New Physical Therapy Evaluation Codes and How to Use Them

By now you’ve heard about the new physical therapy evaluation codes and have started implementing them in your practice. And if you’re evaluating and reevaluating your patients (we certainly hope that you are…) you need to be extremely familiar with how to use each one correctly for accurate insurance reimbursements. In an effort to lend you a hand in deciphering the APTA evaluation code change, we’ve broken the new codes down to make learning the new codes simple. Here’s what you need to know:

The new initial evaluation codes replacing 97001

Code 97001 is gone with the wind to make way for three new, more specific initial evaluation codes:

1. 97161 – Low Complexity
2. 97162 – Moderate Complexity
3. 97163 – High Complexity

Now pairing severity of the patient’s condition with reimbursement rates, the APTA’s new mandated system works by classifying:

1. Patient history
2. Examination
3. Clinical presentation
4. Clinical decision making

How to Choose an Evaluation Code

In a recent article posted by Katie Pring, MPT, she streamlined the decision making process by making three charts to consider when choosing a new evaluation code

Pring also noted “when choosing the complexity of the evaluation, all components must be met and documented. If one of the four components is not met and documented, the therapist must default to a lower complexity evaluation code.”

The new reevaluation code replacing 97002

This is an easy one. Code 97002 is now 97164. No changes in complexity, just numerical.

What you need to know about the new APTA evaluations codes moving forward

In her article, Pring also gave some critical advice on the important implications that these new codes have in the immediate future. These included:

• The new evaluation codes will be accepted by all insurances with the exception of workers compensation and/or auto insurance providers.
• All initial evaluation codes will be reimbursed at the same fee scale.
• In upcoming months, APTA will have patient case scenarios that will allow therapists to review the case and practice determining which evaluation code to use.

While change is not always easy, it’s important to embrace what you have to. For more help with these evaluation codes, leave us a comment or read more at the APTA website and contact one of their professionals. Medbridge offers a free, online course as well!