CPT Codes For Physical Therapy

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.

97110Therapeutic Exercise
97140Manual Therapy
97112Neuromuscular Re-Education
97530Therapeutic Activities
97010Hot/Cold Packs
97014Electrical Stimulation (Unattended)
G0283Electrical Stimulation, Medicare Non-Wound (Unattended)
97035Ultrasound/Phonophoresis
97161PT Evaluation: Low Complexity
97116Gait Training
97162PT Evaluation: Moderate Complexity
97535Self Care/Home Management Training
97016Vasopneumatic Device
97032Electrical Stimulation (Manual)
97012Mechanical Traction
97164PT Re-Evaluation
97113Aquatic Exercise
97150Group Therapy
97124Massage
97018Paraffin Bath
NC001No Charges This Visit
97163PT Evaluation: High Complexity
98941Spinal, Three or Four Regions
97022Whirlpool
97033Iontophoresis
98940Chiropractic Manipulative Treatment (CMT); Spinal, One or Two Regions
97039Laser/Other
97026Infrared Light
97750FCE/Performance Test
98943CMT, 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 CodeDescriptionTimed?Column 2
y = use 59 modifier
n = do not bill the code in combination with code in column 1
90911Biofeedback for IncontinenceN90901n; 97032y; 97110y; 97112y; 97530y; 97535y; 97550y
G0451Developmental TestingN96125y; 96127n; 96146y; 96160y; 96161y
92507Treatment of Speech and Language, IndividualN0373Tn; 36591n; 36592n; 69209n; 69210n; 96523n; 97110y; 97112y; 97127y; 97150y; 97153n; 97154n; 97155n; 97156n; 97157n; 97530y; 97532y; 97533y; G0515y
92508Speech GroupN36591n; 36592n; 69209n; 69210n; 92507y; 96523n; 97110y; 97112y; 97127y; 97150y; 97154n; 97155n; 97156n; 97157n; 97158n; 97530y; 97532y; 97533y; G0515y
92521Evaluation of Speech FluencyN36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92522Evaluation of Speech ProductionN36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; 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; 97151y; 97152y; G0505y; G0268n
92524Behavioral and Qualitative Analysis of Voice and ResonanceN36591n; 36592n; 69209n; 69210n; 92620n; 92621n; 96105y; 96125y; 96130y; 96132y; 96136y; 96138y; 96146y; 96523n; 97151y; 97152y; G0505y; G0268n
92526Treatment of Swallowing DysfunctionN36591n; 36592n; 92511y; 92520y; 96523n; 97032n; 97110y; 97112y; 97127y; 97150y; 97530y; 97532y; G0270n; G0271n; G0283n; G0515y
92597Evaluation of Voice ProstheticN36591n; 36592n; 96523n; 97755n
92607Evaluation of Speech Generating Device (SGD); First HourY36591n; 36592n; 92507y; 92508y; 92521y; 92522y; 92523y; 92524y; 92597n; 92609y; 96523n; 97755n
92608Evaluation of Speech Device (Each Additional 30 Minutes)Y36591n; 36592n; 96523n; 97755n
92609Programming and Training for Speech Generating DeviceN36591n; 36592n; 92507y; 92508y; 92521y; 92522y; 92523y; 92524y; 96523n; 97755n
92610Evaluation of SwallowingN35691n; 35692n; 92511y; 96523n
92611Modified Swallow StudyN36591n; 36592n; 70370y; 70371n; 76120n; 76125n; 92511y; 92610y; 96523n
92612Flexible Endoscopic Evaluation of SwallowingN31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 92614n; 96523n
92614Flexible Endoscopic Evaluation; Laryngeal Sensory Testing by Cine or Video RecordingN31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 96523n
92616Flexible Endoscopic Evaluation of Swallowing and Laryngeal Sensory Testing by Cine or Video RecordingN31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n; 92610y; 92611y; 92612n; 92614n; 96523n
95831Muscle Testing, Extremity (Excluding Hand) or TrunkN36591n; 36592n; 95851n; 97140y
95832Muscle Testing, HandN36591n; 36592n; 95852n; 97140y
95833Muscle Testing, Total Eval Body, Excluding HandsN36591n; 36592n; 95831n; 95832n; 95851n; 97140y
95834Muscle Testing, Total Eval Body, Including HandsN36591n; 36592n; 95831n; 95832n; 95833n; 95851n; 95852n; 97140y
95992Canalith RepositioningN36591n; 36592n; 92531n; 92532n; 97110y; 97112y; 97140y; 97530y
96105Assessment of AphasiaY36591n; 36592n; 96110y; 96125y; 96127n; 96146n; 96160y; 96161y; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; ; G0451y; G0505y
96110Developmental Testing, LimitedN36591n; 36592n;; 96125y; 96146n; 96523n; 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n
96112Developmental Test Administration; First HourY0362Tn; 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)
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; G0406y; G0407y; G0408y; G0410y; G0411y; G0425y; G0426y; G0427y; G0451n; G0459n; G0463y; G0508y; G0509y; Check 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; 97140y; 97535y
29584Multi-Layer Compression System - Entire ArmN29125y; 29126y; 29130y; 29131y; 97140y; 97535y
97012Mechanical TractionN96523n; 97018y; 97140y; 97164y; 97168y
G0281Electrical Stimulation - Stage 3-4 WoundsN96523n; 97032y; G0283y; 97164y; 97168y
G0283Electrical Stimulation - Other Than Wound CareN96523n; 97032y; 97164y; 97168y
97016Vasopneumatic DeviceN96523n; 97018y; 97026y; 97164y; 97168y
97018Paraffin BathN96523n; 97022y; 97164y; 97168y
97022WhirlpoolN96523n; 97164y; 97168y
97024DiathermyN96523n; 97018y; 97026y; 97164y; 97168y
97026InfraredN96523n; 97018y; 97022y; 97164y; 97168y
97028UltravioletN96523n; 97018y; 97022y; 97026y; 97164y; 97168y
97032Electrical Stimulation, ManualY96523n; 97164y; 97168y
97033IontophoresisY96523n; 97164y; 97168y
97034Contrast BathY96523n; 97164y; 97168y
97035UltrasoundY96523n; 97164y; 97168y
97036Hubbard TankY96523n; 97164y; 97168y
97039Unlisted ModalityY96523n; 97164y; 97168y
97110Therapeutic ExercisesY96523n; 97164y; 97168y
97112Neuromuscular Re-educationY96523n; 97022y; 97036y; 97164y; 97168y
97113Aquatic Therapy/ExercisesY96523n; 97022y; 97036n; 97110y; 97164y; 97168y
97116Gait TrainingY96523n; 97164y; 97168y
97124MassageY96523n; 97164y; 97168y
97127Therapeutic Interventions for Cognitive FunctionN96523n; 97155n; 97164y; 97168y; 0373n
97139Physical Medicine ProcedureY96523n; 97164y; 97168y
97140Manual TherapyY96523n; 95851y; 95852y; 97018y; 97124n; 97164y; 97168y; 97530y; 97750y
97150Group Therapeutic ProceduresN96523n; 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
97151Behavior Identification AssessmentY0403Tn; 0488Tn; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96160y; 96161y; 96523n
97152Behavior Identification - Supporting AssessmentY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90889n; 96160y; 96161y; 96523n
97153Adaptive Behavior Treatment by ProtocolY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 92508n; 96523n; 97127n
97154Group Adaptive Behavior Treatment by ProtocolY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n; 97127n
97155Adaptive Behavior Treatment by Protocol ModificationY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n
97156Family Adaptive Behavior Treatment GuidanceY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n; 97127n
97157Multiple-Family Group Adaptive Behavior Treatment GuidanceY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n; 90882n; 90889n; 96523n; 97127n
97158Group Adaptive Behavior Treatment by Protocol ModificationY0403Ty; 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
97161Physical Therapy Evaluation - Low ComplexityN95831n; 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
97162Physical Therapy Evaluation - Moderate ComplexityN95831n; 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
97163Physical Therapy Evaluation - High ComplexityN95831n; 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
97164Physical Therapy Re-evaluationN95831n; 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
97165Occupational Therapy Evaluation - Low ComplexityN95831n; 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
97166Occupational Therapy Evaluation - Moderate ComplexityN95831n; 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
97167Occupational Therapy Evaluation - High ComplexityN95831n; 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
97168Occupational Therapy Re-evaluationN95831n; 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
97530Therapeutic ActivitiesY95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96523n; 97113y; 97116y; 97127y; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97164y; 97168y; 97533y; 97535y; 97537y; 97542y; 97750y; G0515y; 0373Tn
97533Sensory IntegrationY96523n; 97164y; 97168y
97535Self Care/Home Management TrainingY96523n; 97153n; 97154n; 97155n; 97156n; 97157n; 97158n; 97164y; 97168y; 0373Tn
97537Community/Work ReintegrationY96523n; 97164y; 97168y
97542Wheelchair Management - Assessment and TrainingY96523n; 97164y; 97168y
97545Work Hardening; First 2 HoursY96523n; 97140n; 97164y; 97168y
97597Wound Care Selective First 20 Square CentimetersN17250y; 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
97598Wound Care Selective; Each additional 20 Square Centimeters or Any Part ThereofN29105y; 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
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; 29582y; 29583y; 29584y; 96523n; 97164y; 97607n; 97608n
97605Negative Pressure Wound Therapy ≤ to 50 Square CentimetersN96523n; 97164y; 97607y; 97608n
97606Negative Pressure Wound Therapy ﹥50 Square CentimetersN96523n; 97164y; 97607n; 97608y
97610Low Frequency, Non-Contact, Non-Thermal UltrasoundN96523n; 97035y; 97602n; 97607y; 97608y
97750Physical Performance Test or MeasurementY95831n; 95832n; 95833n; 95834n; 95851n; 95852n; 96523n; 97150n
97755Assistive Technology AssessmentY96523n; 97035y; 97110y; 97112y; 97127y; 97140y; 97530y; 97532y; 97533y; 97535y; 97537y; 97542y; 97545y; 97750n; 97760y; 97761y; 97762n; 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; 29280y; 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y; 29581y; 29582y; 29583y; 29584y; 96523n; 97016y; 97110y; 97112y; 97116y; 97124y; 97140y; 97164y; 97168y; 97762y; 97763n
97761Prosthetic Management & Training, Initial Prosthetic(s) EncounterY0213Ty; 0216Ty; 0228Ty; 0229Ty; 0230Ty; 96523n; 97016y; 97110y; 97112y; 97116y; 97124y; 97140y; 97164y; 97168y; 97760y; 97762y; 97763n
97763Orthotic/Prosthetic Management and/or Training, Subsequent Orthotic/Prosthetic Encounter(s)Y0213Ty; 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
G0515Development of Cognitive SkillsY96523n; 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

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

Replacement CPT Codes for 97003

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

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