General Category > General Questions

Physical Therapy Evaluations

(1/1)

Chell5:
What is the difference between 97001 and an E/M consultation?  Also, am I correct that 97002 done when there is a significant change in functioning?  Is there a quantity restriction on the number of rechecks?  My last question is regarding group therapy. . .is there any restrictions on age of the patients?  For example, the pt wants to do group exercised for obese kids.  Thanks for your help!

Michele:
Hi,
   
97001 is the cpt code specifically for an initial physical therapy evaluation to evaluate the client’s condition and establishing the plan of care.  An E&M code is for the evaluation and management of a medical condition, a medical exam that must meet certain key components.  A physical therapist should not be using E&M codes for their initial evaluation since there is a more specific cpt code to indicate the PT initial eval.

As for the 97002, or re-eval, the frequency depends on each individual insurance carriers.  Some state you can only do a re-eval once per year.  Others have different criteria.  There is no universal rule. 

For group therapy, I am not aware of any restrictions specifically due to age.  Each insurance carrier has their own guidelines (sorry if I sound like a broken record :(  )  but usually PT is covered if it is ordered by a physician for a covered medical condition. 

Hope that helps you out.

Michele

Chell5:
It does help. I was hopeful that I could bill an E/M because it is reimbursed so much higher.  Thanks for the information.

Navigation

[0] Message Index