Does Medicare Pay CPT Code 97750 Same Day as an Evaluation

June 11, 2018
Rick Gawenda

Does the Medicare program pay for CPT code 97750 (physical performance test or measurement) the same day a provider also bills either a physical therapy (PT) evaluation, PT reevaluation, occupational therapy (OT) evaluation, or OT reevaluation CPT code? Of course, the answer is not as easy as a simple yes or a simple no. A certain situation must occur that will allow CPT code 97750 to be paid on the same day as a PT or OT evaluation or reevaluation CPT code. So you might ask, what is that situation?

The Medicare program will pay for CPT code 97750 on the same date of service as a physical therapy evaluation/re-evaluation CPT code (e.g. 97161-97164) or occupational therapy evaluation/reevaluation CPT code (e.g. 97165-97168) when the two services are performed

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  1. We are billing a 97750 code when we write a Recertification for the testing that we do for the Recertification. Please advise if this is a correct use of 97750 code. Thank you.

  2. Could you please explain when it is appropriate to use 97750. I understand it is used for functional capacity testing. It also says it is used for “a test or measure of PT and or function on one or more body areas….included in this service is manual muscle testing and range of motion testing”. They are billed in 15′ increments.
    To me that sounds like if you are doing a PN and taking MMT and ROM measures and a written report follows, then you should be able to use this code. However, I was told in another course that you should not use that code. I am confused. Please clarify.