locality adjustments. Check with your MAC for exact rates in your area.
Can 97110 and 97112 be billed together?
Yes, when both services are medically necessary, performed at distinct times, and target different clinical goals. Modifier 59 is required to indicate separate services. Your documentation must clearly show why both therapeutic exercise and neuromuscular reeducation were needed in the same session.
Can you bill 97112 and 97140 together?
Yes, 97112 and 97140 (manual therapy) can be billed together with Modifier 59. Treatment times can’t overlap, and documentation must support different clinical purposes. Soft tissue mobilization for tissue restrictions is separate from balance training for motor control.
What is an example of 97112?
Common examples include PNF techniques like hold-relax and rhythmic stabilization, balance training on unstable surfaces, proprioceptive exercises with eyes closed, postural retraining with cueing, Bobath/NDT techniques for neurological patients, and Feldenkrais Method interventions. Any skilled intervention targeting motor control, balance, or coordination qualifies.
Can chiropractors bill 97112?
Chiropractors may bill 97112 in limited circumstances, but it’s highly disputed by payers. The service must be distinct from chiropractic manipulative treatment, properly documented with specific techniques and functional outcomes, and supported by state scope of practice laws. Expect scrutiny on these claims.
What is the 8-minute rule for 97112?
Bill one unit with 8 to 22 minutes of direct treatment. Two units require 23 to 37 minutes. Three units need 38 to 52 minutes. When billing multiple timed codes in one session, total all timed minutes first, then allocate the remaining unit to the service with the most minutes.
What is the 2026 KX threshold for therapy?
The 2026 KX modifier threshold is $2,480 for PT plus SLP combined, with a separate $2,480 threshold for OT. When charges exceed this amount, claims must include KX to indicate documented medical necessity. The targeted medical review threshold sits at $3,000, triggering increased audit probability.
What documentation is required for 97112?
Documentation must include specific body parts treated, exact techniques performed with parameters, treatment duration in minutes, connection to functional goals, patient response showing progress, skilled intervention justification explaining why therapist expertise was required, and a plan for progression to the next session.
Conclusion — Key Takeaways for 97112 in 2026
Getting CPT code 97112 right isn’t complicated once you understand the fundamentals. It’s neuromuscular reeducation, not therapeutic exercise. That distinction drives everything else: your documentation, your modifiers, your billing decisions.
Here’s what matters in 2026. The KX threshold sits at $2,480 for PT and SLP combined, with OT getting its own $2,480 bucket. Medicare pays around $33.07 per unit in non-facility settings. You’ll need GP or GO modifiers on every claim, plus modifier 59 when billing multiple therapy codes together.
Documentation makes or breaks your 97112 claims. TPE audits target this code specifically. Your notes must show skilled intervention, specific techniques, and measurable progress. Generic documentation that worked three years ago won’t survive today’s scrutiny.
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