CPT Codes For Physical Therapy Billing
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 (1995-2023) 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:
|
| 97168 |
Re-evaluation of occupational therapy established plan of care requiring:
|
If you need further explanation of the evaluation and re-evaluation codes, do not hesitate to contact your StrataPT account manager.