Eli's Rehab Report

Question: One of our therapists is billing CPT 95831 and 95851 to private insurers when he treats his patients, but we are not sure whether therapists can bill these codes. It was our understanding that these codes were strictly for physiatrists. Is this correct?

Tennessee Subscriber

Answer: There are no national guidelines stating which practitioners can bill which CPT codes because these decisions are regulated by state licensing boards. Before billing these codes, you should check with your state board or your local therapy association. In most states, however, therapists are reimbursed for 95831 and 95851.

These codes identify manual muscle testing procedures, which are frequently performed by therapists who need to evaluate a patient's physical limitations. Automated muscle testing is included as part of physical performance testing/measurement (97750) and should not be billed with 95831 or 95851.

Using 95831 (Muscle testing, manual [separate procedure] with report; extremity [excluding hand] or trunk) requires that the practitioner test the patient's muscle strength, compare it to a standardized grading scale and write a report of the findings. Muscle testing performed without recording the specific values for the muscles tested, or without a separate written report, should not be billed using 95831. Instead, the testing would be included in the E/M visit for that day.

Code 95851 (Range of motion measurements and report [separate procedure]; each extremity [excluding hand] or each trunk section [spine]) also requires the therapist or physiatrist to write a report of the findings, and this code can be used when either a manual or computerized range of motion (ROM) measurement is performed.

According to the November 2001 CPT Assistant, neither manual muscle testing (95831-95834) nor range of motion (95851-95852) should be reported separately from physical performance testing/measurement (97750) because both services are included as part of physical performance testing procedures.