1

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

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.