CPT Code 97162 – Face-to-Face Physical Therapy Evaluation, 30 Minutes

Q: How is 97162 different from 97161 and 97163?

97161 = low complexity 97162 = moderate complexity 97163 = high complexity Use 97162 when the patient’s condition and comorbidities require moderate clinical decision-making , and you’re evaluating 2-3 body structures or systems .

Q: What should be documented when billing 97162?

Make sure to include: Patient history with medical and treatment background Clinical reasoning showing moderate decision-making Tests and measurements performed Functional limitations and goals Time spent on evaluation (though this is not time-based)

Q: What ICD-10 codes are commonly billed with 97162?

Common ICD-10 codes include: M25.561 – Pain in right knee M54.5 – Low back pain M62.81 – Muscle weakness R26.9 – Gait abnormality The diagnosis must support medical necessity for a moderate complexity evaluation.

CPT Code 97162 is a billing code that documents a face-to-face physical therapy evaluation lasting approximately 30 minutes. This code applies to patients requiring a moderate complexity evaluation, typically involving moderate impairments, functional limitations, or participation restrictions.

Understanding CPT Code 97162

Duration: 30 minutes of direct interaction with the patient.
Purpose: Evaluation for individuals with moderate therapeutic needs.
Scope: Includes a medical history review, examination of body systems, and development of a treatment plan addressing moderate impairments.

Related Physical Therapy CPT Codes

While 97162 CPT codes are specific to moderate complexity evaluations, other physical therapy CPT codes help document different services in therapy:

CPT Code 97161: Face-to-face evaluation for mild complexity (20 minutes).
CPT Code 97163: Evaluation for high complexity (45 minutes).
CPT Code 97110: Therapeutic exercise to improve strength, endurance, and range of motion.
CPT Code 97116: Gait training for improving walking mechanics.
CPT Code 97140: Manual therapy techniques for joint mobilization or soft tissue manipulation.

Each of these pt. CPT codes ensure accurate reporting and billing for therapy services.

Why is CPT Code 97162 Important?

Accurate Diagnosis: A comprehensive evaluation helps ensure an accurate diagnosis and appropriate treatment plan.
Improved Outcomes: A well-defined treatment plan increases the likelihood of positive outcomes.
Reimbursement: Accurate coding is essential for proper reimbursement from insurance companies.

Choosing the Right Physical Therapy Evaluation CPT Code

Selecting the correct physical therapy evaluation CPT code is essential for compliance and billing accuracy:

Use CPT Code 97161 for mild complexity evaluations.
Apply CPT Code 97162 for moderate complexity evaluations (30 minutes).
Opt for CPT Code 97163 when handling cases of high complexity.

Final Thoughts

The correct application of CPT Code 97162 ensures proper documentation, effective treatment planning, and timely reimbursements. By staying informed about physical therapy CPT codes, practitioners can streamline medical billing and focus on delivering quality patient care.

For assistance with therapy billing or clarification of physical therapy procedure codes, reach out to experienced billing professionals to ensure accuracy and compliance.

Frequently Asked Questions (FAQs)

What is CPT Code 97162 used for?

CPT 97162 is used for a moderate complexity physical therapy evaluation. It’s billed when the therapist assesses a patient’s condition using moderate clinical decision-making and examines 2-3 elements like history, body systems, and functional limitations.

How is 97162 different from 97161 and 97163?

97161 = low complexity
97162 = moderate complexity
97163 = high complexity
Use 97162 when the patient’s condition and comorbidities require moderate clinical decision-making, and you’re evaluating 2-3 body structures or systems.

Can I bill 97162 more than once for the same patient?

No. CPT 97162 is meant for the initial physical therapy evaluation. You can’t bill it again unless the patient has a new condition, or there’s a significant change that requires re-evaluation, in which case you’d use 97164.

How much does CPT 97162 reimburse under Medicare?

As of 2025, Medicare reimburses CPT 97162 at approximately $100–$110 nationally, depending on your location and the MAC (Medicare Administrative Contractor) you fall under. Always check your local fee schedule for accuracy.

What should be documented when billing 97162?

Make sure to include:

Patient history with medical and treatment background
Clinical reasoning showing moderate decision-making
Tests and measurements performed
Functional limitations and goals
Time spent on evaluation (though this is not time-based)

Is CPT 97162 time-based?

No, 97162 is not time-based. It’s an untimed code that reflects the complexity of the evaluation, not the minutes spent. Focus on clinical detail, not duration.

Who can bill for 97162?

Only licensed physical therapists can bill for CPT 97162. It’s not billable by PTAs, techs, or non-PT providers under CMS guidelines.

Can 97162 be billed with treatment codes like 97110 or 97530?

Yes. You can bill 97162 on the same date of service as treatment codes like 97110 (therapeutic exercises) or 97530 (therapeutic activities) if you perform both services and document them separately.

What ICD-10 codes are commonly billed with 97162?

Common ICD-10 codes include:

M25.561 – Pain in right knee
M54.5 – Low back pain
M62.81 – Muscle weakness
R26.9 – Gait abnormality
The diagnosis must support medical necessity for a moderate complexity evaluation.

Does 97162 require a referral or physician order?

In many states, direct access allows physical therapists to evaluate without a referral. However, some insurers, including Medicare, may require a physician’s order for reimbursement. Always confirm payer rules.