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.

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