CPT^® 97164, Under Physical Therapy Evaluations

The Current Procedural Terminology (CPT^®) code 97164 as maintained by American Medical Association, is a medical procedural code under the range - Physical Therapy Evaluations.

Additional/Related Information

Tabs

Summary

The provider, typically a physical therapist, conducts a physical therapy re–evaluation that includes history review and standardized tests and measures to assess body structure and function; she revises the plan of care using standardized instrument and measurable functional outcome assessment tool, typically involving 20 minutes of face–to–face time with the patient or family or both.

For clinical responsibility, terminology, tips and additional info
start codify free trial.

View any code changes for 2024 as well as historical information on code creation and revision.

Crosswalks

Tabs

Combat the #1 denial reason - mismatched CPT-ICD-9 codes - with top Medicare carrier and private payer accepted diagnoses for the chosen CPT® code.

View the CPT® code's corresponding procedural code and DRG. In a click, check the DRG's IPPS allowable, length of stay, and more. To plug inpatient facility revenue drains, subscribe to DRG Coder today.

Crosswalk to an anesthesia code and its base units, and calculate payments in a snap! Subscribe to Anesthesia Coder today.

View matching HCPCS Level II codes and their definitions.

Forum

Have a question about CPT Code 97164 ? Start a discussion here

PT and OMT, Modifier 59

. When both services are provided in the same encounter, PT Re-eval 97164 and OMT 98925, which CPT code should get modifier 59? (The provider is a Physical Therapist)... [ Read More ]

Physiotherapy initial evaluation billing guidelines - 97161

Hi, Greetings! Can anyone assist on the coding/billing guidelines regarding the allowed time limit to bill initial physiotherapy codes(97161-97163), its related to presenting condition/disease or any ... [ Read More ]

97164 billed with 97140

Hello, we billed Aetna commercial using 97164 and 97140:59. They denied for CO151 payer deems the information submitted does not support this many services. We asked for reconsideration with medica... [ Read More ]

Physical Therapy- billing eval/re-eval on same day as other procedures?

So at the beginning of 2020, Medicare had the brilliant idea to say that you couldn't bill 97530 with ANY eval code AT ALL - no modifier allowed. They repealed that decision after everyone threw a fi... [ Read More ]

PT re evals

Hey all! I used to be able to bill a pt eval 97164 w/mod 59 and then also bill therapeutic exercise (97530) and get paid for both. Recently I have been getting paid only for the 97530 and denied the... [ Read More ]

Physical Therapy- billing eval/re-eval on same day as other procedures?

[QUOTE="lexy1011@gmail.com, post: 479701, member: 306427"] I've been having a really hard time getting my physical therapy evaluations paid when any other form of therapy was provided during the same ... [ Read More ]

97164

Hi! I still consider myself a new coder, but I bill/code for a primary care office which also has a physical therapy dept. Around the begging of 2020 we were getting paid for a 97164 using modifier ... [ Read More ]

97164 97164 billing cpt modifier59 physical therapy re-eval

Hi, This is my post in the forum and newly certified. I’m currently work in a physical therapy office. We were discussing utilizing the re-eval. code 97164. I understand that there are some guide... [ Read More ]

Physical Therapy- billing eval/re-eval on same day as other procedures? physical therapy

I've been having a really hard time getting my physical therapy evaluations paid when any other form of therapy was provided during the same session, and I'm hoping someone can help. Examples: 97162 a... [ Read More ]

Physical therapy- new eval with a re-eval

Hello, I have come across a few office notes where our physical therapist is Re- evaluating the patient's initial problem while also doing a new eval on new problem that is NOT related to the initial... [ Read More ]

View All