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
PHYSICAL PERFORMANCE TEST
Physical performance test or measurement, also known as “Functional Capacity Evaluation” (FCE), is performed on patients with neurological or musculoskeletal conditions to evaluate his/her ability to perform specific tasks that includes activities of daily living (ADLs) or instrumental activities of daily living (IADLs). It is a complete objective assessment test of a person’s abilities in work related functional tasks. For this reason, it is used to determine functional status of patient before beginning a work conditioning/hardening program. Performance Test is done manually as well as by using equipment.
Areas of Assessment:
- Activities of daily living (ADLs)
- Instrument activities of daily living (IADLs)
- Aerobic capacity
- Equilibrium and balance
- Cognition
- Dexterity
- Functional mobility
- Occupational performance
Physical Performance Test Includes:
- Balance evaluation such as timed up and go test
- 6 minute walk test
- Evaluation of functional capacity
- Manual muscle testing
- ROM
- Special musculoskeletal tests for one or more body regions
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
» Billed in 15 minutes increment
» Billed in addition to routine physical therapy and occupational therapy evaluation and reevaluation (97161-97172)
» Requires physical 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 97750 to be billed:
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:
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:
- Total direct time spent by the provider with the patient as well as total duration of treatment.
- Documentation of improvement from therapy using objective assessment tools and measurements and functional accomplishments.
- Therapy plan must be developed by a qualified/certified healthcare professional.
- For reimbursement, a separate written report is required which should contain the following elements:
- Measures performed to access patient’s functional capacity.
- Data collected from tests and measurements.
- Impact of outcomes or results of tests on plan of care.
- Payment made not be made in the following conditions:
- If physical therapy services are provided to a patient in a hospital outpatient
department or. - If physical therapy services are provided to an inpatient by an independently
practicing healthcare provider.
- It is suggested to check specific insurance coverage criteria as some insurance limit billing of 97750 with PT/OT evaluation and re-evaluation CPTs on the same date of service.
- Do not report a CPT code from the ROMs series in addition to 97750.
