CPT-97750

Physical performance test or measurement

Code Type

Timed-based code  Billed in 15 mins increment

Add-On Code

No add-on code

Physical Performance Test or Measurement

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).

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:

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

Coding Guidelines

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)

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.

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CPT-97750

Category

Code Type

Add-On Code

Physical Performance Test or Measurement

Areas of Assessment:

Physical Performance Test Includes:

Coding Guidelines

CMS 8-Minute Rule:

Coding Guidelines

Physical Therapy Modifiers

Reimbursement Guidelines

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CPT-97750

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