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CPT Codes For Physical Therapy

StrataPT,

What are CPT Codes?

CPT is short for Current Procedural Terminology and the codes published by the American Medical Association. CPT codes are used to classify medical, surgical and diagnostic services and procedures, and range from 00100 to 99499. CPT, ICD-9 and ICD-10 are numeric representations of data that allow for more efficient data retrieval. Each classifies data much like a zip code identifies a specific area and makes it easier for the Post Office to sort the mail and deliver it quickly.

The Most Common Physical Therapy CPT codes:

Please note: CPT codes are copyrighted (1995-2019) by the American Medical Association. All rights reserved.

97110 Therapeutic Exercise
97140 Manual Therapy
97112 Neuromuscular Re-Education
97530 Therapeutic Activities
97010 Hot/Cold Packs
97014 Electrical Stimulation (Unattended)
G0283 Electrical Stimulation, Medicare Non-Wound (Unattended)
97035 Ultrasound/Phonophoresis
97161 PT Evaluation: Low Complexity
97116 Gait Training
97162 PT Evaluation: Moderate Complexity
97535 Self Care/Home Management Training
97016 Vasopneumatic Device
97032 Electrical Stimulation (Manual)
97012 Mechanical Traction
97164 PT Re-Evaluation
97113 Aquatic Exercise
97150 Group Therapy
97124 Massage
97018 Paraffin Bath
NC001 No Charges This Visit
97163 PT Evaluation: High Complexity
98941 Spinal, Three or Four Regions
97022 Whirlpool
97033 Iontophoresis
98940 Chiropractic Manipulative Treatment (CMT); Spinal, One or Two Regions
97039 Laser/Other
97026 Infrared Light
97750 FCE/Performance Test
98943 CMT, Extraspinal, One or More Regions

CPT, ICD-9 and ICD-10

While Physical Therapists use CPT codes to regiment the treatment of diagnoses, ICD coding is the standard international system for recording diagnoses and classifying mortality and morbidity statistics. The World Health Organization (WHO) created the ICD and still watches over it. ICD-9 was the ninth version of the ICD coding system, connecting the health issues of patients by using 3 to 5 digit alphanumeric codes. However, in 2015, ICD-10 (the 10th revision) was introduced, using 4 to 7 digit alphanumeric code. ICD-10 is now the standard of ICD coding.

In Physical Therapists’ offices, ICD-10 codes are used in combination with CPT codes, which identify the Physical Therapy service provided during the patient’s visit. Both codes are submitted to a payer for the Physical Therapist to be reimbursed. Ideally, the CPT code (treatment, service, procedure) matches up logically with the ICD-10 code (the symptom, injury, etc.). Reimbursement problems can arise when the CPT code doesn’t support the ICD-10 code.

Modifier 59

Modifiers are added to CPT codes when they are required to more accurately describe a procedure performed or service rendered. A modifier should never be used in order to receive a higher reimbursement or to get paid for a procedure that should be bundled with another code.

Let’s look at the CPT Manual definition of Modifier 59:

Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures [and/or] services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

This language can be a bit confusing, and the definition leans toward surgical procedures, however Modifier 59 does have its place in a Physical Therapy setting. It is also a potential red flag for the US Centers for Medicare and Medicaid Services (CMS) and commercial payers. When Modifier 59 is used incorrectly, it can lead to claim denial.

Modifier 59 is used to represent a service that is separate and distinct from another service it’s paired with. For therapists, Medicare uses the following example to explain the proper use of Modifier 59:

Column 1 Code / Column 2 Code – 97140/97530

>CPT Code 97140 – Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes >CPT Code 97530 – Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
Modifier 59 may be reported if the two procedures are performed in distinctly different 15 minute time blocks. For example, one service may be performed during the initial 15 minutes of therapy and the other service performed during the second 15 minutes of therapy. Alternatively, the therapy time blocks may be split. For example, manual therapy might be performed for 10 minutes, followed by 15 minutes of therapeutic activities, followed by another 5 minutes of manual therapy. CPT code 97530 should not be reported and modifier 59 should not be used if the two procedures are performed during the same time block.

When is Modifier 59 Acceptable?

While the CPT Manual may give guidelines for the use of Modifier 59, the language is rather confusing and many Physical Therapists struggle with its use. Keep in mind the following:

  • Submitting a claim containing both codes in an NCCI edit pair (also called linked services) will result in the payment of only one of the procedures. This happens because the payer will automatically assume that one of the procedures or services was built in to the other.
  • If you didn’t actually perform the services together, then you can use Modifier 59 to let the payer know that each service in the edit pair was performed separate and independently of the other, and each service requires its own payment.
  • Make sure you have the appropriate documentation that supports your billing decision. The final decision will come down to the details, and the more you can accurately document, the better off you will be. Never mislead or fake your documentation. Likewise, you shouldn’t get in the habit of using Modifier 59 with re-evaluation codes.
  • Modifier 59 should be used as a last resort. If there’s a better option, use it instead. Frequently, a more descriptive modifier can be applied. Modifier 59 should only be initiated when it best fits the circumstances at hand.

Please be aware that in 2015, CMS created a new set of modifiers for use instead of Modifier 59 (in certain cases). These modifiers, such as XE, XP, XS and XU, are intended to bypass a National Correct Coding initiative edit by denoting a distinct encounter, anatomical structure, practitioner or unusual service. While the APTA has issued a statement that therapists do not need to use these new modifiers in place of Modifier 59, it’s probably just a matter of time before they are required to do so.

We will provide you with an update if we hear any changes on this policy.

Please note: New codes (as of April 2019) are shown in bold.

CPT Code Description Timed? Column 2
y = use 59 modifier
n = do not bill the code in combination with code in column 1
90911 Biofeedback for Incontinence N 90901n; 97032y; 97110y; 97112y; 97530y; 97535y; 97550y
G0451 Developmental Testing N 96125y; 96127n; 96146y; 96160y; 96161y
92507 Treatment of Speech and Language, Individual N 0373Tn; 36591n; 36592n; 69209n; 69210n; 96523n; 97110y; 97112y; 97127y; 97150y; 97153n; 97154n; 97155n; 97156n; 97157n; 97530y; 97532y; 97533y; G0515y
92508 Speech Group N 36591n; 36592n; 69209n; 69210n; 92507y; 96523n; 97110y; 97112y; 97127y; 97150y; 97154n; 97155n; 97156n; 97157n; 97158n; 97530y; 97532y; 97533y; G0515y
92521 Evaluation of Speech Fluency N 36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92522 Evaluation of Speech Production N 36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92523 Evaluation of Speech Production with Evaluation of Language Comprehension and Expression N 36591n; 36592n; 69209n; 69210n; 92522n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92524 Behavioral and Qualitative Analysis of Voice and Resonance N 36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92526 Treatment of Swallowing Dysfunction N 36591n; 36592n; 92511y; 92520y; 96523n; 97032n; 97110y; 97112y; 97127y; 97150y; 97530y; 97532y; G0270n; G0271n; G0283n; G0515y
92597 Evaluation of Voice Prosthetic N 36591n; 36592n; 96523n; 97755n
92607 Evaluation of Speech Generating Device (SGD); First Hour Y 36591n; 36592n; 92507y; 92508y; 92521y; 92522y; 92523y; 92524y; 92597n; 92609y; 96523n; 97755n
92608 Evaluation of Speech Device (Each Additional 30 Minutes) Y 36591n; 36592n; 96523n; 97755n
92609 Programming and Training for Speech Generating Device N 36591n; 36592n; 92507y; 92508y; 92521y; 92522y; 92523y; 92524y; 96523n; 97755n
92610 Evaluation of Swallowing N 35691n; 35692n; 92511y; 96523n
92611 Modified Swallow Study N 36591n; 36592n; 70370y; 70371n; 76120n; 76125n; 92511y; 92610y; 96523n
92612 Flexible Endoscopic Evaluation of Swallowing N 31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 92614n; 96523n
92614 Flexible Endoscopic Evaluation; Laryngeal Sensory Testing by Cine or Video Recording N 31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 96523n
92616 Flexible Endoscopic Evaluation of Swallowing and Laryngeal Sensory Testing by Cine or Video Recording N 31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 92612n; 92614n; 96523n
95831 Muscle Testing, Extremity (Excluding Hand) or Trunk N 36591n; 36592n; 95851n; 97140y
95832 Muscle Testing, Hand N 36591n; 36592n; 95852n; 97140y
95833 Muscle Testing, Total Eval Body, Excluding Hands N 36591n; 36592n; 95831n; 95832n; 95851n; 97140y
95834 Muscle Testing, Total Eval Body, Including Hands N 36591n; 36592n; 95831n; 95832n; 95833n; 95851n; 95852n; 97140y
95992 Canalith Repositioning N 36591n; 36592n; 92531n; 92532n; 97110y; 97112y; 97140y; 97530y
96105 Assessment of Aphasia Y 36591n; 36592n; 96110y; 96125y; 96127n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; ; G0451y; G0505y
96110 Developmental Testing, Limited N 36591n; 36592n;; 96125y; 96146n; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n
96112 Developmental Test Administration; First Hour Y 0362Tn; 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; G0406y; G0407y; G0408y; G0410y; G0411y; G0425y; G0426y; G0427y; G0451n; G0459n; G0463y; G0508y; G0509y; Check E&M Codes as well (99201 – 99497)
96113 Developmental Test Administration; Each Additional 30 Minutes Y 0362Tn; 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; G0406y; G0407y; G0408y; G0410y; G0411y; G0425y; G0426y; G0427y; G0451n; G0459n; G0463y; G0508y; G0509y; Check E&M Codes as well (99201 – 99497)
96125 Standardized Cognitive Performance Testing Y 36591n; 36592n;; 96127n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154; 97155n; 97156n; 97157n; 97158n
29581 Multi-Layer Compression System – Below Knee N 29540y; 29550y; 29580y; 97140y; 97535y
29584 Multi-Layer Compression System – Entire Arm N 29125y; 29126y; 29130y; 29131y; 97140y; 97535y
97012 Mechanical Traction N 96523n; 97018y; 97140y; 97164y; 97168y
G0281 Electrical Stimulation – Stage 3-4 Wounds N 96523n; 97032y; G0283y; 97164y; 97168y
G0283 Electrical Stimulation – Other Than Wound Care N 96523n; 97032y; 97164y; 97168y
97016 Vasopneumatic Device N 96523n; 97018y; 97026y; 97164y; 97168y
97018 Paraffin Bath N 96523n; 97022y; 97164y; 97168y
97022 Whirlpool N 96523n; 97164y; 97168y
97024 Diathermy N 96523n; 97018y; 97026y; 97164y; 97168y
97026 Infrared N 96523n; 97018y; 97022y; 97164y; 97168y
97028 Ultraviolet N 96523n; 97018y; 97022y; 97026y; 97164y; 97168y
97032 Electrical Stimulation, Manual Y 96523n; 97164y; 97168y
97033 Iontophoresis Y 96523n; 97164y; 97168y
97034 Contrast Bath Y 96523n; 97164y; 97168y
97035 Ultrasound Y 96523n; 97164y; 97168y
97036 Hubbard Tank Y 96523n; 97164y; 97168y
97039 Unlisted Modality Y 96523n; 97164y; 97168y
97110 Therapeutic Exercises Y 96523n; 97164y; 97168y
97112 Neuromuscular Re-education Y 96523n; 97022y; 97036y; 97164y; 97168y
97113 Aquatic Therapy/Exercises Y 96523n; 97022y; 97036n; 97110y; 97164y; 97168y
97116 Gait Training Y 96523n; 97164y; 97168y
97124 Massage Y 96523n; 97164y; 97168y
97127 Therapeutic Interventions for Cognitive Function N 96523n; 97155n; 97164y; 97168y; 0373n
97139 Physical Medicine Procedure Y 96523n; 97164y; 97168y
97140 Manual Therapy Y 96523n; 95851y; 95852y; 97018y; 97124n; 97164y; 97168y; 97530y; 97750y
97150 Group Therapeutic Procedures N 96523n; 97110y; 97112y; 97113y; 97116y; 97124y; 97127y; 97140y; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97164y; 97168y; 97530y; 97532y; 97533y; 97535y; 97537y; 97542y; 97760y; 97761y; 97763y; G0515y; 0373Tn
97151 Behavior Identification Assessment Y 0403Tn; 0488Tn; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96160y; 96161y; 96523n
97152 Behavior Identification – Supporting Assessment Y 0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90889n; 96160y; 96161y; 96523n
97153 Adaptive Behavior Treatment by Protocol Y 0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 92508n; 96523n; 97127n
97154 Group Adaptive Behavior Treatment by Protocol Y 0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n; 97127n
97155 Adaptive Behavior Treatment by Protocol Modification Y 0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n
97156 Family Adaptive Behavior Treatment Guidance Y 0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n; 97127n
97157 Multiple-Family Group Adaptive Behavior Treatment Guidance Y 0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n; 97127n
97158 Group Adaptive Behavior Treatment by Protocol Modification Y 0403Ty; 0488Ty; 36591n; 36592n; 90785y; 90791n; 90792n; 90832n; 90833y; 90834n; 90836y; 90837n; 90838y; 90839n; 90840y; 90845n; 90846n; 90847n; 90849n; 90853n; 90863y; 90865n; 90867; 90868n; 90869n; 90870n; 90875y; 90876y; 90880n; 90882n; 90885n; 90887n; 90889n; 92507n; 96523n; 97127n; 97150y
97161 Physical Therapy Evaluation – Low Complexity N 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97164n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97162 Physical Therapy Evaluation – Moderate Complexity N 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97161n; 97164n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97163 Physical Therapy Evaluation – High Complexity N 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96150n; 96130y; 96132y; 96136y; 96138y; 96146y; 96151n; 96152; 96153n; 96154n; 97161n; 97162n; 97164n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97164 Physical Therapy Re-evaluation N 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97165 Occupational Therapy Evaluation – Low Complexity N 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97151n; 97152n; 97168n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97166 Occupational Therapy Evaluation – Moderate Complexity N 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97151n; 97152n; 97168n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97167 Occupational Therapy Evaluation – High Complexity N 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97151n; 97152n; 97168n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97168 Occupational Therapy Re-evaluation N 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96150n; 96151n; 96152; 96153n; 96154n; 97151n; 97152n; 97168n; 97750y; 97755y; 97762n; 97763n; G0270n; G0271n; G0463y; G0505y; G0508y; G0509y
97530 Therapeutic Activities Y 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96523n; 97113y; 97116y; 97127y; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97164y; 97168y; 97533y; 97535y; 97537y; 97542y; 97750y; G0515y; 0373Tn
97533 Sensory Integration Y 96523n; 97164y; 97168y
97535 Self Care/Home Management Training Y 96523n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97164y; 97168y; 0373Tn
97537 Community/Work Reintegration Y 96523n; 97164y; 97168y
97542 Wheelchair Management – Assessment and Training Y 96523n; 97164y; 97168y
97545 Work Hardening; First 2 Hours Y 96523n; 97140n; 97164y; 97168y
97597 Wound Care Selective First 20 Square Centimeters N 17250y; 29105y; 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; 29582y; 29583y; 29584y; 96523n; 97022y; 97164y; 97602n; 97605y; 97606y; 97607y; 97608y; 97610y, 99451n; 99452n; G0471y
97598 Wound Care Selective; Each additional 20 Square Centimeters or Any Part Thereof N 29105y; 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; 29582y; 29583y; 29584y; 96523n; 97022y; 97164y; 97602n; 97605y; 97606y; 97607y; 97608y; 97610y, G0471y
97602 Wound Care Non-Selective N 29105y; 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; 29582y; 29583y; 29584y; 96523n; 97164y; 97607n; 97608n
97605 Negative Pressure Wound Therapy ≤ to 50 Square Centimeters N 96523n; 97164y; 97607y; 97608n
97606 Negative Pressure Wound Therapy ﹥50 Square Centimeters N 96523n; 97164y; 97607n; 97608y
97610 Low Frequency, Non-Contact, Non-Thermal Ultrasound N 96523n; 97035y; 97602n; 97607y; 97608y
97750 Physical Performance Test or Measurement Y 95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96523n; 97150n
97755 Assistive Technology Assessment Y 96523n; 97035y; 97110y; 97112y; 97127y; 97140y; 97530y; 97532y; 97533y; 97535y; 97537y; 97542y; 97545y; 97750n; 97760y; 97761y; 97762n; 97763y;
97760 Orthotic Management & Training, Initial Orthotic(s) Encounter Y 0213Ty; 0216Ty; 0228Ty; 0229Ty; 0230Ty; 0231Ty; 29044y; 29046y; 29049y; 29055y; 29058y; 29065y; 29075y; 29085y; 29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y; 29260y; 29280y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29582y; 29583y; 29584y; 96523n; 97016y; 97110y; 97112y; 97116y; 97124y; 97140y; 97164y; 97168y; 97762y; 97763n
97761 Prosthetic Management & Training, Initial Prosthetic(s) Encounter Y 0213Ty; 0216Ty; 0228Ty; 0229Ty; 0230Ty; 96523n; 97016y; 97110y; 97112y; 97116y; 97124y; 97140y; 97164y; 97168y; 97760y; 97762y; 97763n
97763 Orthotic/Prosthetic Management and/or Training, Subsequent Orthotic/Prosthetic Encounter(s) Y 0213Ty; o216Ty; 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; 96523n; 97016y; 97110y; 97112; 97116y; 97124y; 97140y
G0515 Development of Cognitive Skills Y 96523n; 97164y; 97168y

CPT Updates

Due to CPT changes on January 1, 2017, PTs and OTs can no longer use the following CPT codes when billing for initial evaluation and re-evaluation:

97001, 97002, 97003, and 97004

These four codes have been replaced by a set of eight evaluative codes – two for re-evaluation and six for evaluations.

The new codes for initial evaluation are tiered to designate the complexity of the evaluation.

Replacement CPT Codes for 97001

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

Replacement CPT Codes for 97003

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

Replacement CPT Codes for 97002 and 97004

97164

Re-evaluation of physical therapy established plan of care requiring:

  1. An examination (including a review of history and use of standardized tests and measures)
  2. A revised plan of care (based on use of a standardized patient assessment instrument and/or measurable assessment of functional outcome)
97168

Re-evaluation of occupational therapy established plan of care requiring:

  1. An assessment of changes in patient functional or medical status, along with a revised plan of care
  2. An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals
  3. A revised plan of care (a formal re-evaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required)

If you need further explanation of the evaluation and re-evaluation codes, do not hesitate to contact your StrataPT account manager.

Uniquely Personal

Your patients depend on your guidance, expertise and feedback to ensure their complete recovery.  They appreciate the personal interaction with you and know that they are receiving care from someone that truly understands their unique situation.  Shouldn’t you expect the same from your billing and EMR partner?  We think so.

You are thinking about starting your own practice.

You just started your own practice.

You treat Medicare Part B patients in the home.

You have a single location practice.

You have a multi-location practice.

No matter what category you fall into, StrataPT can help. We pride ourselves in being able to provide uniquely personalized software coupled with concierge level customer service.

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The StrataPT Team is available to answer your complex physical therapy billing questions and looks forward to exceeding your expectations in delivering an outstanding software experience with unmatched customer service in the industry.  Click the button below to request a demo with one of our team members today!

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