Please note that this article contains information that is only relevant to American clinics.

 

January 1, 2017 not only marks the beginning of a New Year, but a new set of evaluation codes for physical and occupational therapists, too. In this article, we’ll be sharing some information regarding the latest changes to the evaluation codes.  Check them out below:

 

New Evaluation Codes for Physical Therapists

 

As of right now, PTs are required to use the ‘97001’ CPT code to bill for an evaluation. But, on January 1, this code will no longer exist. Instead, it will be replaced by three new CPT codes. They are:

 

97161 – Low complexity PT evaluation

 

97162 – Moderated complexity PT evaluation

 

97163 – High complexity PT evaluation

 

Click here to learn about the CMS’ final rule for 2017. 

 

New Evaluation Codes for Occupational Therapists

 

For OTs, it is currently necessary to use the ‘97003’ CPT code to bill for an evaluation; however, on January 1, they’ll be required to use three new CPT codes. The use of each evaluation code depends on the situation surrounding the evaluation. They are:

 

97165 – Low complexity OT evaluation

 

97166 – Moderate complexity OT evaluation

 

97167 – High complexity OT evaluation

 

Now that we’ve covered all of the new evaluation codes, you’re probably wondering what types of facilities and insurance carriers they’re relevant to. Let’s start with the insurance carriers.

 

Simply put, these new evaluation codes will affect everyone who receives outpatient therapy services. More specifically, all HIPAA compliant health plans, healthcare clearinghouses, and healthcare providers who electronically transmit claims will be required to use these codes.

 

There are also several different types of facilities who are required to use this new CPT code. Some of them include private practices, outpatient rehab centers, and skilled nursing facilities. If you’re unsure whether your facility will be affected by these new changes, we recommend contacting your clearing house or your patients’ insurance carriers for more details.

 

Did you find this article helpful? Click here to access more content like this on the Gawenda Seminars & Consulting website.

---