Accurate billing is a cornerstone of a successful chiropractic practice. Beyond compliance, proper coding ensures fair reimbursement, reduces audit risks, and reflects the true value of the care you provide. Two of the most commonly misunderstood CPT codes in chiropractic and rehabilitation settings are 97110 (Therapeutic Exercises) and 97530 (Therapeutic Activities). While they may appear similar on the surface, their intent, application, and documentation requirements differ significantly.
This guide is designed to help chiropractors clearly understand the differences between these codes, apply them appropriately, and document them effectively to maintain ethical, compliant, and sustainable billing practices.
Understanding CPT Code 97110: Therapeutic Exercises
CPT 97110 is using to report therapeutic exercises aimed at improving specific physical functions. These exercises are typically structured, repetitive, and focused on restoring or improving:
- Strength
- Range of motion
- Flexibility
- Endurance
Common Examples of 97110
- Resistance band exercises for shoulder stabilization
- Core strengthening routines for lumbar support
- Stretching protocols for hamstrings or hip flexors
- Isolated muscle re-education exercises
The key characteristic of 97110 is that the exercises are targeted and isolated, focusing on specific muscle groups or joints rather than full-body functional movement.
Billing Requirements
- Time-based code: Billed in 15-minute increments
- Requires direct one-on-one supervision
- Must be medically necessary and part of a documented treatment plan
Documentation Tips
Your notes should clearly include:
- The specific exercises performed
- The targeted body region
- The therapeutic goal (e.g., improved lumbar stability)
- Patient response and progression
Understanding CPT Code 97530: Therapeutic Activities
CPT 97530 is using for therapeutic activities that involve dynamic, functional movements designed to improve the patient’s ability to perform daily tasks.
Unlike therapeutic exercises, therapeutic activities are multi-joint, task-oriented, and functional in nature.
Common Examples of 97530
- Sit-to-stand training
- Functional lifting and carrying activities
- Balance training simulating daily movement
- Reaching, pulling, or pushing activities
These activities mirror real-world movements and help patients transition from clinical recovery to functional independence.
Billing Requirements
- Time-based code: Billed per 15 minutes
- Requires direct patient contact
- Must demonstrate a clear functional outcome
Documentation Tips
Your notes should emphasize:
- The functional task being trained
- Why is the activity necessary for daily living
- How it relates to the patient’s condition
- Measurable improvements or limitations
Key Differences Between 97110 and 97530
|
Feature |
97110 |
97530 |
| Focus | Isolated muscle or joint | Functional, real-life movements |
| Movement Type | Repetitive and structured | Dynamic and task-oriented |
| Goal | Improve strength or ROM | Improve daily function |
| Example | Theraband shoulder exercises | Lifting mechanics training |
Understanding this distinction is essential. Misusing these codes or billing for the same activity can raise red flags during audits and lead to claim denials.
Can You Bill Both Codes on the Same Visit?
Yes, both 97110 and 97530 may be billed in the same session, provided:
- The activities are distinct and separate
- Each service is medically necessary
- Time is clearly documented for each code
- The exercises and activities address different treatment goals
For example, a patient may perform isolated lumbar stabilization exercises (97110) followed by functional lifting training (97530). However, overlapping or duplicative activities should never be double-billed.
Common Billing Mistakes to Avoid
- Using the wrong code for functional movement
Functional tasks belong under 97530, not 97110. - Insufficient documentation
Vague notes like “performed exercises” are not defensible. - Upcoding time
Time must reflect actual one-on-one treatment. - Billing without medical necessity
Every service must be linked to a diagnosis and a functional goal.
Why Accurate Coding Matters in Complex Cases
As patient care becomes more integrated and multidisciplinary, chiropractors increasingly treat complex conditions that require careful coordination and documentation. In cases involving chronic pain, post-injury rehabilitation, or degenerative conditions, correct coding supports continuity of care and proper reimbursement.
For example, patients seeking the best treatments for spinal stenosis often require a combination of therapeutic exercises to improve spinal stability and therapeutic activities to restore functional mobility. Accurate differentiation between 97110 and 97530 ensures that treatment complexity is reflecting appropriately in billing.
The Role of Chiropractors in Interdisciplinary Care
Modern chiropractic care extends beyond adjustments. Chiropractors frequently collaborate with medical providers, physical therapists, and legal professionals. In personal injury or workers’ compensation cases, proper coding becomes especially critical.
Clear, defensible documentation supports chiropractor referrals for lawyers, where treatment records are scrutinized for medical necessity, functional progress, and billing accuracy. Correct use of 97110 and 97530 strengthens the credibility of your clinical reports and protects both patient outcomes and professional integrity.
Compliance Expectations for Chiropractors in California
For any chiropractic doctor in California, compliance with payer guidelines, Medicare rules, and state regulations is non-negotiable. Audits increasingly focus on time-based codes and functional justification, making it essential to align treatment, documentation, and billing.
California chiropractors must ensure:
- Treatment plans are clearly outlined
- Functional goals are measurable
- Progress notes support continued care
- Billing reflects actual services rendered
Proper understanding of therapeutic exercise and activity codes is not just a billing issue; it’s a professional responsibility.
Best Practices for Ethical and Effective Billing
- Use 97110 for targeted, isolated therapeutic exercises
- Use 97530 for dynamic, functional activities
- Document what, why, and how long
- Tie every service to a functional outcome
- Educate staff regularly on coding updates
Final Thoughts
Mastering the distinction between CPT codes 97110 and 97530 enables chiropractors to bill accurately, avoid compliance issues, and effectively demonstrate the true value of their care. When used correctly, these codes reflect a thoughtful, patient-centered approach to rehabilitation. One that supports recovery, restores function, and withstands payer scrutiny.