CATEGORY
Physical Medicine and Rehabilitation Tests and Measurements
CODE TYPE
Timed-based code
Billed in 15 mins increment
ADD-ON CODE
No add-on code
ASSISTIVE TECHNOLOGY ASSESSMENT
Assistive technology (AT) assessment assess the suitability and benefits of technological interface to match the abilities of the patient and the features of a device. This CPT is being used for disabled patients for whom new technology advancement can help in compensating the functional loss.
Assistive technology (AT) assessment is done to restore, improve or compensate for the loss of functional ability in order to integrate the individual into society and to maximize his/her potential.
Functional skills are those that enable the person to function in an environment without assistance. As assistive device optimizes functional tasks and maximizes the patient’s environmental accessibility. At assessment also determines the need for modification of components of assistive device. Custom components/systems are designed, Tested and modified according to need of the patient.
It would not be appropriate to use CPT 97755 when another CPT describes the service more clearly. It is usually billed by the occupational and physical therapists.
CODING GUIDELINES
» Require the skills of qualified healthcare professionals such as:
- Physical Therapist
- Occupational Therapist
- Chiropractors
- Physical Therapist Assistant
- Occupational Therapy Assistant
» Direct patient contact by the provider
» Requires a therapy modifier (GP, GN, GO, CO, CQ)
» CMS 8-minute rule and AMA rule of Eights are applied
CMS 8-Minute Rule:
A minimum of 8 minutes of direct contact with the patient must be provided for a single unit of 97755 be billed:
| Units | Number of Minutes |
|---|---|
| 1 unit | ≥ 08 minutes through 22 minutes |
| 2 units | ≥ 23 minutes through 37 minutes |
| 3 units | ≥ 38 minutes through 52 minutes |
| 4 units | ≥ 53 minutes through 67 minutes |
| 5 units | ≥ 68 minutes through 82 minutes |
| 6 units | ≥ 83 minutes through 97 minutes |
| 7 units | ≥ 98 minutes through 112 minutes |
| 8 units | ≥ 113 minutes through 127 minutes |
The pattern remains the same for treatment times of more than 2 hours.
AMA Rule of Eights:
“AMA guidelines state that incremental intervals of treatment performed on the same session may be added together when determining total time in direct contact of a qualified healthcare provider with the patient is necessary. Each unique timed service is counted separately instead of combining the time from multiple units”
PHYSICAL THERAPY MODIFIERS
Below mentioned modifiers are used when services are provided for the respective plan of care:
| MODIFIERS | PLAN OF CARE |
|---|---|
| GP | Outpatient Physical Therapy |
| GO | Outpatient Occupational Therapy |
| GN | Outpatient Speech-Language Pathology |
| CQ | Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially) |
| CO | Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially) |
TOTAL NO. OF BILLABLE UNITS
08 units are allowed per date of service by CMS but more units can be billed if justified by medical notes.
REIMBURSEMENT GUIDELINES
For reimbursement of these CPTs following elements must be documented in the Physical Therapy Notes:
- The therapy plan is developed by a qualified/certified healthcare professional who have additional knowledge of assistive devices.
- This code requires submission of a separate written report explaining the nature and complexity of assistive technology required by the patient and should contains documentation of following key points:
- Time spent in assessment (Time spent in preparing the assessment report is not included)
- Goals and short term objectives
- Patient’s functional needs and abilities, demands of various environment, functional tasks and objectives
- Ability to use recommended assistive device
- Recommendations based on data form assessment
- A written rationale for recommendations made
- Payment made not be made in following conditions:
- If physical therapy services are provided to a patient in a hospital outpatient department
- If physical therapy services are provided to an inpatient by an independently practicing healthcare provider.
Coverage Guideline:
- This CPT is covered for high level assessment of assistive device to determine the suitability and benefits of technological interface with patient’s abilities and not for routine evaluation of assistive mobility devices like wheelchair, etc.
- For Medicare insurance, the multiple procedure payment reduction (MPPR) policy applies to this CPT. Under MPPR, when multiple “Always Therapy” services are provided to the same patient on a single date of service even if the services are provided in a separate session, the procedure with the highest practice expense value that day is reimbursed at 100 percent, and all other subsequent services are paid at 50 percent. For commercial Insurance: The amount of reduction may vary according to insurance and insurance plan.
