Goodbye, 97001 & 97002

By Monica White, DPT, PRCP

As you may have heard, Centers for Medicaid & Medicare Services (CMS) is changing how we code for physical therapy evaluations in 2017. There will be three new evaluation codes– 97X61, 97X62, and 97X63–that will replace 97001, and one new re-evaluation code, 97X64, that will replace 97002.

How will this change the reimbursement rate?

At this point we’re not sure. CMS will publish the final ruling on payment rates in late October or early November. CMS has proposed to keep the same reimbursement rate whether you are evaluating a relatively simple or a complex patient or whether you spend 20 minutes or 45 minutes evaluating a patient. Check out what the new codes will look like below:

New Physical Therapy CPT Codes

Code	CPT Long Form Descriptors for Physical Medicine and Rehabilitation
97X61	Physical therapy evaluation: low complexity, requiring these components: ● A history with no personal factors and/or comorbidities that impact the plan of care; ● 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; ● A clinical presentation with stable and/or uncomplicated characteristics; and ● Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. ●Typically, 20 minutes are spent face-to-face with the patient and/or family
97X62	Physical therapy evaluation: moderate complexity, requiring these components: ● A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; ● An examination of body systems 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; and ● Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. ● Typically, 30 minutes are spent face-to-face with the patient and/or family.
97X63	Physical therapy evaluation: high complexity, requiring these components: ● A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; ● An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; ● A clinical presentation with unstable and unpredictable characteristics; and ● Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. ● Typically, 45 minutes are spent face-to-face with the patient and/or family
97X64	Reevaluation 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; and ● Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome Typically, 20 minutes are spent face-to-face with the patient and/or family. 97X65 Occupational therapy evaluation, low complexity, requiring these components…

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-16097.pdf

Change is just around the corner! Keep an eye on the SOWH Blog and the SOWH Payment, Policy, and Advocacy web page for more updates: http://www.womenshealthapta.org/practice/payment-policy-and-advocacy/

AUTHOR: Monica White, DPT, PRCP, is a CAPP-Pelvic certified member of the SOWH Reimbursement Committee.

New Physical Therapy CPT Codes

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