• News New Blog Banner

  • Questions on CPT Codes? APTA Has Answers

    Even though the new Current Procedural Terminology (CPT) coding set that started up on January 1 isn't so new anymore, APTA is continuing its award-winning efforts to educate members on how the 3-tiered evaluation system works—most recently, by way of an FAQ page that includes extensive links to detailed information.

    The new page uses a set of 7 question categories as a springboard to dive into not just the hows, but also the whys behind the new system, which stratifies evaluations by complexity—low (97161), moderate (97162), and high (97163). Among the questions: "Do the new evaluation codes apply to all patients receiving services under Medicare?" "What happens if I use an old code after January 1, 2017?" and "Why did the 3 new codes replace the single evaluation code?"

    The addition of the FAQ further enhances a suite of resources and educational offerings that earned APTA the American Medical Association's 2017 CPT Excellence in Education Award, an honor given in recognition of an organization's efforts to keep its members and nonmembers fully informed of changes and issues related to the CPT code set. APTA's informational outreach includes webinars, quick reference tools, interactive forums, and, now, a set of in-depth FAQs.

    For a quick take on of some of APTA's CPT educational resources, check out this PT in Motion News roundup, which includes links to the resources themselves. And remember, signing up for the Payment edition of APTA's Friday Focus series, a monthly collection of the top payment-related stories from PT in Motion News, helps you stay on top of a range of payment issues including the CPT codes.


    • can you tell me if Medicare pays for P.T servies in the home by a licensed therapist and what the codes would be? TYIA Paula B.

      Posted by paula blumenthal on 4/3/2017 11:21 AM

    • Is there a code for tube check/change for feeding tube patients.?

      Posted by Lisa Enriquez on 6/8/2017 5:37 PM

    • How do you bill Medicare when you remove multiple kidney stones from one kidney?

      Posted by Kevin Pasciak on 7/19/2017 2:50 PM

    • I am looking for correct CPT code to use for a family training model. I am a physical therapist certified in sensory integration and praxis test. I would like to provide consultation and family training to families dealing with children with sensory processing Disorders under early intervention program.

      Posted by Suzanne Ward on 4/13/2018 10:25 AM

    • @Suzanne: There is no specific code for family training. The physical therapists would include any family training under whatever is the most appropriate code to bill in terms of the type of treatment intervention.

      Posted by APTA Staff on 4/16/2018 12:21 PM

    • What codes do I use for physical therapy of the lower extrmities? Thanks

      Posted by Lilly Olateru on 4/18/2018 8:31 PM

    • I need to know if I can use Therapeutic Activities (97530) for aquatic PT for children. I only use the water as a medium for exercise. I feel confident that it should be used, but my supervisor states aquatic must be billed aquatic.

      Posted by Carrie Loeffler on 7/6/2018 7:13 AM

    • do complexity levels only pertain to Medicare and commercial/private insurance? We don't use complexity levels for Medicaid, correct?

      Posted by Barbara Crotts -> AHS^<K on 1/14/2019 9:05 PM

    • Since a ROTEM tests (thromboelastograph) are run several times during an OR procedure why can a CPT code for the test only be billed once? H & H tests are run repeatedly on patients and are charged everytime. Please explain...

      Posted by Daniel Pach on 1/22/2019 12:57 PM

    • I work at a cancer center and we treat patient's with chemotherapy-related neuropathy (sensory and motor). Are we allowed to bill Sensory Integration (97533) when performing manual techniques that are aimed at improving sensation (i.e. stimulation of nerves including use of fabrics for habituation, joint compression for stimulation of nerves in joint for improved proprioception)? Everything I'm seeing online states this is most often used for children with developmental sensory processing issues. Is it correct to assume this can be used for my case as well?

      Posted by Cris on 5/15/2019 10:33 AM

    • @Cris: It is possible that the treatment you describe may be best reflected by the neuromuscular re-education code in terms of addressing proprioception or by the manual therapy code with the use of joint compression, but you should check payer policy and, based on the policy, select the most appropriate code. Please contact alicebell@apta.org if you have specific questions.

      Posted by APTA Staff on 5/16/2019 8:24 AM

    Leave a comment
    Name *
    Email *