How to Bill Patient Education in Physical Therapy

Patient education sits at the heart of physical therapy. You teach people how to move, breathe, lift, balance, and self-manage. You also need to bill correctly for that teaching.

The tricky part is that there’s rarely a single “education” line on the claim. Most payers expect you to fold education into the skilled service you provide, unless a specific code applies. That’s why you need a simple process you can follow every visit.

This no-nonsense guide shows you how to bill patient education in physical therapy without guesswork. You’ll see:

• When to wrap education into 97110, 97112, or 97530,
• When to consider 98960-98962,
• How caregiver training codes (97550-97552) fit
• How to document so payers say “yes” every time. 

Patient Education CPT Code (PT Education CPT Code)

There isn’t one universal “patient education” CPT code for PT. Most of the time, you include education inside the time-based intervention you’re delivering. That means you pick the code that best matches the skilled intent of your PT services. This includes what you taught, therapeutic exercise, neuromuscular re-ed, or therapeutic activities.

That’s the norm many payer policies and PT billing resources reinforce, such as APTA and Sprypt. Use these as your default anchors:

• 97110 – Therapeutic Exercise: You can include education when you teach and dose a HEP, coach technique, or progress sets and reps to build strength, ROM, or endurance, if it’s skilled and you’re cueing and correcting during the teaching.
  
• 97112 – Neuromuscular Re-education: You can include education when you train posture, motor control, balance, coordination, proprioception, or breathing mechanics and you provide skilled feedback while the patient learns.
  
• 97530 – Therapeutic Activities: You can include education while you coach functional tasks (lifting, transfers, stairs, floor recovery, work tasks) with graded practice and safety instruction tied to real-world goals.

How to Bill Patient Education in Physical Therapy

In physical therapy, patient education is usually included as part of other therapy services and is not billed on its own. Physical therapists (PTs) should write down the education they provide, but they typically use the same billing codes as the therapy treatment it relates to.

For example, if a PT teaches exercises to a patient, they can bill it under CPT code 97110, which is for therapeutic exercise. You can follow below-given steps in order.

1). Decide if the education is part of a skilled intervention (most common)

Most education happens while you perform a billable, skilled intervention. You’re not just talking; you’re demonstrating, cueing, correcting, and progressing. Bill the time under the code that fits the clinical intent of the teaching.

Before you list codes, set your intent and then match it:

• If the goal is capacity (strength/ROM/endurance): bill 97110 and include the teaching time.
• If the goal is motor control or balance: bill 97112 and include the teaching time.
• If the goal is functional performance: bill 97530 and include the teaching time.

These picks reflect payer expectations: education is typically part of the intervention’s time, not a separate line.

2). Track time and apply the 8-Minute Rule correctly

You should count only the skilled, one-on-one minutes you spend providing the intervention (instruction, demonstration, cueing, correction). Add that to the rest of the timed minutes for the code, and then apply Medicare’s unit thresholds (8–22 minutes = 1 unit; 23–37 = 2 units; etc.). CMS lays this out in its therapy booklet.

Here’s how to turn minutes into clean units without overbilling:

• Sum the minutes of timed services for the day, then assign units using CMS thresholds.
• Do not count time from untimed services toward timed units.
• Document start/stop or total minutes to show you met thresholds.

Therapists get tripped up by “leftover” minutes. Follow CMS’s unit grid and your MAC’s examples to avoid denials and downcoding.

3). Document skilled education so medical necessity is obvious

You must show why the education mattered and how you delivered it. Payers look for evidence of skilled teaching, not just handing out a PDF. Clear documentation supports the treatment plan and payment decisions.

Add brief, specific lines like this before you bullet key details:

• Purpose/intent: “Educated for safe deadlift setup to reduce LBP during work crates, functional goal.”
• Method: “Demonstrated; guided practice; verbal/tactile cues; corrected spine angle and hip hinge.”
• Patient response: “Returned demo with 2 cues; safe form x8; issued HEP with load/rep targets.”

These short notes prove the service was skilled, necessary, and tied to function.

4). Use 98960–98962 only when true self-management education applies

Sometimes you provide a standardized curriculum for self-management of an established illness (e.g., arthritis, asthma, COPD). In those cases, CPT 98960 (individual), 98961 (2–4), and 98962 (5–8) may fit, but only if you meet the curriculum and face-to-face requirements. Many payers follow AAPC/AMA coding rules for these codes.

Set context first, then choose appropriately:

• 98960 (individual, 30 minutes): standardized curriculum, face-to-face, taught by a qualified non-physician provider (like a PT).
• 98961 / 98962 (group): same curriculum rules but delivered to small groups (2–4 or 5–8).
• Document the curriculum, objectives, and outcomes to support the code.

Important: Medicare historically bundles 98960–98962 (no separate payment, status “B”), though some commercial payers reimburse. Always verify payer policy before you schedule these sessions.

5). Bill caregiver training without the patient present using 97550–97552 (when applicable)

Caregivers often need hands-on coaching to help the patient at home. Medicare now pays for specific caregiver training services when delivered by PTs, OTs, and SLPs under a plan of care. Use these codes only when the patient is not present.

Give two to three lines of setup, then list the right code:

• 97550 – initial 30 minutes of caregiver training for a single patient’s caregivers; full 30 must be met.
• 97551 – each additional 15 minutes for that same patient’s caregivers; full 15 must be met.
• 97552 – group caregiver training (multiple sets of caregivers for different patients), untimed per session per patient represented.

These codes have clear time rules and documentation expectations. State who the caregivers are, what you taught, and how it supports the plan of care.

6). Use group education only with the correct group codes

If you educate multiple patients at once, pick a code that actually describes group education. For self-management curricula, 98961–98962 may apply with certain payers; for caregiver groups, 97552 applies under Medicare. Your documentation should still be individualized for each person.

Keep it simple before bullets:

• Record each participant’s goals and participation.
• Attach the curriculum or outline you delivered.
• Note any adaptations for safety or comprehension.

7). Consider Remote Therapeutic Monitoring (RTM) when education continues at home

If you use connected HEP platforms and track adherence or response, RTM codes can apply. PTs can bill 98975–98977 for device/episode setup and supply, and 98980–98981 for RTM management time, when requirements are met.

Add two short lines to frame it, then list the actions:

• Confirm your platform and workflows meet RTM code definitions.
• Track time and interactions for 98980–98981 management.
• Document patient-reported data and your clinical decisions.

8). Verify payer rules and modifier needs before you submit

Education touches many code families, and every payer has quirks. Some commercial payers reimburse 98960–98962; Medicare bundles them. Telehealth rules also differ by code. Take one minute up front to check each plan’s policy for coverage, telehealth allowances, and any modifier requirements.

Add two or three practical lines, then list your checks:

• Telehealth? Medicare doesn’t list 98960–98962 for permanent telehealth coverage; some plans do, often with modifier 95 and a telehealth POS. Verify first.
• Therapy modifiers? For standard PT interventions (97110/97112/97530), follow your MAC and payer modifier rules as usual.
• Local edits? Check NCCI edits and your MAC’s guidance when you stack codes.

CPT 98960 for Physical Therapy (FAQs and More)

• PTs can meet the “qualified non-physician” role for 98960 with some payers, but Medicare bundles 98960–98962 (no separate payment).
• For caregiver training without the patient, Medicare pays 97550–97552 under the therapy plan of care with clear time rules.
• For most day-to-day PT education, use 97110/97112/97530 and document the skilled intent.

Can PTs Bill for Patient Education?

Yes. You can bill for patient education by including it in time-based therapy codes like 97110, 97112, and 97530. This applies when your teaching is skilled and related to the intervention’s purpose. For special cases, use codes 98960–98962 for self-management curricula, but note these depend on the payer. You can also use 97550–97552 for caregiver training without the patient. These are covered by Medicare.

What is CPT code 98960 used for?

CPT 98960 describes education and training for patient self-management. This service is provided by a qualified non-physician professional. It uses a standardized curriculum.

The training happens face-to-face. Each session lasts 30 minutes. It is for an individual patient, but caregivers or family may attend. It applies to chronic conditions like asthma, COPD, or arthritis. You must use a recognized curriculum and measure patient learning.

When to use CPT code 98960 (and when not to)?

Use 98960 only when the main purpose of the visit is to deliver a standardized, evidence-based self-management curriculum. This must be for a specific condition. You must meet the 30-minute, face-to-face rule.

Do not use 98960 for teaching exercise technique, posture, or functional tasks in a typical physical therapy session. That education should be included in codes 97110, 97112, or 97530 instead.

What is the CPT 98960 time requirement?

Each unit of 98960 requires a full 30 minutes of qualifying education. For group versions, 98961 (2–4 patients) and 98962 (5–8) follow the same curriculum logic with group sizes defined in their descriptors.

How to bill CPT code 98960?

Bill 98960 once when you give 30 minutes of face-to-face, standardized self-management training to one person. If you teach 2 to 4 patients together with the same curriculum, bill 98961. If you teach 5 to 8 patients, bill 98962. In your note, include the curriculum name, objectives, materials, and how you checked patient understanding.

Does CPT 98960 need a modifier?

There is no universal modifier for 98960. Some commercial payers may require a telehealth modifier (95) if they allow telehealth for this service. Others do not cover it via telehealth at all. Medicare does not include 98960–98962 for permanent telehealth coverage. Always check each payer’s policy to avoid denied claims.

Is CPT code 98960 payable?

Coverage depends on the payer. Many commercial plans pay if you meet all requirements and benefits including the service. Medicare considers 98960–98962 “bundled” codes (status B). Medicare does not pay separately for these under its Physician Fee Schedule.

CPT 98960 fee schedule

Medicare has no separate fee schedule rate for 98960 because it bundles this service. Commercial payers set different fees by market. Check each payer’s fee schedule or your clearinghouse reports to know allowed amounts before planning programs.

CPT 98960 documentation requirements

Your documentation must show you used a recognized, standardized curriculum (from a group like APTA or a physician society).

• Document face-to-face time.
• List the objectives and materials used.
• Describe how the patient engaged and understood the material.
• Record outcome measures related to self-management.
• Keep a copy of the curriculum on file.

CPT 98960 vs G0108 (and G0109)

G0108 and G0109 are Medicare codes for Diabetes Self-Management Training (DSMT). These require approved DSMT programs, instructors, and set hours. They are different from 98960–98962. Use G0108 for individual DSMT and G0109 for group DSMT only if you meet all DSMT rules. If you are not an approved DSMT supplier, 98960 does not replace these Medicare codes.

Documentation Checklist for Patient Education

Good notes drive payment. Great notes prevent audits. Use this quick checklist to capture what payers expect. Start with two short lines to anchor your note, then check the bullets:

• Intent: What problem were you solving with the education (capacity, control, function, safety, self-management)?
• Method: Did you demonstrate, dose, cue, correct, or progress with skilled judgment?
• Content: What topics or tasks did you teach (be specific)?
• Patient performance: How did the patient respond? Could they return-demo with fewer cues?
• Materials: What HEP, handouts, or videos did you issue, and how did you tailor them?
• Time: How many minutes of one-on-one skilled instruction were included?
• Link to POC: Which goals does this education advance?

For 98960–98962, add: curriculum name, evidence basis, objectives, pre/post understanding, and any outcome metric (quiz, teach-back, or performance).

Common Payer Traps & Denial Fixes

Denials usually come from simple misses. You can prevent them with a few habits. Read these two short lines, then tighten your workflow with the bullets:

• Match the code to intent. Don’t slap 98960 on general HEP teaching; put it under 97110/97112/97530.
• Prove the skill. Show the cues, corrections, and clinical decisions you made.

Now handle the high-risk areas:

Time precision: Use the CMS thresholds; don’t round up minutes. Log total timed minutes per code.

Telehealth mismatches: If you deliver education by telehealth, confirm the code is covered that way and add the right POS/modifier if required by that payer.

Curriculum gaps for 98960: If you can’t name the standardized curriculum and its objectives, you shouldn’t bill 98960. Use your therapy codes instead.

Using the wrong “education” code: For caregiver training without the patient, bill 97550–97552 under Medicare when criteria are met, not 98960.

Short, Real-World Examples You Can Copy

Use these templates to tighten your documentation right now.

Example A ,  97110 with education (strength/ROM intent):

“Coached squat setup for knee OA to build quad strength and reduce joint load. Demonstrated; used tactile cues for hip hinge; progressed to 3×8 with RPE targets. Patient returned-demo with fewer cues. Issued HEP with 3×8, 2–3/week; logged 12 minutes of skilled instruction under 97110.”

Example B ,  97112 with education (motor control/balance intent):

“Trained diaphragmatic breathing + postural stacking for rib flare and balance. Provided cueing to reduce accessory breathing; practiced tandem stance with external focus. The patient improved stability from 10→20 seconds with one cue. Counted 10 minutes under 97112.”

Example C ,  97530 with education (functional task intent):

“Taught floor-to-stand via half-kneel for fall recovery at home. Graded task with chair support; gave safety rules and environment setup tips. The patient performed x5 reps with two rest breaks; issued a step-by-step handout. Logged 15 minutes under 97530.”

Example D ,  98960 (payer-permitting):

“Delivered standardized COPD self-management module (American Lung Association–based). Covered inhaler technique, pacing, flare-up plan; pre/post teach-back quiz. 30 minutes face-to-face; patient/caregiver present; goals met. Billed 98960 x1 (verify payer coverage).”