Description Of CPT Code 97116
This procedure may be medically necessary for training patients whose walking abilities have been impaired by neurological, muscular, or skeletal abnormalities or trauma.
Specific Indications For Gait Training (CPT Code 97116)
- The patient has suffered a cerebral vascular accident resulting in impairment in the ability to ambulate, now stabilized and ready to begin rehabilitation.
- The patient has recently suffered a musculoskeletal trauma, either due to an accident or surgery, requiring ambulation education.
- The patient has a chronic, progressively debilitating condition for which safe ambulation has recently become a concern.
- The patient has had an injury or condition that requires instruction in the use of a walker, crutches, or cane.
- The patient has been fitted with a brace prosthesis and requires instruction in ambulation; and/or
- The patient has a condition that requires retraining in stairs/steps or chair transfer in addition to general ambulation.
CPT Code 97116 Is Not Always Considered Medically Necessary
Gait training (CPT 97116) is not considered medically reasonable and necessary when the patient’s walking ability is not expected to improve.
CPT 97116 is not considered medically necessary when the goal is to increase the patient’s strength and endurance.