​​As we continue to transition to our next generation platform, we want to remind providers about the appropriate reporting requirements for physical and occupational therapy re-evaluations. 

​The following re-evaluation CPT® codes should not be routinely reported during a planned course of physical therapy (PT) and occupational therapy (OT): 

• PT = 97164​​​
• OT = 97168

Pre-payment edits will apply to these services when reported with other PT and OT services. 

When a patient's status changes and a re-evaluation is necessary and supported by the documentation in the medical record, the re-evaluation may be reported in addition to PT and OT services. When PT and OT services are reported in the same sessionwith re-evaluations, the re-evaluation services, 97164 or 97168, should be reported with the appropriate modifier appended. 

These edits are applied based on reporting requirements and guidelines endorsed by the Centers for Medicare & Medicaid Services (CMS) Medicare NCCI Policy Edits, Medicare NCCI 2023 Coding Policy Manual – Chapter 11, and the American Medical Association (AMA) Current Procedural Terminology (CPT) coding guidelines. 

Visit our Platform Transition page to stay informed of our ongoing platform transition.

​CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

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