Drastic changes are coming to evaluation and re-evaluation codes for physical and occupational therapy in 2017. As of January 1st, 2017, the current evaluation and re-evaluation codes (97001, 97002, 97003, and 97004) will be removed from the CPT code list and replaced with three new evaluation codes for both PT and OT along with one new re-evaluation code for each discipline. All HIPAA covered entities must use the current year’s CPT codes which means Medicare and most commercial insurances will be required to switch to the new codes on January 1st. Workers comp carriers and auto insurance carriers are not mandated by HIPAA to use the CPT codes and could therefore still use the old eval and re-eval codes.
The new evaluation codes will include different components of complexity and severity. For physical therapy, those components include:
The new evaluation codes for physical therapy are:
For occupational therapy, the components of complexity and severity are:
The new occupational therapy codes along with their descriptors are:
As mentioned earlier, there will also be new re-evaluation codes for each discipline. For PT, the new re-evaluation code is 97164 (Reevaluation of physical therapy established plan of care) and will require these components:
For OT, the new re-evaluation code is 97168 (Reevaluation of occupational therapy established plan of care) and will require these components:
Future blog posts will provide a deeper dive into defining the parameters outlined above as well as additional information regarding the selection criteria for the different evaluation codes. Stay tuned.
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