As we continue to transition to our next generation platform, we want to remind providers about the appropriate reporting requirements for physical and occupational therapy re-evaluations.
The following re-evaluation CPT® codes should
not be routinely reported during a planned course of physical therapy (PT) and occupational therapy (OT):
Pre-payment edits will apply to these services when reported with other PT and OT services.
When a patient's status changes and a re-evaluation is necessary and supported by the documentation in the medical record, the re-evaluation may be reported in addition to PT and OT services. When PT and OT services are reported in the
same session
with re-evaluations, the re-evaluation services, 97164 or 97168, should be reported with the appropriate modifier appended.
These edits are applied based on reporting requirements and guidelines endorsed by the Centers for Medicare & Medicaid Services (CMS) Medicare NCCI Policy Edits,
Medicare NCCI 2023 Coding Policy Manual – Chapter 11, and the American Medical Association (AMA) Current Procedural Terminology (CPT) coding guidelines.
Visit our Platform Transition page to stay informed of our ongoing platform transition.
CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
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