CPT code 97750 is a code that many providers of therapy services do not understand when to use this code, when not to use this code and what interventions are included under this code. I often receive questions regarding CPT code 97750 such as:
- When can I bill CPT code 97750?
- Can we use CPT code 97750 in place of a reevaluation if an insurance carrier does not pay for a reevaluation?
- Can we use this code for the time it takes us to take range of motion measurements and perform manual muscle testing?
- Can we bill this CPT code for the time a patient completes a questionnaire and we review it with the patient?
- How often can we bill CPT code 97750?
- Can we bill CPT code 97750 for writing a Progress Report?
- Can we bill CPT code 97750 every 10th visit on Medicare patient’s when completing functional limitation reporting?
- What time counts towards “the each 15 minutes” when determining how many units to bill?
The description of CPT code 97750 is “Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes”.
Lets now answer the questions from above.
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If preforming a functional test to determine level of disability, can you charge this code for the 3 hours spent on the testing?? Would this be the correct charge or would another charge be more appropriate??
CPT code 97750 can be used for a functional capacity evaluation. CPT code 97750 is focused on patient performance of a specific activity or group of activities. If you have questions regarding coverage of this CPT code, I recommend you contact the insurance carrier.
So can it be billed on the same day as an PT or OT evaluation if we are doing a Purdue Pegboard or Timed Get up and Go?
The Medicare program does not pay for 97750 on the same day you bill a PT or OT evaluation. Regarding private and commercial insurances, you would need to check with each insurance carrier. Many payers would consider any test or measurement performed on the day of the evaluation or reevaluation a part of the evaluation or reevaluation.
What are acceptable functional tests for the upper extremity for a rotator cuff repair? Is grip strength testing acceptable for 97750?
Isokinetic/isometric testing of involved extremity strength compared to un-involved extremity strength and/or normative data could be an example of a physical performance test or measurement.
Just a small addition…
I own a pediatric private practice, now open 28 years. Just an addition to your valuable info above, we have been able to bill 97750 in addition to the PT or OT Eval codes on over 95% of our BCBS patients. Poor experience however with other insurance companies. The 5% who have been denied on a BCBS plan are denied locally by their own HR dept. or local labor group.
So if I sped 45 minutes doing a tug, tug cognitive and dgi and interpretation of scores and educating the pt on all scores, the norms, fall risk wtc I could bill 3 units of this?
CPT code 97750 is billed in 15-minute increments. If the total time to administer the test(s) and interpret the results with the patient present totaled 45 minutes, then it would be appropriate to bill 3 units of 97750. How many units an insurance carrier pays for 97750n and how often they pay for 97750 is insurance carrier specific.
On Question #3, you stated that it would be more appropriate to use codes from 95831 – 95852, but you have cautioned in the past that these are almost never billed properly by PTs. What specifics must we meet to bill these codes properly?
The only thing that research has shown me is that it requires a separate distinct written report?
To get your answer to your question, please read “When Can I Use CPT Codes 95831 and 95851” at http://gawendaseminars.com/2015/current-news-posts/cpt-code-95831and-95851/
Can 97750 ever be billed with re-eval code
The Medicare program does not pay for 97750 on the same day you bill an evaluation or reevaluation. You would need to check with other insurance carriers; however, in my opinion, in test or measurement is included in the evaluation or reevaluation CPT code.
Can PT and OT bill for 97750 on the same day using different tests in the inpatient acute care setting? (Neither PT or OT using evaluation or re-evaluation)- thanks
In true acute care being paid via DRGs, you do not submit claims using CPT codes to the Medicare program.
Thank you for your reply!
Our hospital finance bills DRG but also uses CPT codes to track productivity as well capture the patients on observation or who do switch to part B coverage. We use the outpatient charge structure.
From that perspective, can PT and OT both use the 97750 for different tests on the same day?
Does the 97750 require separate documentation or can it be included in the daily note.
Under outpatient therapy, the Medicare program would pay for 97750 on the same day if done by both PT and OT for different tests. What other payers pay for is payer specific. Keep in mind that 97750 is not used in place of the evaluation code.
You are not paid via CPT codes on the inpatient side, rather, via DRG’s. If billing CPT codes for tracking purposes, yes, PT and OT cna both bill 97750 on the same day. This code does not take the place of an evaluation.
Does the 97750 require Functional Limitation reporting on each use in the inpatient acute care setting?
Does the 97750 require separate documentation than a daily note when used in the acute care setting? Thank you!
In true acute care being paid via DRGs, you do not submit claims using CPT codes to the Medicare program. If the Medicare patient was under Observation status or switched from Part A to Part B because they did not qualify for an inpatient admission, then FLR would be required if billing 97750.
Is there a limit on the number of units of 97750 Medicare will pay on a given Date of Service?
Nationally, the Medicare program as no limits on the use of CPT code 97750. Your Medicare Administrative Contractor may or may not have limits.
If we are billing 2 separate tests, for instance, a one day FCE that requires up to 3 – 4 hours of time spent, and a pre placement screen that requires 30 min – an hour, using the same code 97750. Can we bill these 2 tests with the same code with different price amounts, or do they need to be billed with the specific amount of units per time spent with the patient?
You should have 1 fee for each 15 minutes of 97750 and then bill the appropriate number of units based on the minutes providing that service.
Can a provider use a medical assistant to perform components of the FCE? Or is the doctor or PT required to perform the test
You would have to check your state practice act to see who you can utilize under your supervision. You would also need to check with the insurance carrier. In my opinion, a PT or OT should be doing the FCE, not a medical assistant.
my Dr going to perform the the Buffalo treadmill concussion test. It is a post-concussion exercise test (about 30′) it also called (BCTT) Buffalo concussion treadmill test. Would you please advise which CPT CODE I can use to bill for that or instruct where can I find the CPT CODE ?
You would need to determine if it meets the requirement of a physical performance test and measurement or not. If yes, that would be CPT code 97750.
Can an ATC charge 97750 instead of the evaluation code 97169 when evaluating for rehab/therapy?
You would need to check with the insurance carrier to see if they pay for services provided by an ATC. Most do not.
Can you use this code for performing the testing and calculating results when using the adult FIM or weefim2 systematic evaluation of function?
97750 is for any physical performance test or measurement. It would not be appropriate to use for questionnaires.
Does sensory mapping with report and bilateral comparison fall under 97750?
You have to make the determination if sensory mapping meets the definition of a physical performance test or measurement.
Great information as always….
Our practice often receives referrals for EXIT testing post concussion. If we have never seen the patient prior, can we use 97750 or should we be billing PT eval?
That would be up to the therapist to make that determination.
Can we use 97750 to perform a computerized Gait Analysis Test?
I would recommend you look at CPT codes 96000 – 96003 for motion analysis.
Can we use 97750 for dynamic plantar pressure analysis? No need for full motion analysis with CPT 96001.
You would need to determine if this qualifies as a physical performance test or measurement.
Can 97750 be billed for reviewing a functional outcome survey with the patient?
Can I bill the BCTT test 97750 with the E& M code in the same day? and do I need to append modifier 25 on the E&M and modifier 59 on the 97750
You would want to check the current version of the NCCI edits.
In billing with code 97750, does this include time that the pt is filling out intake paperwork, and report write up time for the therapist, or is it only while the pt and therapist are face to face performing the FCE? Also, where is the medicare rule for this? Thank you
The time that counts towards the billable time is the time the therapist spends administering the test and analyzing the results with the patient present. Filling out forms is not billable time. Not sure what you are asking about a Medicare rule. The Medicare program does not create nor define the CPT codes. This is done by the American Medical Association.
Thank you. Where is it found about what is considered the “billable time” within the A.M.A.? What rule # is it please?
There is no rule number. Are you a Gold Member to my website?
Since my last comment in 2016 above, where I stated that BCBS usually paid for 97750 as part of an eval, we can no longer assume this is true in our own pediatric practice since the inception of the new eval codes. It’s a whole new ball game now, and we will check this out slowly with different subgroups of BCBS.
In my opinion, if you are billing an evaluation, all testing done that day is part of the evaluation and should not have been billed separately using CPT code 97750.
To follow up with reply above, if direct one on one patient contact is required for billing 97750, how can a therapist bill for the hours that it may take to analyze the information from the FCE performance? Analyzing all the data is not possible as the testing is occurring. As such this documentation takes place after FCE completion. Please reply, and thanks!
CPT code 97750 description does not contain the words “requires direct one-on-one patient contact”. Documentation time is not billable time under CPT code 97750.
Correct. So is there any other way to be able to bill for the time that is spent assessing/analyzing the information from the FCE?
For CPT code 97750 being billed to an insurance carrier, the billable time is the time to perform the test and analyze and interpret the results with the patient present. No other time is billable to the insurance carrier.
Rick, what are your thoughts of the SOT as part of the CDP as a physical performance test? The SOT is the CTSIB as you know and has a printed report? Is there a specific area in CMS that describes the actual definition of the PPT? You can say it is measure the musculoskeletal balance system as well as it it a functional capacity evaluation of the balance system?
CPT codes are developed and defined by the American Medical Association (AMA) and not CMS. You would have to determine if whatever test you are having the patient perform is a physical performance test or measurement.
In billing 99456 for an impairment rating, we have a denial requesting a modifier. There is not same day services or separate services & we have not used a modifier on this code in the past when no other services are performed same day and we have had no issues with that on getting paid. After calling to verify, they are still saying yes to a modifier. Any ideas as to what modifier they would be looking for? Thank you!!
No! Why are you billing 99456 under a PT plan of care?
What is the appropriate code to bill impairment rating under a PT?
The question must have been misinterpreted.
The impairment rating is not being billed under a PT plan of care. Thanks for your response though.
The article you are responding to deals with CPT code 97750 and outpatient therapy services.
My PT does a quick ROM test and then the rest of the session is her giving me exercises to do at home, she will demo once and then watch me repeat the exercise once. Then she will write the exercises down on a card for me to take home. That’s it. I checked my EOB and there were two 97110 codes and one 97750 code for a 40-minute session (The session usually ends early). I feel like I am not actually doing any therapeutic exercise (does 1 rep count as therapy), as most of the therapy occurs at home in my own time.
I would suggest you discuss your concerns with your therapist and if not satisfied with their response, perhaps discuss with the appropriate individual.
My company is trying to get me to bill 97750 for discussing a self-reported questionnaire with a patient (such as LEFS, Quick DASH, NDI and Revised Oswestry). I have expressed these questionnaires do not apply for those code. Is this correct? The code only applies to testing a patient PERFORMING a functional measurement (such as BERG, TUG, 6 min walk test ect)?
You are correct!
I work in a hospital and Therapy is being asked to help respiratory therapy with home oxygen evaluations due to the number of patients on vents currently. What CPT should be used to document and charge for this? Can it be done by a PT or PTA or OT? If the patient has not been evaluated by PT or OT previously, do they need to do a full evaluation or is there another CPT that can be used. The respiratory therapists currently bill CPT 94618 but that is not a CPT that we typically use. Thank you for your assistance w/ this!
You would need to check with your respective sate practice act regarding your scope of practice and what you are allowed to do. Since this is an inpatient, you are not paid via CPT codes, rather, are paid via DRG’s. There are no CPT codes for OTs and PTs to “bill” for home oxygen evaluations.
In worker’s comp, is it appropriate for a provider to bill 97750 for an evaluation prior to creating a work hardening/work conditioning program? Or should the provider bill one of the 97161-97163 or 97165-97167 codes?
97750 is not an evaluation CPT code and does not take the place of a PT or OT evaluation and the respective CPT codes.
My thoughts exactly. Thank you.
If completing a so called pre-placement screen for an interdisciplinary pain management program that discusses goals and completes objective measures, how would you bill? This would be the first patient interaction.
Could you comment on when it is appropriate to bill Performance Test and Measure at the initial meeting versus an evaluation? Conversely, why is 97750 appropriate for an FCE and not billed as an evaluation?
Any information you could provide would be helpful
A pre-placement screen would not be billable to an insurance company as PT or OT services unless that payer covers pre-placement screens. Regarding your other question, this is not something I can address in this format and would fall under my consulting services.
Let’s say you evaluated a patient with a traumatic brain injury on their first day of inpatient rehab, and then the next day you completed grip strength testing with a dynamometer, coordination assessments with 9 Hole Peg Test and Box and Blocks in a 30 minute session. Could you ethically bill Physical Performance Test for that 30 minutes? Thank you!
In an IRF setting, you are not paid via CPT codes, rather, via case-mix groups. Key is did patient receive 3 hours of intensive therapy at least 5 out of 7 days.
Re: Written Report. Does the treatment note count as the written report or do I have to have a completely distinct/separate report and then upload into the chart or otherwise save in essence two notes (1 for 97750 and one for my other interventions that visit)?
That would be up to you to make that determination.
I was told msk us would be best used using the 97550 code and writing a report with findings and documenting why the test was used to guide the poc and was medically necessary. Can you share your thoughts?
I do not provide consulting services via a blog.
While billing Medicare, can a PT bill CPT 97750 for a balance assessment (Berg, Tinetti…) prior to or without a PT evaluation code? For instance in a direct access state such as Michigan, where PT can provide treatment without a prescription from a licensed physician if the patient is seeking physical therapy services for purposes of injury prevention or promoting fitness. Can 97750 be billed without an evaluation CPT code being billed?
Whether or not an insurance carrier will reimburse you for 97750 without first billing an evaluation CPT code would be insurance carrier specific.