UnitedHealthcare Commercial physical therapy coverage: codes and who can bill
By Javier Alvarez · Updated · 1 min read
1 row: UnitedHealthcare. Public policy, not the member's benefits.
UnitedHealthcare Commercial
UnitedHealthcare Commercial and Individual Exchange reimbursement policies 2026R0098A and 2026R0121A · All states
| 97161 | Listed (paid to physical therapists, not to physical therapist assistants) [1] |
|---|---|
| 97162 | Listed (paid to physical therapists, not to physical therapist assistants) [1] |
| 97163 | Listed (paid to physical therapists, not to physical therapist assistants) [1] |
| 97164 | Listed (paid to physical therapists, not to physical therapist assistants) [1] |
| Where it applies | Follows CMS: the GP (physical therapy) modifier is required on codes CMS designates as always therapy services, for dates of service on or after July 1, 2020. Applies to UnitedHealthcare Commercial and Individual Exchange plans billed on the CMS 1500. [1] |
| Who can bill | Physical therapists are reimbursed for evaluation and re-evaluation codes 97161 to 97164. Physical therapist assistants are not. Neither PTs nor PTAs are reimbursed for E/M codes 99202 to 99499, 99091 or G2252. [1] |
| Payment | Multiple therapy procedure reduction: the highest practice expense RVU procedure is paid without reduction, and the practice expense portion of every other reducible therapy procedure or unit on the same date, by the same group (same TIN), is reduced by 50%. It applies to multiple units of the same code too. [2] |
| Medicare rules | Modifier CQ is required for services furnished in whole or in part by a PTA (date of service on or after January 1, 2020), on the claim line with GP. "In part" means the PTA minutes exceed 10% of the total minutes for that service. CQ does not apply to PTA services that are incident to a physician or NPP. [1] |
| Also | The reduction list is the set of codes with indicator 5 in the CMS multiple procedure payment reduction field. It does not apply to flat-rate per diem contracts, and the CCI editing policy may also apply. [2] |
- UnitedHealthcare Commercial: Reimbursement Policy 2026R0098A, Physical Medicine & Rehabilitation, PT/OT Evaluation and Management (PDF), checked October 30, 2026
- UnitedHealthcare Commercial: Reimbursement Policy 2026R0121A, Physical Medicine & Rehabilitation, Multiple Therapy Procedure Reduction (PDF), checked October 30, 2026
What UnitedHealthcare Commercial's documents say
The table above has every field we found for UnitedHealthcare Commercial, with numbered sources. In short:
- Who can bill. Physical therapists are reimbursed for evaluation and re-evaluation codes 97161 to 97164. Physical therapist assistants are not. Neither PTs nor PTAs are reimbursed for E/M codes 99202 to 99499, 99091 or G2252.
- Where it applies. Follows CMS: the GP (physical therapy) modifier is required on codes CMS designates as always therapy services, for dates of service on or after July 1, 2020. Applies to UnitedHealthcare Commercial and Individual Exchange plans billed on the CMS 1500.
- Codes. 97161, 97162, 97163 and 97164 are listed.
Physical therapy coverage at other national payers
Medicare, UnitedHealthcare Medicare Advantage, Aetna, Cigna, Humana and TRICARE.
Check UnitedHealthcare Commercial's claim against the row
Before the claim goes out, compare it with the row above: the evaluation code matches the complexity you documented, the timed codes fit the minutes, any prior authorization covers the visit, and the plan of care is signed when the payer asks for it. The physical therapy table compares UnitedHealthcare with every other payer we checked.