# ? regarding Physical Medicine CPT code



## DSchrlau (Sep 17, 2008)

I have a question regarding codes 97005 and 97006 regarding an Athletic training evaluation what are the rules on using this code or who (or where) would I be able to find out what the regulations are for charging for an Athletic training.  I work for an orthopaedic office and he is looking into hiring an Athletic trainer and was asking if we would be able to charge for his visits.

If anyone would be able to direct me to some answers.

Thank you

Diane


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## mbort (Sep 17, 2008)

I think the HUGE question here is whether the insurance carriers will pay for it, but here is a CPT assistant that may be of help:

Year: 2002 

Issue: June 

Pages: 9 

Title: Athletic Training Evaluations and Reevaluations 

Body: Coding Communication

CPT codes 97005, Athletic training evaluation, and 97006, Athletic training re-evaluation, were accepted by the CPT Editorial Panel specifically to report athletic training evaluations and re-evaluations. The therapist is required to be state-licensed to perform the athletic training evaluations and re-evaluations services. The following clinical vignettes describe typical work for these services.

Clinical Vignette: 97005

The patient is a 26-year-old male with a knee injury resulting from participation in a recreational basketball game. He has had a surgical procedure on the knee and presents with the required physician's order for an athletic training evaluation.

An evaluation was performed that included the patient's history, detailing the present condition, as well as a description of the occurrence of the sport-related trauma. This included any past or present medical conditions, and any prior or present treatment for the athletic injury; allergies are established. A physical evaluation was then done of the athletic injury and the current status including (as appropriate), but not limited to, visual inspection, palpation, active and passive range of motion measurements, anthropometric measurements, strength testing, and endurance testing. The patient is then evaluated for his capacity to return to sport activities.

The origination and documentation of a plan for the delivery of athletic training services is carried out by a licensed provider (eg, athletic trainer). The trainer then discussed the findings and the care plan with the patient to the mutual satisfaction of both parties, including the anticipated time frame for re-evaluating the progress toward returning to sport or athletic activity.

Clinical Vignette: 97006

A 26-year-old male with a knee injury resulting from participation in a recreational basketball game presents for a re-evaluation of his sport-related injury, following a course of athletic training services. This service is performed under a current physician order.

The patient is re-evaluated by the licensed provider (eg, athletic trainer) to determine specific progress made by the patient toward stated goals, including returning to sport or athletic activity, and a review of effectiveness in delivery of athletic training services related to the patient's stated goals.

Summary

Although the CPT book does not specify the credentials an individual practitioner must have to report a given service, the services are reported in the overall context of state licensure. Only those individuals licensed by a particular state to perform the described services should use these codes. Thus, the therapist providing the service must be state licensed to provide athletic training, as the evaluations and re-evaluations identified in the code descriptors are specifically limited to athletic training evaluations/re-evaluations.

As licensure varies from state to state, the applicable state laws and requirements determine who may perform specific types of services, including athletic training evaluations and re-evaluations. An athletic trainer who is not state-licensed (according to applicable state laws and requirements) to perform athletic training evaluations/re-evaluations should not report CPT codes 97005-97006.


© 2005 American Medical Association


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