97750 CPT Code: Know Your Codes
97750 CPT Code Basics
97750 CPT Code Description: Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes. Physical testing or measurement describes tests and measurements performed by a physician or other qualified health care professional. A physical performance test or measurement may be reasonable and necessary for patients with neurological or musculoskeletal conditions when there is a need to evaluate the ability to perform specific tasks. It may include a number of multi-varied tests and measurements of the physical performance of a select area or number of areas.
These services are not to be used in lieu of evaluation or re-evaluation services. Testing may be manual and/or performed using the equipment. Some examples of testing that are typically reported with CPT code 97750 include isokinetic testing for assessing the combination of strength, endurance, and power while performing certain movements with the trunk or extremities, functional capacity testing, and specific tests and measures related to balance such as the timed up-and-go test. It is not medically reasonable and necessary to bill this service as part of a routine assessment/evaluation of rehabilitation services. Direct one-on-one patient contact is required.
MUE for 97750
- Providers sometimes run into trouble when billing 97750 CPT code. Providers use this procedure code to bill for functional capacity exams, including physical performance tests and measurements, with written reports. However, Medically Unlikely Edit (MUE) complicates the matter by limiting the number of billable units. MUE represent the maximum number of units that require further documentation to support.
- In the case of CPT 97750, the Centers for Medicare and Medicaid Services (CMS) determined that physicians are ‘unlikely’ to need more than 2 hours to perform and report functional capacity tests for a given patient on any single day. Units of service for 97750 are 15 minutes each; thus, the maximum number of billable units is 8.
- If your testing and reports have exceeded the two hours of MUE allowable units, or if you plan to perform additional exams under code 97750 in the same month, we recommend get a signed agreement with the employer or insurer’s claims administrator. If your office receives denied payment due to MUE for 97750, it is suggested you submit a request for second review.
Standardized testing batteries may be incorporated into a physical performance test. It would not be appropriate to report a code from the 95831-95834 or the 95851- 95852 series in addition to 97750.
As code 97750 is a time-based code, the test or measurement procedure as well as the time spent analyzing and interpreting the results in the presence of the patient are elements of the visit that must be documented. The time element determines the number of units to be reported for this procedure. Three-time elements must be documented to correctly report code 97750:
- Total time spent with the patient in providing the test and measurement, including the time spent preparing the patient for the test and measurement procedure;
- The time spent performing the selected protocol; and
- The time spent with the patient in providing any post-testing instructions.
The elements of documentation that support the reporting of code 97750, include documentation of the testing elements and/or protocols, documentation and interpretation of the data collected, and impact on the patient’s plan of care (i.e., discharge, return to sport or activities of daily living (ADL), or modification of treatment). Time spent in direct contact with the patient determines the number of units to be reported for this procedure.
For accurate medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for its accurate and affordable medical billing services. To know more about our medical billing services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com
CPT codes and their descriptions and the policies discussed in this article do not reflect or guarantee coverage or payment. Just because a CPT code exists, payment for the service it describes is not guaranteed. Coverage and payment policies of governmental and private payers vary from time to time and for different areas of the country.