Q&A on CPT Code 97750

By Rick Gawenda, PT

Many providers of therapy services struggle with when to use CPT code 97750, when not to use this code, who can use this code, what interventions are included under this code and what time is included toward the billing of this code. I often receive questions regarding CPT code 97750 such as:

1. When can I bill CPT code 97750?
2. Can we use CPT code 97750 in place of a reevaluation if an insurance carrier does not pay for a reevaluation?
3. Can we use CPT code 97750 for the time it takes us to take range of motion measurements on a patient?
4. Can we use CPT code 97750 for the time it takes us to perform manual muscle testing on a patient?
5. Can we bill this CPT code for the time a patient completes a questionnaire, and we review it with the patient?
6. How often can we bill CPT code 97750?
7. How many units of CPT code 97750 will insurance carriers pay when billed on the same date of service?
8. Can we bill CPT code 97750 for writing a Progress Report?
9. What must be documented to support the use and billing of CPT code 97750?
10. What time counts towards “each 15 minutes” when determining how many units to bill?
11. Does the time it takes to document the tests results and develop the plan of care count towards the billable time?
12. Would computerized muscle testing be an example when to bill CPT code 97750?
13. Does the Medicare program pay for CPT code 97750 on the same day that the same discipline bills an evaluation or reevaluation CPT code?
14. Can a physical therapist assistant or occupational therapy assistant perform a physical performance test or measurement with a patient and bill CPT code 97750?

The description of CPT code 97750 per CPT 2021 Professional Edition is “Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes.”¹

Let’s now answer the questions from above.

QUESTION

When can I bill CPT code 97750?

ANSWER

You can bill this CPT code when you provide a physical performance test and measurement that is separate and distinct from an evaluation or reevaluation. This testing may be manual and/or performed using equipment. Examples include, but are not limited to Berg Balance Test, Tinetti, Timed Get Up and Go Test, Purdue Pegboard Test, isokinetic/isometric strength testing, Four Square Step Test, and Dynamic Gait Index.

QUESTION

Can we use CPT code 97750 in place of a reevaluation if an insurance carrier does not pay for a reevaluation?

ANSWER

No, unless an insurance carrier states you can bill this CPT code in place of the reevaluation CPT code. CPT code 97750 is not the same as a reevaluation (CPT code 97164 (PT reevaluation) or 97168 (OT reevaluation)). Per the Centers for Medicare and Medicaid Services, a reevaluation is warranted when the professional assessment of a clinician indicates a significant improvement, or decline, or change in the patient’s condition or functional status that was not anticipated in the plan of care while CPT code 97750 is focused on patient performance of a specific activity or group of activities.²

QUESTION

Can we use CPT code 97750 for the time it takes us to take range of motion measurements on a patient?

ANSWER

No! If the intent of the therapist or other qualified healthcare provider is to perform a range of motion test of an entire extremity or hand, with or without comparison to the opposite side, as a separate procedure, it would be appropriate for the provider to choose the appropriate CPT code of either 95851 or 95852. As a side note, to bill 95851, the therapist must take range of motion measurements of all the planes of motion in that extremity or trunk, excluding the hand. Since most of the time, we are only treating one joint such as the shoulder, elbow, hip, knee, or ankle, there would be no need to take range of motion measurements of all the planes of motion in an extremity to justify the billing of 95851. If the therapist’s services are more comprehensive and include performance testing, then the minutes taking range of motion measurements would be included within CPT code 97750.³

QUESTION

Can we use CPT code 97750 for the time it takes us to perform manual muscle testing on a patient?

ANSWER

If only performing manual muscle testing (MMT) on a muscle or group of muscles and it’s not part of a more comprehensive physical performance test or measurement, then the time (minutes) performing the MMT would be added into the other time-based interventions provided that date of service and would not be billed under CPT code 97750. If the MMT is more comprehensive and includes physical performance testing, then the minutes performing the MMT would be included within CPT code 97750.³

QUESTION

Can we bill this CPT code for the time a patient completes a questionnaire, and we review it with the patient?

ANSWER

No! A questionnaire would not be considered a physical performance test or measurement and would not qualify to be billed under CPT code 97750.

QUESTION

How often can we bill CPT code 97750?

ANSWER

That would be dependent upon the insurance the patient has as some insurance carriers may limit how often they will pay for the CPT code during the same episode of care and/or during the same benefit calendar year. Nationally, the Medicare program does not limit how often this CPT code can be billed; however, your Medicare Administrative Contractor may limit how often this CPT code can be billed and/or how many units they will pay when the CPT code is billed on the same date of service.

QUESTION

How many units of 97750 will insurance carriers pay when billed on the same date of service?

ANSWER

Of course, the answer depends on each insurance carrier. Per the Centers for Medicare and Medicaid Services (CMS) Medically Unlikely Edits (MUEs) effective April 1, 2021, CMS states they will allow 8 units of 97750 on the same date of service for private practice settings and 8 units of 97750 on the same date of service facility settings. If a provider bills more than 8 units of CPT code 97750 to their Medicare Administrative Contractor (MAC) and those units in excess of 8 are automatically denied upon claim submission, MACs may pay units of service (UOS) in excess of the MUE value if there is adequate documentation of medical necessity of correctly reported units. If MACs have pre-payment evidence (e.g. medical review) that UOS in excess of the MUE value were actually provided, were correctly coded, and were medically necessary, the MACs may bypass the MUE for 97750 and reimburse the provider for the UOS that were in excess of 8 units.⁴

For additional information on MUEs, read MLN Matters MM8853. You can access this document at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8853.pdf.

QUESTION

Can we bill CPT code 97750 for writing a Progress Report?

ANSWER

No, this CPT code is not used for writing a Progress Report. If you did a physical performance test or measurement as part of a Progress Report and it meets the minimum minutes to bill CPT code 97750, then you could bill 97750 for the test or measurement that was completed.

QUESTION

What must be documented to support the use and billing of CPT code 97750?

ANSWER

Per the May 2008 CPT Assistant, when billing CPT code 97750, the therapist is required to have a separate written report noting the findings. The therapist should include the reason for performing the test or measurement, identification of any protocol or standardized test that was used, data that was collected, direct contact time spent with the patient, and analysis of the findings.⁵

QUESTION

What time counts toward “each 15 minutes” when determining how many units to bill?

ANSWER

The time that counts toward the “each 15 minutes” is the time it takes to administer the test and analyze and interpret the results with the patient present.

Per CPT Assistant May 2008, documentation of the following time elements will assist in supporting the number of units billed for this procedure:

• Total time spent with the patient in providing the test and measurement, including the time spent preparing the patient for the test and measurement procedure
• The time spent performing the selected protocol
• The time spent with the patient in providing any post-testing instructions⁵

QUESTION

Does the time it takes to document the tests results and develop the plan of care count towards the billable time?

ANSWER

No, documentation time is not billable time and those minutes must not be included when determining how many units of 97750 to bill.

QUESTION

Would computerized muscle testing be an example when to bill CPT code 97750?

ANSWER

Yes! Per CPT Assistant May 2008, computerized muscle testing would be billed using CPT code 97750.^{5 <}/p>

QUESTION

Does the Medicare program pay for 97750 on the same day that the same discipline bills an evaluation or reevaluation CPT code?

ANSWER

No, the Centers for Medicare and Medicaid Services (CMS) does not reimburse for CPT code 97750 when billed on the same day as an initial evaluation billed by the same discipline. Per Chapter 11 of the 2021 National Correct Coding Initiative (NCCI) Policy Manual for Medicare, page xi-33 and xi-34, CMS states the following: “CPT codes 97750 (Physical performance test or measurement), 97755 (Assistive technology assessment), and 97763 (Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes) are not separately reportable for the same date of service with a physical therapy evaluation/re-evaluation CPT code (e.g., 97161-97164) or occupational therapy evaluation/re-evaluation CPT code (e.g., 97165-97168) when the 2 services are performed by a single practitioner or 2 practitioners of the same specialty. If the 2 services are performed by 2 different practitioners of different specialties, the 2 services may be reported using an NCCI PTP-associated modifier. For example, if a physical therapist performs 1 service and an occupational therapist performs the other service, the 2 services may be reported separately. However, if a physical therapist performs 1 service and a different physical therapist performs the other service, the 2 services are not separately reportable.”⁶

QUESTION

Can a physical therapist assistant (PTA) or occupational therapy assistant (OTA) perform a physical performance test or measurement with a patient and bill CPT code 97750?

ANSWER

A PTA or OTA can perform a physical performance test or measurement under the direction and appropriate supervision of the physical therapist or occupational therapist (OT), respectively, if allowed by their respective state practice act. The time in minutes that would count towards the billable time would only be the time it takes to perform the applicable test(s) and/or measurement(s). A PTA or OTA can’t analyze and interpret the results. That would need to be performed by the physical therapist or OT and if done, those minutes would then be added to the minutes spent performing the applicable test(s) and/or measurement(s) to determine how many units of 97750 can be billed. 

References:

¹Current Procedural Terminology 2021, Professional Edition. Chicago, IL: American Medical Association; 2020.

²Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, Section 220. Centers for Medicare and Medicaid Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf. Accessed May 7, 2021.

³CPT Assistant February 2004. https://www.ama-assn.org/system/files/2020-09/cpt-assistant.pdf. American Medical Association. Accessed May 7, 2021

⁴Medicare, National Correct Coding Initiative Edits, Medically Unlikely Edits, Effective 04-01-2021. Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE. Accessed May 7, 2021.

⁵CPT Assistant May 2008. American Medical Association. https://www.ama-assn.org/system/files/2020-09/cpt-assistant.pdf. Accessed May 7, 2021.

⁶Medicare, National Correct Coding Initiative Edits, NCCI Policy Manual for Medicare, 2021 National Correct Coding Initiative (NCCI) Policy Manual for Medicare, copyright 2020, Chapter XI, Medicine, Evaluation and Management Services, CPT Codes 90000-99999. Centers for Medicare and Medicaid Services. https://www.cms.gov/files/document/chapter11cptcodes90000-99999final112021.pdf. Accessed May 7, 2021.

Rick Gawenda, PT, is the founder and president of Gawenda Seminars & Consulting, Inc. and member of the PPS Payment Policy Committee. He may be reached at info@gawendaseminars.com and on Twitter @gawendaseminars.