CPT 97110, therapeutic exercise. The highest-volume code in outpatient physical therapy, billed in 15-minute units on nearly every visit. When one payer's contracted rate sits a few dollars under the market for that one code, the gap rides every unit, every visit, all year, and no alarm ever goes off. Since July 2022, federal law makes that rate public. You can look yours up.
Under the 8-minute rule, treatment time converts into 15-minute billing units, and therapeutic exercise is where most of those units live. In the CMS Part B data, 97110 sits at the top of outpatient therapy volume year after year. A full caseload turns into hundreds of units a month. The unit is small. The volume is not.
A contracted rate a few dollars under the local benchmark trips no alarm. Each remittance reconciles cleanly against the fee schedule your biller loaded, not against what the same payer pays the practice across town for the same unit of the same code. The shortfall is invisible at the claim level and enormous at the year level, precisely because it compounds where volume is highest.
The evaluation side is no different. Medicare prices all three PT evaluation tiers, 97161 through 97163, at one identical rate, and re-evaluation 97164 below them. Commercial payers each set their own numbers for those codes, and most owners have never seen them side by side.
Federal rule 45 CFR 180 requires every major commercial payer to publish machine-readable files of their negotiated rates, refreshed monthly, including the 97110 rate attached to your NPI. The catch: a single payer's files run from tens of gigabytes to over a terabyte. Public in name, unreachable in practice. Reddenda parses and indexes those filings so a practice owner can simply look up their own number.
This is illustrative arithmetic you control, not a measurement of any practice. Pick a per-unit gap and a weekly unit count, and watch what one quiet code does to a year.
Arithmetic set by you, shown with its formula. It is not practice data and not a promise. Your actual contracted rates are sitting in your payers' federal filings. Look them up free →
The structural facts below are public record from the Medicare Physician Fee Schedule and the federal Transparency-in-Coverage rule. Your commercial numbers for each code are what the free Snapshot looks up.
The volume backbone of outpatient PT billing. Billed in 15-minute units on nearly every plan of care, which is exactly why a small per-unit gap matters most here.
One of the most-billed PT codes in the Part B data, frequently delivered in the same visit as 97110. Two timed codes, two contracted rates, one compounding gap.
Valued above 97110 on the Medicare fee schedule. If a commercial contract prices it at or below your 97110 rate, that is a question worth asking in writing.
Also valued above 97110 on the Medicare schedule. The spread between your timed codes is part of the negotiation picture most practices never see laid out.
Medicare pays all three complexity tiers one identical rate. Commercial payers each set their own three numbers, and they are published in their TiC files.
Priced below an initial evaluation on the Medicare schedule. Commercial contracted rates for re-evaluation vary widely from payer to payer. Yours are in the filings.
Medicare applies a 50% multiple-procedure reduction to the practice-expense portion of the second and later timed therapy procedures in a visit, and commercial contracts write their own versions of the same idea. One more reason the per-unit number you assume is rarely the per-unit number you receive.
Evergreen clauses roll a fee schedule forward year after year unless someone asks. Payers do not call to offer an increase, and a practice without benchmark data rarely feels equipped to ask for one.
Billing verifies payment against the fee schedule loaded in your system. If that schedule itself sits below the market, a perfectly clean reconciliation still leaks money on every unit.
The federal filings that would settle the question are tens of gigabytes to over a terabyte per payer, refreshed monthly. Reddenda built the parsing infrastructure so a practice owner never has to.
The Snapshot is free forever. Everything past it is a flat fee, never a percentage of anything.
Any NPI. Your top codes against payer filings, scored 300 to 850. About 15 seconds, no PHI, no card, no account.
Run it free →A payer-ready negotiation memo for a single renewal, every number cited to its federal filing.
See pricing →Full-practice review: every code, every payer, one strategy, with the documentation to back it.
See pricing →Continuous monitoring, rate-change alerts, saved snapshots, and support at every renewal.
See pricing →Enter your NPI. Your top codes come back benchmarked against your payers' own federal filings, with a RateScore from 300 to 850. Results appear in your browser in about 15 seconds. No email required. No credit card. No PHI.
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