CPT Eval Codes for Occupational Therapy Cheat Sheet

FROM PATIENT TO PAYMENT

New 2017 CPT Eval Codes for Occupational Therapy

On January 1, 2017, the CPT codes for OT evaluations and re-evaluations (codes 97003 and 97004) 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

O C C U PAT I O N A L PROFILE AND MEDICAL

AND THERAPY HISTORY

PERFORMANCE DEFICITS

IDENTIFIED DURING ASSESSMENT

CLINICAL DECISION MAKING

COMORBIDIITES THAT AFFECT

O C C U PAT I O N A L PERFORMANCE

M O D I F I C AT I O N S OR ASSISTANCE

NEEDED TO COMPLETE E VA L U AT I O N

APPROX. FACE-

TO-FACE TIME WITH

PAT I E N T

RVU

97165

Occupational therapy evaluation, LOW COMPLEXITY

Brief history including review of medical and/or therapy records

1-3 PERFORMANCE DEFICITS that result in activity limitations and/or participation restrictions

LOW COMPLEXIT Y: includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options

None

No modifications

30 minutes

1.2

or assistance

97166

Occupational therapy evaluation, M O D E R AT E COMPLEXITY

Expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history

3-5 PERFORMANCE DEFICITS that result in activity limitations and/or participation restrictions

MODERATE ANALY TIC COMPLEXIT Y: includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options

Maybe

Minimal to

45 minutes

1.2

moderate

modification of

tasks or assistance

97167

Occupational therapy evaluation, HIGH COMPLEXITY

Review of medical and/ or therapy records and EXTENSIVE additional review of physical, cognitive, or psychosocial history

5 OR MORE PERFORMANCE DEFICITs that result in activity limitations and/or participation restrictions

HIGH ANALY TIC COMPLEXIT Y: Includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options

Ye s

Significant

60 minutes

1.2

modification of

tasks or assistance

97168 Reevaluation

Requires the following components:

30 minutes

0.6

of occupational Assessment of changes in patient functional or medical status with revised plan of care

therapy

Update initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals

established plan Revised plan of care

of care

Reevaluation performed when there is a documented change in functional status or a significant change to the POC is required

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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.

? 2016 Clinicient Inc. All rights reserved. TS024 v1.2 | December 2016

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