New Reevaluation Codes to Begin January 1, 2017

December 12, 2016
Rick Gawenda

Effective January 1, 2017, CPT codes 97002 (physical therapy reevaluation) and 97004 (occupational therapy reevaluation) are being deleted and will be replaced with one new reevaluation code for physical therapy and one new reevaluation code for occupational therapy. In this article, I will answer the following questions:

  1. What is the new physical therapy reevaluation code?
  2. What is the new occupational therapy reevaluation code?
  3. What is required to be performed during the reevaluation?
  4. When is it appropriate to bill a reevaluation?
  5. Does the Medicare program pay for a reevaluation?
  6. How often will the Medicare program pay for a reevaluation?
  7. How much does the Medicare program pay for the PT and OT reevaluation codes?

The new reevaluation codes for physical therapy and occupational therapy are:

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    1. In the IP setting, you are not paid via CPT codes, rather, via DDRGs in the acute care setting. If a patient is switched from Part A to Part B, then the new evaluation codes would apply.

  1. Does the therapist need to write a justification of why they chose the level of eval that they are charging? All of the information is documented throughout the eval but some therapist at my location have asked if they needed to summarize why they are charging that level.

    1. The documentation in the medical record would need to support the level of evaluation billed. How you do that is up to the individual practice or organization.