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    v1.0.28
    OpenPayerBilling CodesTemporary National Codes (Non-Medicare)HCPCS hcpcs-s9131-physical-therapy-home-per-diem
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    HCPCS Level II S9131: Physical therapy, in the home, per diem

    Commercial payers pay $102 on average nationally for this procedure.

    HCPCS Level II code S9131 describes physical therapy provided in the patient’s home on a per diem basis, representing skilled therapeutic services delivered by a licensed clinician to address functional limitations, strength, mobility, and activities of daily living; service type: physical therapy, typical site of service: home health / patient residence.

    For related coverage guidance, see recent payer policy updates: Fixed Wing Air Ambulance Transport, Air Ambulance, Ambulance Services (for New Mexico Only).

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    National Reimbursement Benchmarks

    Commercial rates for HCPCS S9131 cluster around BUCA’s average commercial benchmark of $102.30, while individual payer distributions display meaningful divergence. Blue Cross Blue Shield (BCBS) shows the highest upper-bound volatility with a P75−P25 interquartile range of $48.10 ($132.50 − $84.40), reflecting a wide spread in typical paid levels; Aetna is much tighter with an IQR of $3.00 ($77.00 − $74.00). UnitedHealth Group has an unusual profile with a P25 of $0.00 and P75 of $122.00, producing an IQR of $122.00 driven by zero-value observations and a high median at $115.00.

    Cigna and BUCA sit between these extremes: Cigna’s IQR is effectively $0.00 ($97.90 − $97.90), indicating highly concentrated common payments, while BUCA’s IQR is $63.60 ($118.10 − $75.50), showing moderate dispersion around its $102.30 mean. Overall, payers range from very concentrated typical rates (Cigna, Aetna) to wide variability (UnitedHealth Group, BCBS, BUCA), which affects predictability of reimbursement for this code.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 72-year-old patient recently discharged home after hospitalization for a left-sided ischemic stroke presents with residual hemiplegia and generalized muscle weakness. The patient reports difficulty walking (R26.2), right knee pain limiting transfers (M25.561), and chronic low back pain (M54.5) that interfere with activities of daily living. Home health orders request per diem physical therapy services to address mobility, fall risk reduction, gait training, strengthening, and functional transfers. A licensed physical therapist (taxonomy 225100000X) performs an initial home evaluation and then provides daily in-home therapy sessions under the per diem home physical therapy benefit billed with S9131.

    The clinical workflow: the home health agency receives the referral and physician orders; the physical therapist completes an initial assessment, documents baseline measures (e.g., balance, gait speed, transfer ability), establishes goals, and initiates a plan of care. Subsequent daily home visits focus on therapeutic exercises, neuromuscular reeducation, therapeutic activities, and periodic performance testing. Progress, barriers, and physician communications are documented in the home health record. Per-diem billing with S9131 reflects the daily in-home skilled physical therapy service provided by authorized clinicians according to payer rules.

    Related CPT Codes

    CPT Code

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    225100000XPhysical TherapistPhysical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who…
    225X00000XOccupational TherapistAn occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for O…
    225400000XRehabilitation PractitionerA health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.
    207V00000XObstetrics & Gynecology PhysicianAn obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproducti…
    207QA0401XAddiction Medicine (Family Medicine) PhysicianA family medicine physician who specializes in the diagnosis and treatment of addictions.
    2088F0040XUrogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianA subspecialist in Urogynecology and Reconstructive Pelvic Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education …
    237700000XHearing Instrument SpecialistIndividuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is …
    163WR0006XRegistered Nurse First AssistantA perioperative registered nurse who works in collaboration with the surgeon and other health care team members to achieve optimal outcomes. The RNFA…

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Fixed Wing Air Ambulance TransportCigna2026-08-15
    Air AmbulanceAmbetter Georgia2026-08-01
    Ambulance Services (for New Mexico Only)UnitedHealthcare2026-08-01
    Ambulance Services (for Tennessee Only)UnitedHealthcare2026-08-01
    Clinical Policy: Air AmbulanceArizona Complete Health2026-08-01
    Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceAmbetter Nevada2026-08-01
    Ambulance TransportProvidence Health Plan2026-07-01
    Air ambulance transport coverage criteriaeocco2026-07-01

    Related Codes

    HCPCS-LEVEL-II-S2152-SOLID-ORGAN-TRANSPLANTATION-GLOBAL-CARE

    HCPCS Level II S2152: Solid Organ Procurement and Transplantation

    HCPCS-LEVEL-II-S2266-INDUCED-ABORTION-29-TO-31-WEEKS

    HCPCS Level II S2266: Induced Abortion, 29 to 31 Weeks

    HCPCS-LEVEL-II-S3630-EOSINOPHIL-COUNT-BLOOD-DIRECT

    HCPCS Level II S3630: Eosinophil Count, Blood, Direct

    HCPCS-LEVEL-II-S4017-INCOMPLETE-ART-CYCLE-CANCELLED-PRIOR-TO-STIMULATION

    HCPCS Level II S4017: Incomplete Cycle — Cancelled Prior to Stimulation

    HCPCS-LEVEL-II-S8055-ULTRASOUND-GUIDANCE-MULTIFETAL-REDUCTION-TC

    HCPCS Level II S8055: Ultrasound Guidance for Multifetal Pregnancy Reduction

    HCPCS-LEVEL-II-S8940-EQUESTRIAN-HIPPOTHERAPY-PER-SESSION

    HCPCS Level II S8940: Equestrian/Hippotherapy, Per Session

    HCPCS-LEVEL-II-S9024-PARANASAL-SINUS-ULTRASOUND

    HCPCS Level II S9024: Paranasal Sinus Ultrasound

    HCPCS-LEVEL-II-S9366-HOME-TPN-1-2L-PER-DAY-HOME-INFUSION

    HCPCS Level II S9366: Home Infusion TPN, 1–2 L/day

    HCPCS-LEVEL-II-S9446-GROUP-PATIENT-EDUCATION-NON-PHYSICIAN

    HCPCS S9446: Patient Education, Non-Physician Provider, Group, Per Session

    HCPCS-LEVEL-II-S9451-EXERCISE-CLASS-NON-PHYSICIAN-SESSION

    HCPCS S9451: Exercise Classes, Non-Physician Provider, Per Session

    Showing 1–10 of 532

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Description
    Relationship to This Procedure
    97110Therapeutic exercises to develop strength and endurance, range of motion and flexibilityCommon direct treatment included during in-home per-diem PT sessions to address muscle weakness and mobility.
    97112Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activitiesUsed for gait training and balance retraining during home visits for patients with hemiplegia and difficulty walking.
    97530Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutesApplied during functional task practice (transfers, bed mobility, ADL simulations) performed in the home as part of per-diem therapy.
    97750Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutesUsed for baseline and periodic objective assessments documented in the home health record to measure progress and justify ongoing per-diem therapy.