CPT Eval Codes for Physical Therapy Cheat Sheet

FROM PATIENT TO PAYMENT

New 2017 CPT Eval Codes for Physical Therapy

On January 1, 2017, the CPT codes for PT evaluations and re-evaluations (codes 97001 and 97002) will be replaced by a new, tiered set of codes. Use the following cheat sheet to familiarize yourself with the codes and to determine complexity levels based on a set of criteria.

NEW CPT CODE*

DESCRIPTION

PERSONAL FACTORS AND/OR CO-MORBIDITIES THAT IMPACT THE

PLAN OF CARE

BODY SYSTEMS EXAMINED

CLINICAL P R E S E N TAT I O N

CLINICAL DECISION MAKING

A P P R O X I M AT E FAC E -T O - FAC E

TIME WITH PATIENT AND/

OR FAMILY

RVU

97161

Physical therapy evaluation: LOW COMPLEXITY

NONE

1-2 ELEMENTS from any

STABLE and/or

LOW COMPLEXITY using

20 minutes

1.2

of the following: Body

uncomplicated

standardized patient

structures and functions,

characteristics

assessment instrument and/

activity limitations, and/or

or measurable assessment

participation restrictions

of functional outcome

97162

Physical therapy

1-2

3 OR MORE ELEMENTS

E VO LV I N G

MODERATE COMPLEXIT Y

30 minutes

1.2

evaluation:

from any of the following:

with changing

using standardized patient

M O D E R AT E

Body structures and

characteristics

assessment instrument and/

COMPLEXITY

functions, activity

or measurable assessment

limitations, and/or

of functional outcome

participation restrictions

97163

Physical therapy evaluation: HIGH COMPLEXITY

3

4 OR MORE ELEMENTS

UNSTABLE and

HIGH COMPLEXITY using

45 minutes

1.2

from any of the following:

unpredictable

standardized patient

Body structures and

characteristics

assessment instrument and/

functions, activity

or measurable assessment

limitations, and/or

of functional outcome

participation restrictions

97164

Reevaluation of

not applicable

Examination including a

not applicable

Revised plan of care using

20 minutes

0.6

physical therapy

review of history and use

a standardized patient

established plan

of standardized tests and

assessment instrument and/

of care

measures is required

or measurable assessment

of functional outcome

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This document is meant as summary information only and is based on our best understanding of Medicare requirements at the time it was written. There are no warranties, either expressed or implied, that the information is completely accurate. Please refer to Medicare as your source for complete and accurate information.

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