97750 CPT Code: Know Your CPT Codes
97750 CPT Code Basics
97750 CPT Code Description: Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with a 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 evaluating the ability to perform specific tasks. It may include several multi-varied tests and measurements of the physical performance of a select area or several areas.
These services are not to be used instead 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.
Medically Unlikely Edit (MUE) for 97750 CPT Code
Providers sometimes run into trouble when billing the 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 represents the maximum number of units that require further documentation to support.
The Medically Unlikely Edit (MUE) for CPT code 97750 is currently set at 4 hours per day, meaning providers are unlikely to require more than 4 hours to perform and report functional capacity tests for a single patient. However, justifications may exist for exceeding the MUE, such as:
- Complex testing protocols involving multiple specialized measures.
- Patients with significant functional limitations or multiple co-morbidities require extensive assessment.
- Unexpected complications during testing necessitate additional interventions or adjustments.
- Extensive report writing with detailed interpretations and individualized treatment recommendations.
For exceeding the MUE, thorough documentation and strong justifications are crucial to avoid claim denials.
Documentation Requirements
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.
Feeling confident about 97750 CPT code billing?
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References:
The American Medical Association (AMA) owns the copyright for the Current Procedural Terminology (CPT) coding system. It’s important to note that CPT codes can vary over time and may be subject to updates and revisions. The AMA periodically releases new editions of the CPT code set to reflect changes in medical practices and technology, as well as updates in reimbursement guidelines.
