In which situation is a billable re-evaluation appropriate?
A re-evaluation may be appropriate prior to planned discharge for the purposes of determining whether goals have been met, or for the use of the physician or the treatment setting at which treatment will be continued.
What is PT eval low complex 20 m?
Characteristics of a Low-Complexity Evaluation Typically, the PT spends 20 minutes face-to-face with the patient and/or family. The patient has a history of the present problem without any personal factors and/or comorbidities that impact the plan of care.
What is PT eval high complex 45?
PT Evaluative Procedures
| Code | Short Descriptor |
|---|---|
| 97161 | PT Eval Low Complex 20 min |
| 97162 | PT Eval Mod Complex 30 min |
| 97163 | PT Eval High Complex 45 min |
| 97164 | PT Re-eval Est Plan Care |
Does CPT code 97162 need a modifier?
Therapy modifiers This payment policy requires that each new PT evaluative procedure code – 97161, 97162, 97163 or 97164 – to be accompanied by the GP modifier; and, (b) each new code for an OT evaluative procedure – 97165, 97166, 97167 or 97168 – be reported with the GO modifier.
What is the definition of CPT code 97112?
CPT 97112 means “neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.” Like therapeutic activity, therapeutic procedures also apply to one or multiple body parts and require direct contact with the proper provider1.
What is the CPT code for PT eval?
These new evaluation codes are based on patient complexity and the level of clinical decision-making – low, moderate and high complexity: for PT, codes 97161, 97162 and 97163; and for OT, codes 97165, 97166 and 97167. Re-evaluation Codes.
What is PT Eval Mod complex 30 min?
Moderate Complexity – Typically, 30 minutes are spent face-to-face with the patient and/or family. High Complexity – Typically, 45 minutes are spent face-toface with the patient and/or family. Reevaluation – Typically, 20 minutes are spent face-to-face with the patient and/or family.
Does Medicare pay for 97162?
Non-Billable Eval Codes Update This means that if you perform an initial evaluation (CPT code 97161, 97162 or 97163) and bill CPT code 97530 and/or 97150, you will NOT receive payment for 97530 and/or 97150, even with the use of Modifier 59.
Is the GP Modifier only for Medicare?
Medicare also requires the GP modifier for physical medicine codes; however, since Medicare does not cover physical medicine services when rendered by Doctors of Chiropractic, your billed physical medicine services would include both the GP and GY (non-covered service) modifiers.