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CPT® Code 96004 refers to the review and interpretation conducted by a physician or other qualified healthcare professional of comprehensive computer-based motion analysis. This procedure encompasses various advanced techniques, including dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography. The primary purpose of this code is to provide a detailed written report based on the analysis of these complex motion studies. Comprehensive computer-based motion analysis is particularly beneficial for patients with intricate movement disorders, such as those resulting from cerebral palsy, spina bifida, traumatic brain injury, amputation, stroke, or other conditions that impair movement. The analysis is performed in specialized motion analysis laboratories equipped with sophisticated technology, including 3-D kinematics, 3-D kinetics, and dynamic electromyography. The process involves the use of markers placed on specific bony landmarks, allowing for precise tracking of joint movements and muscle activity during various functional activities. Ultimately, the findings from this analysis assist healthcare professionals in determining the most appropriate therapeutic services, braces, prosthetics, or surgical interventions tailored to the patient's unique needs.
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The procedure associated with CPT® Code 96004 is indicated for patients with complex movement problems. These conditions may include:
The procedure for CPT® Code 96004 involves several detailed steps to ensure comprehensive analysis of the patient's movement. The process begins with the placement of markers on specific bony landmarks on the pelvis and lower extremities. This is crucial for accurate tracking during the motion analysis. The patient is then instructed to walk in a designated area where specialized cameras are positioned to capture the movement of the markers from multiple angles, including the front, back, and sides. This step allows for the collection of data on joint movement and power as the patient walks over force plates embedded in the ground. Additionally, stride characteristics are measured using electronic sensors placed on the patient's feet or by the tracking markers, providing further insight into the patient's gait dynamics.
Following this, dynamic plantar pressure measurements are taken. This involves the application of electronic sensors on the patient's feet, which record and measure the weight-bearing pressures on the bottom of the foot as the patient walks. This data is essential for understanding how the patient's weight is distributed during movement.
Next, surface electrodes are placed bilaterally on the muscles of the lower extremities, including the adductors, rectus femoris, quadriceps, hamstrings, and calf muscles. As the patient engages in walking or other functional activities, these electrodes capture the activity of each muscle, recording the timing and magnitude of muscle responses. This information is vital for assessing muscle function and coordination.
Finally, the physician or other qualified healthcare professional reviews and analyzes all the collected data from the motion analysis studies. This comprehensive review culminates in a written report that details the findings and provides insights into the patient's movement patterns and potential therapeutic interventions. It is important to note that CPT® Code 96004 is reported only once, regardless of the number or types of motion studies performed.
After the completion of the motion analysis and the generation of the written report, the patient may receive recommendations based on the findings. These recommendations could include specific therapeutic services, the need for braces or prosthetics, or suggestions for surgical interventions. The healthcare professional may also discuss the results with the patient and their family, providing guidance on the next steps in the management of the patient's movement disorder. Follow-up appointments may be scheduled to monitor the patient's progress and to adjust any treatment plans as necessary. Overall, the post-procedure phase is crucial for ensuring that the patient receives the most effective care tailored to their individual needs.
| Short Descr | PHYS REVIEW OF MOTION TESTS | Medium Descr | PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR | Long Descr | Review and interpretation by physician or other qualified health care professional of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 2 - Professional Component Only Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 2 - 150% payment adjustment does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x) | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | T2D - Other tests - other | MUE | 1 | CCS Clinical Classification | 227 - Other diagnostic procedures (interview, evaluation, consultation) |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GP | Services delivered under an outpatient physical therapy plan of care | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area |
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| 2013-01-01 | Changed | Description Changed |
| 2007-01-01 | Changed | Code description changed. |
| 2002-01-01 | Added | First appearance in code book in 2002. |
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