Physical Therapy Evaluation (97001) and Physical Therapy Re-evaluation (97002) codes have been deleted for 2017 and replaced with four new codes.
The new evaluation codes 97161-97163 describe services that range in complexity from low to high and have a code descriptor that has specific required components. I have cited some of these requirements below from the new AMA 2017 CPT codebook however I do recommend that you review it as well.
#•97161 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.
#•97162 Physical therapy evaluation: moderate complexity, requiring these components:
• A history of present problems with 1-2 personal factors and/or comorbidities that impact the plan of care;
• An examination of body system(s) 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 he patient and/or family.
#•97163 Physical therapy evaluation: high complexity, requiring these components:
• A history of present problems with 3 or more personal factors and/or comorbidities that impact the plan of care;
• An examination of body system(s) using standardized tests and measures in addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
• An 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.
For re-evaluation of physical therapy established plans of care, you would now utilize CPT 97164.
#•97164 Re-evaluation of physical therapy established plan of care, requiring these components: