CPT 97001 – CPT 97004 | Descriptions & Replacement Codes

CPT 97001 and CPT 97002 were used for physical therapy, and CPT 97003 and CPT 97004 described occupational therapy. These codes were removed on 01-01-2017 and replaced. 

This deletion was made as part of the code set change, replacing the existing CPT codes for therapy evaluations and reevaluations (CPT 97001 until CPT 97006) with new codes considering evaluation complexity.

To report these services, CPT advises using new codes CPT 97161 to CPT 97172 that indicate a tiered level of complexity for physical and occupational therapy and athletic training evaluations and reevaluations.

CPT Code 97001 (DELETED)

CPT 97001 was used for physical therapy evaluation of 30 minutes and provided by a physical therapist. They checked the patient’s join flexibility, gait, muscle strength, and neuromuscular function.

Description

The description of CPT code 97001 was: “Physical therapy evaluation.”

Procedure

The 97001 CPT code procedure started with the physical therapist’s general evaluation of the patient. After that, a brief medical history was taken.

Then, the physical therapist performed an analysis of the patients;

• mobility;
• gross neuromuscular status;
• coordination;
• balance;
• flexibility; and
• muscle strength.

If the patient had a prosthetic device, it was also reviewed by the physical therapist. A variety of movements were checked throughout the evaluation.

This procedure took, on average, 30 minutes. Finally, the clinical findings were put into the SOAP note sheet’s Assessment and Planning section for evaluation.

Possible physical therapy intervention and the overall diagnosis were discussed with the patient after the evaluation.

Replacement Code For CPT 97001

The 2017 CPT codes manual deleted CPT 97001, which describes a general physical therapy (PT) evaluation to assess factors such as joint flexibility, muscle strength, gait, mobility, and neuromuscular function.

CPT 97001 is replaced with CPT 97161, CPT 97162, or CPT 97163 for physical therapy evaluations.

CPT Code 97002 (DELETED)

CPT code 97002 was used for physical therapy reevaluation of 60 minutes and provided by a physical therapist. The reevaluation only happened if the documentation of the patient showed a significant change in the condition or diagnosis of a patient.

The physical therapist may be needed to modify expected outcomes and anticipated goals, followed by reevaluation of the patient’s progress. All of the components of the initial evaluation (as described by CPT code 97001) are part of the reevaluation.

Description

CPT 97002 was described by the CPTs manual as: “Physical therapy reevaluation.”

Procedure

The physical therapist performed a general overall reevaluation of the patient. First, a medical history was taken, which was followed by an analysis of mobility, flexibility, muscle strength, balance, gross neuromuscular status, and coordination. A variety of movements were asked to perform, and if present, the condition of any prosthetic device was reviewed.

The total time of the reevaluation took, on average, 60 minutes. The findings were reported in the Evaluation sheet’s Assessment and Planning section of the SOAP note section. The possible physical therapy intervention and diagnosis were discussed with the patient.

Replacement Code For CPT 97002

CPT advises replacing CPT code 97002 with CPT 97164.

CPT Code 97003 (DELETED)

CPT 97003 was used for occupational therapy evaluation by evaluating day–to–day activities of a patient’s life that are needed and give them purpose.

Description

CPT code 97003 was described by the CPTs manual as: “Occupational therapy evaluation.”

Procedure

The 97003 CPT code procedure started with an initial evaluation by an occupational therapist to assess the patient’s lifestyle by reviewing their home, play, work, and general lifestyle conditions.

The occupational therapist tested the upper extremity function of a patient, manual muscles, range of motion, muscle tone, and sensory and performed other tests if needed.

Replacement Code For CPT 97003

CPT 97003 for occupational therapy evaluation was removed from the CPTs manual in 2017 and replaced with CPT 97165, CPT 97166, and CPT 97167.

CPT Code 97004 (DELETED)

CPT 97004 was used for occupational therapy reevaluation for ongoing therapy.

Description

The CPT manual described the 97004 CPT code as: “Occupational therapy reevaluation.”

Procedure

CPT code 97004 described a reevaluation of ongoing occupational therapy. The occupational therapist measured progress to see if the patient improved in basic skills, physical activities, and other areas if needed.

Replacement Code For CPT 97004

CPT 97004 was removed on the 1st of January 2017 and replaced with CPT 97168.

Resources

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52866&bc=CAAAAAAAAAAA

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=33413