Wiki Question re: Therapy evaluation codes

[BarbaraBate2023]

Reviewing a plan that includes CPT 97162 x 2 (one-hour eval). Can more than one unit be billed for PT evals or is there a modifier if it takes longer than the "typical" # minutes that is referenced in the description? I couldn't find anything. My understanding is that these codes are "one unit" codes. Thanks so much!

 

[amyjph]

Incorrect. The MUE is one, this is not billed in multiple units for time like the "each 15 minutes" type codes. If it was a higher complexity the CPT (if requirements met) would be 97164 (typical time 45 mins). If the documentation meets moderate (97162) you can only bill one.

You "might" be able to append a 22 modifier but I have never seen this done in my 20+ years. It would be a really far out chance it would be paid and it would definitely trigger a records request in my opinion. Time alone and it taking longer is not enough to justify this. And, as an auditor I would question why 97164 was not billed.