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CPT Code 97750 Guide to Physical Performance Testing in Medical Billing
CPT code 97750 is used to report a physical performance test that evaluates a patient’s functional capacity. This test assesses strength, endurance, balance, and other factors critical to rehabilitation.
It is commonly known as a Functional Capacity Evaluation (FCE) and plays a vital role in determining a patient’s ability to perform daily activities or return to work after an injury.
Purpose of CPT Code 97750
This code is used to:
- Assess a patient’s physical capabilities, such as musculoskeletal function and endurance.
- Determine appropriate treatment plans and rehabilitation goals.
- Monitor progress over time and adjust therapy accordingly.
Who Requires a Functional Performance Test?
A physical performance test is often required for:
- Patients with neurological or musculoskeletal conditions.
- Individuals undergoing rehabilitation after an injury or surgery.
- Workers preparing to return to work post-illness or injury.
What’s included in the Evaluation?
A written report is essential for documentation and reimbursement. The evaluation typically covers:
- Activities of Daily Living (ADLs): Bathing, dressing, mobility tasks.
- Instrumental Activities of Daily Living (IADLs): Shopping, cooking, and using a phone.
- Aerobic capacity, balance, cognition, dexterity, and functional mobility.
Billing and Time-Based Structure
- Billed in 15-minute increments.
- Some insurance providers limit reimbursement to four units per session.
- The CMS 8-Minute Rule and AMA Rule of Eights apply to determine billable units.
CMS 8-Minute Rule Guidelines
- 1 unit: 8 to 22 minutes
- 2 units: 23 to 37 minutes
- 3 units: 38 to 52 minutes
- 4 units: 53 to 67 minutes (and so on)
Who Can Bill CPT Code 97750?
Only qualified healthcare professionals can bill for CPT 97750, including:
- Physical Therapists (PTs) and Occupational Therapists (OTs)
- Chiropractors
- Physical Therapy Assistants (PTAs) and Occupational Therapy Assistants (OTAs) (with supervision)
Modifier Requirements for CPT 97750
Appropriate modifiers must be applied when medical billing, depending on the treatment setting:
- GP – Outpatient Physical Therapy
- GO – Outpatient Occupational Therapy
- GN – Speech-Language Pathology
- CQ – Therapy by a Physical Therapist Assistant
- CO – Therapy by an Occupational Therapy Assistant
Coding Guidelines & Documentation Requirements
To ensure proper reimbursement and avoid claim denials:
- Document the total treatment time and the provider’s direct contact with the patient.
- Include measurable outcomes to justify the necessity of therapy.
- A separate written report must outline the functional capacity tests performed, data collected, and how results impact the treatment plan.
Common Challenges in Billing CPT 97750
- Exceeding Medically Unlikely Edits (MUE) limits
- Incorrect coding or missing documentation
- Limited payer reimbursement policies restricting the number of units allowed
Conclusion
CPT 97750 is a timed-based code used for assessing a patient’s functional performance. Proper documentation, appropriate modifiers, and adherence to billing guidelines are essential for successful reimbursement. Healthcare providers should verify payer-specific policies to avoid denials and optimize revenue.
Frequently Asked Questions (FAQs)
CPT Code 97750 is used to bill for physical performance testing that evaluates functional abilities, such as strength, balance, flexibility, or mobility. This includes standardized assessments (e.g., timed walking tests, grip strength) to quantify a patient’s physical limitations or progress.
This code is justified for patients requiring objective measurement of physical function due to:
- Post-surgical rehabilitation (e.g., joint replacement).
- Chronic conditions (e.g., Parkinson’s, multiple sclerosis).
- Injury recovery (e.g., fractures, spinal cord injuries).
Documentation must link testing to a specific treatment plan or diagnosis.
Yes, but services must be distinct and separately documented. For example:
- 97110 (Therapeutic exercise) for active treatment.
- 97750 for performance testing to assess progress.
Avoid “routine” testing bundled into standard therapy sessions.
Modifiers may be needed if billing multiple units or overlapping services:
- Modifier 59: To indicate testing is separate from other procedures performed the same day.
- Modifier KX: To confirm medical necessity if required by payers like Medicare.
Common ICD-10 codes include:
- M62.81 (Muscle weakness).
- R26.2 (Difficulty walking).
- G20 (Parkinson’s disease).
- S72.001A (Fracture of femur, initial encounter).
Typically, one unit per day, as it represents a single episode of testing. Exceptions require documentation proving extended time (e.g., complex multi-system assessments).
Some insurers (e.g., Medicaid, commercial plans) may require prior authorization. Verify payer-specific rules, especially for non-acute or chronic conditions.
No. This code requires in-person, hands-on testing to accurately measure physical performance. Telehealth assessments of function would use other codes (e.g., 99421-99423 for virtual care).
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