CPT 97750 refers to the evaluation of a patient’s physical performance through tests and activities, with a written report provided. This article will cover the code description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.
1. What is CPT 97750?
CPT 97750 is a medical billing code used to describe the evaluation of a patient’s physical performance, such as musculoskeletal and functional capacity, through various tests and activities. The healthcare provider assesses the patient’s performance and completes a written report detailing the tests performed, results, and treatment options. This code is used to bill for comprehensive and detailed performance testing related to a specific ailment.
2. 97750 CPT code description
The official description of CPT code 97750 is: “Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes.”
- The provider prepares the testing area with the necessary equipment based on the patient’s case.
- After calibrating the instruments, the provider evaluates the patient based on individual needs, such as level of pain, sensation, and grip strength, as well as mobility activities like walking, crawling, and climbing.
- The provider also checks activities related to positional tolerance like standing, sitting, and stopping, and those related to strength like lifting, pushing, and pulling.
- The provider then documents in a written report the details of the tests performed, results, and treatment options.
- He instructs the patient about activities such as those related to work and safety.
4. Qualifying circumstances
Patients eligible to receive CPT code 97750 services are those who require a comprehensive evaluation of their physical performance due to a specific ailment or condition. This may include patients with musculoskeletal disorders, functional limitations, or those recovering from an injury or surgery. The provider must determine that the evaluation is medically necessary and appropriate for the patient’s condition.
5. When to use CPT code 97750
It is appropriate to bill the 97750 CPT code when a healthcare provider performs a comprehensive and detailed evaluation of a patient’s physical performance related to a specific ailment or condition. The evaluation must include various tests and activities, and the provider must complete a written report detailing the results and treatment options. One unit of 97750 should be billed for every 15 minutes of physical performance testing performed.
6. Documentation requirements
To support a claim for CPT 97750, the healthcare provider must document the following information:
- Reason for the evaluation and its medical necessity
- Specific tests and activities performed during the evaluation
- Results of the tests and activities
- Treatment options and recommendations based on the evaluation results
- Duration of the evaluation, in 15-minute increments
7. Billing guidelines
When billing for CPT code 97750, healthcare providers should adhere to the following guidelines:
- Bill one unit of 97750 for every 15 minutes of physical performance testing performed.
- Ensure that the evaluation is comprehensive and detailed, covering all relevant physical performance tests for the patient’s specific ailment or condition.
- Document the evaluation thoroughly, including the reason for the evaluation, tests and activities performed, results, treatment options, and duration.
8. Historical information
CPT 97750 was added to the Current Procedural Terminology system on January 1, 1995. There have been no updates to the code since its addition.
9. Similar codes to CPT 97750
Five similar codes to CPT 97750 and how they differentiate are:
- CPT 97755: This code is used for assistive technology assessments, focusing on the patient’s need for specific devices or equipment.
- CPT 97760: This code covers orthotic management and training, which involves the use of orthotic devices to support or correct a patient’s physical function.
- CPT 97761: This code is for prosthetic training, which focuses on the patient’s ability to use and maintain a prosthetic device.
- CPT 97762: This code is used for checkout for orthotic/prosthetic use, which involves the evaluation of a patient’s ability to use an orthotic or prosthetic device effectively and safely.
- CPT 97763: This code covers orthotic/prosthetic management and training for patients with specific conditions, such as cerebral palsy or spinal cord injury.
Here are 10 detailed examples of CPT code 97750 procedures:
- Evaluation of a patient’s functional capacity following a knee replacement surgery, including tests for strength, range of motion, and mobility.
- Assessment of a patient’s grip strength and dexterity following a hand injury, with recommendations for occupational therapy interventions.
- Evaluation of a patient’s ability to perform activities of daily living (ADLs) after a stroke, including tests for mobility, balance, and coordination.
- Assessment of a patient’s functional capacity for work following a back injury, including tests for lifting, carrying, and positional tolerance.
- Evaluation of a patient’s endurance and cardiovascular fitness following a cardiac event, with recommendations for a supervised exercise program.
- Assessment of a patient’s balance and risk of falls following a hip fracture, including tests for strength, range of motion, and gait.
- Evaluation of a patient’s functional capacity for sports participation following an ankle injury, including tests for agility, speed, and power.
- Assessment of a patient’s ability to perform self-care tasks following a spinal cord injury, including tests for upper extremity function and mobility.
- Evaluation of a patient’s functional capacity for independent living following a traumatic brain injury, including tests for cognitive and motor skills.
- Assessment of a patient’s ability to perform work-related tasks following a shoulder injury, including tests for strength, range of motion, and endurance.