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Enfinity Medical Billing

Complete Guide to Physical Therapy CPT Codes for Accurate Billing

CPT Code For Physical Therapy

Struggling with billing errors and claim denials? Incorrect use of physical therapy CPT codes is often the culprit, leading to delayed reimbursements and audits. In this guide, we’ll help you master the most important CPT codes for physical therapy to avoid costly mistakes.

What is a CPT Code?

CPT (Current Procedural Terminology) code is a five-digit number used to identify specific medical, surgical, and diagnostic services. These codes are used by healthcare providers, including physical therapists, to describe the services they provide. Proper usage of CPT codes for physical therapy ensures that treatments are correctly documented and billed.

For physical therapy CPT codes define everything from therapeutic exercises and manual therapy to modalities like electrical stimulation. These codes help insurance companies and Medicare determine the appropriate payment for the services rendered. Without correct coding, claims can be delayed or denied.

physical therapy CPT codes

What are the Most Common Physical Therapy CPT Codes?

The most common physical therapy CPT codes are essential for almost every therapy session. Some of the most frequently used codes are

97110Therapeutic exercises designed to improve strength, endurance, range of motion, and flexibility (15 minutes)
97140Manual therapy methods, including connective tissue massage, joint mobilization and manipulation, and manual traction (15 minutes)
97112Neuromuscular Re-education: Therapeutic procedure for one or more areas, each lasting 15 minutes; focusing on neuromuscular reeducation of movement, balance, coordination, kinesthetic awareness, posture, and/or proprioception for sitting and/or standing activities
97530Therapeutic Activities/Kinetic
97010Hot packs
97010Hot or cold packs therapy
97010Cold packs
97014Electrical stimulation (unattended)
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care.)
97161Physical therapy evaluation (Low complexity)
97035Ultrasound (15 minutes)
97116Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing)(15 minutes)
97162Physical Therapy Evaluation (Moderate complexity)
97535Self-care/Home Management Training: One-on-one direct contact (15 minutes) focusing on activities of daily living (ADL), compensatory training, meal preparation, safety procedures, and guidance on the use of assistive technology devices or adaptive equipment.
97507Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
97016Vasopneumatic devices
97164Re-evaluation of physical therapy established plan of care
97032Electrical stimulation (manual), each 15 minutes
97012Application of modality to one or more areas; traction, mechanical
97150Therapeutic procedure(s), group (2 or more individuals), untimed

PT CPT codes are copyrighted by the American Medical Association (2022). All rights reserved.

Understanding Modifier 59: What It Is and How to Use It.

Modifier 59 is used to indicate that a procedure or service is distinct and separate from other services performed on the same day. It’s typically used when a procedure that is normally billed together with another service needs to be reported separately because it was performed independently under certain circumstances.

In the therapy setting, modifier 59 may come into play if you are providing two completely separate services during the same treatment session. For example, if you’re performing two distinct procedures that are not usually billed together, modifier 59 can be used to indicate that these services are separate and unrelated.

CPT Modifier 59 - physical therapy CPT codes

When Should You Use Modifier 59?

Modifier 59 is used when the services performed are:

  • A different session or patient encounter
  • A different procedure, site, or organ system
  • A separate incision/excision, lesion, or injury

However, if there is another modifier that more accurately describes the situation, it should be used instead of modifier 59. Modifier 59 is a fallback option when no other modifier fits, and it should only be applied when there is a clear distinction between the services provided.

How Does It Work in Therapy?

In therapy, certain procedures are often performed together. The National Correct Coding Initiative (NCCI) identifies these common procedure pairs, called “edit pairs.” If you bill a PT CPT code that is part of one of these pairs, you may only receive payment for one of the codes. If the procedures you’re billing for are truly separate and distinct, modifier 59 allows you to bypass the NCCI edit and get reimbursed for both services.

Imagine a patient receives both manual therapy and therapeutic activities during a single session. These are two distinct services, and if Modifier 59 is applied to indicate they were performed independently, the therapist can receive reimbursement for both. Without the modifier, the insurance company might assume they were bundled as part of a single treatment and reimburse only one service.

When Should I Use Modifier 59?

Using Modifier 59 appropriately is key to ensuring that services are paid for correctly. You should use Modifier 59 when:

Are you billing for two services that form an NCCI edit pair?

Many procedures are subject to National Correct Coding Initiative (NCCI) edits, which suggest that certain services should be bundled together. Modifier 59 allows therapists to override this rule and bill the services separately if appropriate.

Did you perform those two services separately and independently of one another?

If the two treatments were distinct and performed separately, Modifier 59 can be used to bill each service independently. This applies when there is a clear difference between the two treatments.

Does your documentation support your assertion that you performed the two services separately and independently?

Proper documentation is crucial. Your notes must clearly show that the services provided were distinct and necessary for the patient’s treatment. This documentation is essential for justifying the use of Modifier 59.

Is a more descriptive modifier available?

Sometimes, a more specific modifier (such as XS, XP, or XE) might be more appropriate than Modifier 59, depending on the circumstances. If a more descriptive modifier applies, it should be used instead of Modifier 59.

What are the Most Commonly Used CCI Edits for PT, OT, and SLP Private Practice Settings?

The following table, provided by PT compliance expert Rick Gawenda, owner of Gawenda Seminars & Consulting, includes common CCI edit pairs related to various therapy types. Here’s how to use it:

  • Locate the primary PT CPT codes you are billing in Column 1.
  • Review Column 2. If the code listed in Column 2 is included, it will be considered linked or mutually exclusive.
  • If you see a “y” next to the code in Column 2, you may apply modifier 59.
  • If there’s an “n,” do not bill the code from Column 2 in combination with the code from Column 1.

Please note that this CCI edit list is specifically for Medicare. Most government insurers, including Medicare, Tricare, and Medicaid, generally follow this same list. However, private insurance providers often create their own edit pairs, so reimbursement is not guaranteed, even with modifier 59 applied.

PT CPT CodeDescriptionTimed?Column 2 y = use 59 modifier n = do not bill the code in combination with code in column 1
90912Biofeedback Pelvic Health: Initial 15 MinutesN90901n; 97032y; 97110y; 97112y; 97530y; 97535y; 97550y
G0451Developmental testingN96125y; 96127n; 96146y; 96160y; 96161y; 96523n
92507Speech and Language Treatment, IndividualN0373Tn; 36591n; 36592n; 69209n; 69210n; 96523n; 97110y; 97112y; 97129y; 97150y; 97153n; 97154n; 97155n; 97156n; 97157n; 97530y; 97533y; G0268n
92508Speech GroupN0373Ty; 36591n; 36592n; 69209n; 69210n; 92507y; 96523n; 97110y; 97112y; 97129y; 97150y; 97154n; 97155n; 97156n; 97157n; 97158n; 97530y; 97533y; G0268n
92521Evaluation of Speech FluencyN36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151n; 97152n; G0268n
92522Evaluation of Speech ProductionN36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151n; 97152n; G0268n
92523Evaluation of Speech Production; with Evaluation of Language Comprehension and ExpressionN36591n; 36592n; 69209n; 69210n; 92522n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151n; 97152n; G0268n
92524Behavioral and Qualitative Analysis of Voice & ResonanceN36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151n; 97152n; G0268n
92526Treatment of Swallowing DysfunctionN36591n; 36592n; 69705y; 69706y; 92511y; 92520y; 96523n; 97032n; 97110y; 97112y; 97150y; 97530y; 97802n; 97803n; 97804n; G0270n; G0271n; G0283n
92597Evaluation of Voice ProstheticN36591n; 36592n; 96523n; 97755n
92607Evaluation of Speech Generating DeviceY36591n; 36592n; 92507y; 92508y; 92521y; 92522y; 92523y; 92524y; 92597n; 92609y; 96523n; 97755n
92608Eval of Speech Device (additional 1/2 hour)Y36591n; 36592n; 96523n; 97755n
92609Training and Fitting for DeviceN35691n; 35692n; 92511y; 96523n
92611Radiopaque Swallow StudyN36591n; 36592n; 69705y; 69706y; 70370y; 70371n; 76120n; 76125n; 92511y; 92610y; 96523n
92612Flexible Endoscopic Swallow EvalN31575n; 36591n; 36592n; 69705n; 69706n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 92614n; 96523n
92614Flexible Fiberoptic Endoscopic Evaluation, laryngeal sensory testing by cine or video recordingN31575n; 36591n; 36592n; 69705n; 69706n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 96523n
92616Flexible Fiberoptic Endoscopic Evaluation of swallowing and laryngeal sensory testing by cine or video recordingN31575n; 36591n; 36592n; 69705n; 69706n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 92612n; 92614n; 96523n
95992Canalith Re-positioningN36591n; 36592n; 92531n; 92532n; 96523n; 97110y; 97112y; 97140y; 97530y
96105Assessment of AphasiaY36591n; 36592n; 96110y; 96125y; 96127n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; G0451y
96110Developmental testing, limitedN36591n; 36592n;; 96125y; 96146n; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n
96112Developmental Test Administration; First Hour0362Tn; 0373Tn; 36591n; 36592n; 90791y; 90792y; 90832y; 90833y; 90834y; 90836y; 90837y; 90838y; 90839y; 90845y; 90846y; 90847y; 90849y; 90853y; 90865y; 90870y; 90880y; 92002y; 92004y; 92012y; 92014y; 96105y; 96110n; 96125y; 96127n; 96130y; 96131y; 96132n; 96133n; 96136n; 96137n; 96138n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97161y; 97162y; 97163y; 97164y; 97165y; 97166y; 97167y; 97168y; G0380y; G0381y; G0382y; G0383y; G0384y; G0410y; G0411y; G0451n; G0463y; Check other E/M codes as well (99201-99497)
96113Developmental Test Administration; Each Additional 30 MinutesY0362Tn; 0373Tn; 36591n; 36592n; 90791y; 90792y; 90832y; 90833y; 90834y; 90836y; 90837y; 90838y; 90839y; 90845y; 90846y; 90847y; 90849y; 90853y; 90865y; 90870y; 90880y; 92002y; 92004y; 92012y; 92014y; 96110n; 96125y; 96127n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97161y; 97162y; 97163y; 97164y; 97165y; 97166y; 97167y; 97168y; G0380y; G0381y; G0382y; G0383y; G0384y; G0410y; G0411y; G0451n; G0463y; Check other E/M codes as well (99201-99497)
96125Standardized Cognitive Performance TestingY36591n; 36592n; 96127n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154; 97155n; 97156n; 97157n; 97158n
29581Multi-Layer Compression System – Below KneeN29540y; 29550y; 29580y; 64451n; 64454y; 97140y; 97535y
29584Multi-Layer Compression System – Entire ArmN29125y; 29126y; 29130y; 29131y; 29260y; 64451n; 64454y; 97140y; 97535y
97012Mechanical TractionN96523n; 97018y; 97140y; 97164y; 97168y
G0281Electrical Stimulation – Stage 3-4 WoundsN96523n; 97032y; 97164y; 97168y; G0283y
G0283Electrical Stimulation – Other Than Wound CareN64451y; 64454y; 96523n; 97032y; 97164y; 97168y
97016Vasopneumatic deviceN64451y; 64454y; 96523n; 97032y; 97164y; 97168y
97018Paraffin BathN96523n; 97022y; 97164y; 97168y
97022WhirlpoolN96523n; 97602y; 97164y; 97168y
97024DiathermyN96523n; 97018y; 97026y; 97164y; 97168y
97026InfraredN96523n; 97018y; 97022y; 97164y; 97168y
97028UltravioletN96523n; 97018y; 97022y; 97026y; 97164y; 97168y
Physical Therapy Procedure CodesDescriptionTimed?Column 2 y = use 59 modifier n = do not bill the code in combination with code in column 1
97032Electrical Stimulation, ManualY96523n; 97164y; 97168y
97033IontophoresisY96523n; 97164y; 97168y
97034Contrast BathY96523n; 97164y; 97168y
97035UltrasoundY96523n; 97164y; 97168y
97036Hubbard TankY96523n; 97164y; 97168y
97039Unlisted ModalityY96523n; 97164y; 97168y
97110Therapeutic ExercisesY36591n; 36592n; 96523n
97112Neuromuscular Re-EducationY36591n; 36592n; 96523n; 97022y; 97036y
97113Aquatic Therapy/ExercisesY36591n; 36592n; 96523n; 97022y; 97036n; 97110y
97116Gait TrainingY36591n; 36592n; 96523n
97124MassageY97164y; 97168y
97129Cognitive Function–Initial 15 MinutesY36591n; 36592n; 96523n; 97153n; 97155n; 97164y; 97168y
97130Cognitive Function–Each Additional 15 MinutesY36591n; 36592n; 96523n; 97153n; 97155n; 97164y; 97168y
97139Physical Medicine ProcedureY36591n; 36592n; 96523n; 97164y; 97168y
97140Manual TherapyY95851y; 95852y; 96523n; 97018y; 97124n; 97750y
97150Group Therapeutic ProceduresN95851n; 96523n; 97110y; 97112y; 97113y; 97116y; 97124y; 97127y; 97140y; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97530y; 97533y; 97535y; 97537y; 97542y; 97760y; 97761y; 97763y
97530Therapeutic ActivitiesY36591n; 36592n; 95851n; 95852n; 96523n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97537y; 97542y; 97750y
97533Sensory IntegrationY36591n; 36592n; 96523n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97164y; 97168y
97535Self Care/Home Management TrainingY36591n; 36592n; 96523n; 97164y; 97168y; G0270n; G0271n
97537Community/Work ReintegrationY36591n; 36592n; 96523n; 97164y; 97168y; G0270n
97542Wheelchair Management— Assessment andTrainingY36591n; 36592n; 96523n; 97164y; 97168y
97545Work Hardening, First 2 HoursY36591n; 36592n; 96523n; 97140n; 97164y; 97168y
97597Wound Care Selective First 20 sq centimetersN29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280y; 29305y; 29325y; 29345y; 29355y; 29358y; 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29584y; 96523n; 97022y; 97164y; 97602n; 97605y; 97606y; 97607y; 97608y; Check other E/M codes as well
97598Wound Care Selective; Each additional 20 sq centimetersN29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y;29260y; 29280y; 29305y; 29325y; 29345y; 29355y; 29358y; 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29584y; 96523n; 97022y; 97164y; 97602n; 97605y; 97606y; 97607y; 97608y; 97610y; Check other E/M codes as well
97602Wound Care Non-SelectiveN29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280y; 29305y; 29325y; 29345y; 29355y; 29358y; 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29584y; 96523n; 97164y; 97607n; 97608n
97610Low Frequency, Non-Contact, Non-Thermal UltrasoundN36591n; 36592n; 96523n; 97035y; 97602n; 97607y; 97608y
97750Physical Performance TestY36591n; 36592n; 95851n; 95852n; 96523n; 97150n
97755Assistive Technology AssessmentY36591n; 36592n; 95851n; 95852n; 96523n;97035y; 97110y; 97112y; 97140y; 97150n; 97530y; 97533y; 97535y; 97537y; 97542y; 97545y; 97750n; 97761y; 97763y
97760Orthotic Management & Training, Initial Orthotic(s) EncounterY0213Ty; 0216Ty; 0228Ty; 0229Ty; 0230Ty; 0231Ty; 29044y; 29046y; 29049y; 29055y; 29058y; 29065y; 29075y; 29085y; 29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280; 29305y; 29325y; 29345y; 29355y; 29358y; 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29584y; 36591n; 36592n; 96523n; 97016y; 97110y; 97112y; 97116y; 97124y; 97140y; 97164y; 97168y; 97763n
97761Prosthetic Management and Training, Initial Prosthetic(s) EncounterY36591n; 36592n; 96523n; 97016y; 97110y; 97112y; 97116y; 97124y; 97140y; 97164y; 97168y; 97760y; 97763n
97763Orthotic/Prosthetic Management and/or Training, Subsequent Orthotic/Prosthetic Encounter(s)Y0213Ty; 0216Ty; 0228Ty; 0229Ty; 0230Ty; 0231Ty; 29044y; 29046y; 29049y; 29055y; 29058y; 29065y; 29075y; 29085y; 29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280; 29305y; 29325y; 29345y; 29355y; 29358y; 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29584y; 36591n; 36592n; 96523n; 97016y; 97110y; 97112y; 97116y; 97124y; 97140y
98975Remote Therapeutic Monitoring – Initial Set-Up and Patient EducationN36591n; 36592n; 93241n; 93242n; 93243n; 93244n; 93245n; 93246n; 93247n; 93248n; 96523n; 99091n; 99473n
98976Remote Therapeutic Monitoring – Respiratory SystemN36591n; 36592n; 93241n; 93242n; 93243n; 93244n; 93245n; 93246n; 93247n; 93248n; 96523n; 99091n; 99473n
98977Remote Therapeutic Monitoring – Musculoskeletal SystemN36591n; 36592n; 93241n; 93242n; 93243n; 93244n; 93245n; 93246n; 93247n; 93248n; 96523n; 99091n; 99473n
98978Remote Therapeutic Monitoring – Cognitive Behavioral TherapyN36591n; 36592n; 96158y; 96159y; 96523n; 98975n; 98976n; 98977n; 99091n; 99424n; 99425n; 99426n; 99427n; 99437n; 99439n; 99453n; 99454n; 99457n; 99458n; 99484n; 99492n; 99493n; 99494n
98980Remote Therapeutic Monitoring Treatment Management Services – Initial 20 MinutesY97750n
98981Remote Therapeutic Monitoring Treatment Management Services – Each Additional 20 MinutesY97750n

How to Submit Claims for Initial Evaluation and Re-evaluation Services

Starting January 1, 2017, physical therapists (PTs) and occupational therapists (OTs) are no longer allowed to use PT CPT codes 97001, 97002, 97003, and 97004 for billing initial evaluations and re-evaluations. These codes have been replaced by a set of eight new evaluative codes: two for re-evaluations and six for evaluations.

However, this change is not as simple as a direct replacement. The new codes for initial evaluations are categorized based on the complexity of the evaluation. PTs and OTs must now assess whether a patient’s evaluation is of low, moderate, or high complexity and select the appropriate CPT code for physical therapy that reflects the level of complexity. Here’s a brief overview of the new codes:

Replacement CPT codes for physical therapy for 97001

97161Physical therapy evaluation: low complexity
97162Physical therapy evaluation: moderate complexity
97163Physical therapy evaluation: high complexity

Replacement CPT Physical Therapy Codes for 97003

97165Occupational therapy evaluation: low complexity
97166Occupational therapy evaluation: moderate complexity
97167Occupational therapy evaluation: high complexity

Replacement CPT code for physical therapy for 97002 and 97004

97164thorough examination (which involves reviewing the patient’s history and utilizing standardized tests and measures)
An updated plan of care (developed using a standardized patient assessment tool and/or measurable evaluation of functional outcomes)
97168Re-evaluation of an occupational therapy plan involves assessing changes in the patient’s status, updating the occupational profile, and revising the plan of care when there are changes in functional status or when significant adjustments are needed.

Different Types of Physical Therapy Services

Physical therapy can look different depending on what the patient needs. There are several types of services to choose from, each offering unique benefits. Let’s take a closer look at some of the most popular ones:

Physical Therapy Concierge

Physical Therapy Concierge is a personalized service where the therapist works closely with you, often at your home or another location of your choice. This approach gives you more one-on-one attention and flexibility with your treatment. It’s perfect for people who want a customized plan and prefer to avoid going to a clinic.

One on One Physical Therapy

With One on One Physical Therapy, the therapist focuses on just you during the session. You get their full attention, and they tailor the treatment to your needs. This type of therapy is ideal for people who are recovering from surgery, injuries, or need special care. It helps you make faster progress since the therapist can focus entirely on you.

Travel Physical Therapy

Travel Physical Therapy is a service where physical therapists travel to different locations to provide therapy. This can be helpful if you can’t regularly visit a clinic, either because of distance, health issues, or a busy schedule. You get therapy wherever you are, whether it’s at home or another facility. This service is also great for people who are traveling or need therapy for a short period.

Choice Physical Therapy

With Choice Physical Therapy, you get to choose your therapist and treatment plan. This gives you more control over your recovery. Whether you prefer a specific therapy style or a therapist with a certain specialty, this service lets you decide what works best for you. It’s great for people who want to be more involved in their rehabilitation process.

Where to Find the Physician Fee Schedule Final Rule

CY 2024 Physician Fee Schedule Final Rule can be found here.

Let Enfinity help manage the complexities of Medicare modifiers. If we had a middle name, it’d be compliance. We have an in depth understanding of Medicare regulations CPT codes, ICD-10 codes, and all applicable modifiers, inside and out. Click the button to schedule a free online tour of Enfinity, and we’ll show you how we ensure regulatory compliance, so you get paid and avoid penalties.

FAQS – CPT code for physical therapy?

What is a CPT code for physical therapy?

CPT (Current Procedural Terminology) code is a five-digit code used to describe physical therapy procedures and services for billing and reimbursement.

Is 97140 a physical therapy code?

Yes, CPT code 97140 is used for manual therapy techniques like joint mobilization and manipulation.

What is a procedure code in therapy?

Procedure code in therapy refers to a numeric or alphanumeric code used to identify and describe specific therapy treatments for billing purposes.

What are ICD-10 codes for physical therapy?

ICD-10 codes are used to describe a patient’s diagnosis or condition that requires physical therapy. These codes help healthcare providers and insurers understand the reason for therapy.

b mean in physical therapy?

The term “B” in physical therapy often refers to “Bilateral”, meaning both sides of the body. For example, “B” might be used to indicate that a treatment or exercise involves both the left and right sides of the body.

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