Here comes 2017 and we have 3 New Physical Therapy Evaluation Codes. CMS has proposed a new physical therapy codes for 2017 as part of the Medicare Physician Fee Schedule (CMS-1654-P) proposed rule for 2017.
Recently it was announced that the Physical Therapy Evaluation (97001) and Physical Therapy Re-evaluation (97002) codes have been deleted, and four new codes have been released in their place. These codes will be effective by January 1, 2017.
We have now the:
- CPT Code 97001 is DELETED and REPLACED by 3 new physical therapy evaluation Codes.
- CPT Code 97002 is DELETED and REPLACED by one single re-evaluation code.
The new evaluation codes (97161 to 97163) center on services ranging in complexity from low to high, each with a code descriptor specifying required components.
These New Physical Therapy Evaluation Codes has 4 Components of Complexity and Severity:
- Code no. 97161 – Physical therapy evaluation: low complexity, requiring the following components:
- A history with no personal factors and/or co morbidity that impact the plan of care.
- Identify and Document Personal Factors that may impact the plan of care for Physical Therapy treatment; Eg. Age, gender, social history, education background, lifestyle, coping styles, job/profession, present/past experience. Document the overall behavior patterns including experience with disability.
- An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions.
- Existing personal factors that will not impact the plan of care should not be used when selecting the level of service.
- Code no. 97162 – Physical therapy evaluation: moderate complexity, requiring these components:
- A history of present problems with 1-2 personal factors and/or co morbidities that impact the plan of care.
- Examination of body system(s)using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions.
- An evolving clinical presentation with changing characteristics.
- Clinical decision making of moderate complexity using standardised patient assessment instrument and/or measurable assessment of functional outcome.
- Code no. 97163 – Physical therapy evaluation: high complexity, requiring these components:
- A history of present problems with 3 or more personal factors and/or co morbidity that impact the plan of care.
- A clinical presentation with unstable and unpredictable characteristics.
- An examination of body system(s) using standardized tests and measures in addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions.
- Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.
- Code no. 97164 – Re-evaluation of physical therapy established plan of care, requiring these components:
- An examination, including a review of history and use of standardized tests and measures is required;
- Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome.
Since these codes are untimed codes, the time (minutes) rendered during the evaluation are now part of the “total minutes” of treatment time this includes both the untimed and timed codes.
“It’s evident that these new codes focus on complexity levels of evaluations, which means that therapists will have to be diligent in accurately identifying low, medium and high complexity. And of course, it would be best for therapists to review and understand the changes fully by looking at the new AMA 2017 CPT code book”