Knowledge Base Article

Q:

What is new for outpatient rehabilitative therapy services for 2017?

A:

Answer: CPT is deleting the existing rehabilitative therapy evaluation codes 97001-97004 and replacing them with eight new codes, CPTs 97161-97168. The new codes include complexity levels of low, moderate, and high for the evaluation codes for physical therapy (PT) and occupational therapy (OT) respectively and one re-evaluation code for each. Below are the new codes with their short descriptors, but the long descriptors can be found in the table at the end of MLN Matters Article MM9782 which also adds the new codes as “always therapy” codes to the therapy code list.

• CPT 97161 – PT Evaluation, Low Complexity, 20 minutes
• CPT 97162 – PT Evaluation, Moderate Complexity, 30 minutes
• CPT 97163 – PT Evaluation, High Complexity, 45 minutes
• CPT 97164 – PT Revaluation of Established Plan of Care

• CPT 97165 – OT Evaluation, Low Complexity, 30 minutes
• CPT 97166 – OT Evaluation, Moderate Complexity, 45 minutes
• CPT 97167 – OT Evaluation, High Complexity, 60 minutes
• CPT 97168 – OT Revaluation of Established Plan of Care

Medicare has also released the Therapy Cap Values for 2017 in MLN Matters Article MM9865. For physical therapy and speech-language pathology combined, the 2017 therapy cap will be $1,980. For occupational therapy, the cap for 2017 will be $1,980. As a reminder, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the therapy caps exceptions process through December 31, 2017 and also extended the application of the therapy caps, and related provisions, to outpatient hospitals until January 1, 2018. The exceptions process allows billing of therapy services exceeding the limit with the KX modifier if the services are medically necessary.