Understanding CPT Code 97750
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, who can use this code, what interventions are included under this code and what time is included towards the billing of 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 CPT code 97750 for the time it takes us to take range of motion measurements on a patient?
- Can we use CPT code 97750 for the time it takes us to perform manual muscle testing on a patient?
- 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?
- How many units of CPT code 97750 will insurance carriers pay when billed on the same date of service?
- Can we bill CPT code 97750 for writing a Progress Report?
- What must be documented to support the use and billing of CPT code 97750?
- What time counts towards “the each 15 minutes” when determining how many units to bill?
- Does the time it takes to document the tests results and develop the plan of care count towards the billable time?
- Would computerized muscle testing be an example when to bill CPT code 97750?
- Does the Medicare program pay for CPT code 97750 on the same day that the same discipline bills an evaluation or reevaluation CPT code?
- Can a physical therapist assistant or occupational therapy assistant perform a physical performance test or measurement with a patient and bill CPT code 97750?
The description of CPT code 97750 per CPT 2021 Professional Edition is “Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes”.
Lets now answer the questions from above.
Question
When can I bill CPT code 97750?
Answer
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Question
Can we use CPT code 97750 in place of a reevaluation if an insurance carrier does not pay for a reevaluation?
Answer
The content here is for members only log in here or sign up.
Question
Can we use CPT code 97750 for the time it takes us to take range of motion measurements on a patient?
Answer
The content here is for members only log in here or sign up.
Question
Can we use CPT code 97750 for the time it takes us to perform manual muscle testing on a patient?
Answer
The content here is for members only log in here or sign up.
Question
Can we bill this CPT code for the time a patient completes a questionnaire and we review it with the patient?
Answer
The content here is for members only log in here or sign up.
Question
How often can we bill CPT code 97750?
Answer
The content here is for members only log in here or sign up.
Question
How many units of 97750 will insurance carriers pay when billed on the same date of service?
Answer
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Question
Can we bill CPT code 97750 for writing a Progress Report?
Answer
The content here is for members only log in here or sign up.
Question
What must be documented to support the use and billing of CPT code 97750?
Answer
The content here is for members only log in here or sign up.
Question
What time counts towards “the each 15 minutes” when determining how many units to bill?
Answer
The content here is for members only log in here or sign up.
Question
Does the time it takes to document the tests results and develop the plan of care count towards the billable time?
Answer
The content here is for members only log in here or sign up.
Question
Would computerized muscle testing be an example when to bill CPT code 97750?
Answer
The content here is for members only log in here or sign up.
Question
Does the Medicare program pay for 97750 on the same day that the same discipline bills an evaluation or reevaluationCPT code?
Answer
The content here is for members only log in here or sign up.
Question
Can a physical therapist assistant (PTA) or occupational therapy assistant (OTA) perform a physical performance test or measurement with a patient and bill CPT code 97750?
Answer
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References:
- Current Procedural Terminology 2021, Professional Edition, American Medical Association, copyright 2020
- American Medical Association, CPT Assistant May 2008
- 2021 National Correct Coding Initiative (NCCI) Policy Manual for Medicare, copyright 2020
- American Medical Association, CPT Assistant February 2004
- American Medical Association, CPT Assistant December 2003
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Can 97750 be used for girth measurements with our lymphedema folks?
No
We have a motion analysis center and often have requests from physician for a one time patient foot pressures assessment. (https://en.wikipedia.org/wiki/Pedobarography). For example, if we get a referral to see a patient with clubfoot, and we perform foot pressure, abbreviated rom/MMT of the ankle and a description of their gait (observation gait analysis) that include the foot pressure can I use CPT code 97750. Typically there is not plan of PT care, this is a one time visit, with a focused assessment of the foot.
You might want to look at the motion analysis CPT codes in the 96000 series.
We have physicians requesting that we perform a 6 min walk test for their patients. They are not referring them for a full PT assesement/evaluation, so there would not be a PT plan of care. Can our clinicians perform this test, and bill 97750 as a stand alone procedure, without a full evaluation being completed and would it be appropriate to bill this code?
You would need to look at your respective state practice act as well as the insurance carriers therapy policies, if applicable, to obtain your answer.
If you perform the functional test on one day and review the results on a separate day, can this code be billed on both dates of service?
If the time spent reviewing, analyzing and interpreting the data was done for enough time, technically yes, but I do not advise it. Do it all on the day of the testing.
I have found that Medicare is not paying for 97750 if we bill any other cpt code, ei: 97110, 97112, etc along with 97750. A biller suggested that 97750 is a stand alone under the FCE category, and advised to bill 97750 by itself for whatever units equate to the time spent.
Can you clarify further?
You would need to look at the current version of the NCCI edits to see if Modifier 59 is allowed.
Does the assessment need to be performed as a standardized test, or could the assessment of stair performance or gait be formally assessed, documented, and define your POC be covered under this code?
97750 does not state a standardized physical performance test or measurement. Gait and stair assessment, in my opinion, is not an example of a physical performance test or measurement.