NGS Results of Reevaluation CPT Code Post-payment Review

July 28, 2021
Rick Gawenda

National Government Services (NGS) has released the findings of their post-payment review they conducted on the physical therapy reevaluation CPT code, 97164 for the states of New York, Connecticut, Massachusetts, Maine, New Hampshire, Vermont and Rhode Island. The review focused on bill type 13X or 85X which means the claims selected were submitted by a hospital outpatient therapy department (bill type 13X) or a critical access hospital (bill type 85X).

The results of this review provide a summary of claims with dates of service of 1/1/2019 through 2/28/2020 and do not include appeal results for overturns and decision reversals.


Number of Claims Reviewed: 1,258

Number of Claims Denied: 956

Claims Denial/Error Rate: 75.99%

Charges/Payment Error Rate: 86.48%

To read the full report and see what the denial reasons were, click HERE.

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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  1. It appears NGS changed up their website and I cannot locate the full report. I have scrolled the headlines of hundreds of articles on their site. Is there an updated link or pdf you could post? Many thanks !!

  2. The above click here link does not take you to the NGS website to look at the review. How can I access it ?