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CPT Code 97164 | Reevaluation Of Physical Therapy Plan Of Care

CPT code 97164 describes a re-evaluation of a physical therapy plan of care. This procedure includes examining standardized tests and measures and revising the plan using assessment instruments and functional outcome measures.

What Is CPT Code 97164?

CPT 97164 is used to reevaluate a physical therapy plan of care. This includes reviewing the patient’s history and standardized tests and measures to assess the patient’s body structure and function.

The physical therapist uses this assessment to revise the care plan, typically spending around 20 minutes face-to-face with the patient or their family.

Description

The CPT book describes CPT code 97164 as: “Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is needed, and Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome. 

Typically, 20 minutes are spent face-to-face with the patient and/or family.”

Procedure

The physical therapist (PT) performs a general overall evaluation of the patient. 

First, the PT reviews the patient’s medical history. She uses standardized instruments, i.e., criteria established and agreed upon by experts and measurable functional outcome tools, to assess the patient’s body structure and function.

The patient may be asked to perform a variety of movements throughout this evaluation. The PT spends approximately 20 minutes of face–to–face time with the patient or family and uses the assessment to revise the care plan.

How To Use CPT 97164

You may use CPT code 97164 only for the re-evaluation of the physical therapy established plan of care. You can use CPT 97261, CPT 97162, or CPT 97163 for initial physical therapy evaluation of low, moderate, and high complexity.

References

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53309&Cntrctr=All&UpdatePeriod=780

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