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Physical Performance Testing Made Simple with 97750 CPT Code

Name: Cures Medical Billing Services Company
Address: 3811 Ditmars Blvd# 1124, Astoria, NY 11105, Astoria, NY, 11105, USA
Telephone: +1 (917) 994-9941

Overall performance testing plays an important role in comparing a patient’s capacity to carry out daily obligations after accidents, surgeries, or illnesses. One of the largest pieces of equipment for this motive is the 97750 CPT code, also called the Functional Capacity Evaluation (FCE) CPT code. This blog post explores its use of hints and blessings in the element, presenting a complete guide for healthcare providers.

What is CPT Code 97750?

The 97750 CPT code represents a physical overall performance check conducted in 15-minute increments to evaluate a patient’s musculoskeletal and purposeful potential. These checks are essential for patients undergoing rehabilitation or making ready to return to work after an injury or illness. The results are compiled into an in-depth written record that enables healthcare provider’s layout personalized treatment plans.

Key Features of 97750 CPT Code

Timed-based code, billed in 15-minute increments.
Requires direct patient-provider contact.

It includes tasks we do every day, like personal care (ADLs) and more complex activities like managing household duties (IADLs).
These activities are commonly addressed in physical therapy, occupational therapy, and chiropractic care.

Areas of Assessment

When making use of the CPT 97750, healthcare provider’s assess many areas of a patient’s functional capacity, such as:

Activities of Daily Living (ADLs): Basic responsibilities include eating, bathing, and dressing.

Complex duties like dealing with price range or cooking.

Aerobic Capacity Instrumental Activities of Daily Living (IADLs): Assessing cardiovascular endurance.

Balance and Equilibrium: Tests like the Timetabled Up and Go (TUG) test.

Cognition: Evaluating mental abilities associated with bodily overall performance.

Dexterity: Measuring great motor competencies.

Functional Mobility: Ability to transport and perform bodily duties efficiently.

What Tests Are Covered Under 97750 CPT Code?

A sort of check falls beneath the 97750 CPT code descriptions, consisting of:

6-Minute Walk Test: Measures aerobic ability and residing power.

Manual Muscle Testing (MMT): Evaluates strength.

Range of Motion (ROM) Testing: Checks how well joints can move.

Balance Evaluations: Includes dynamic and static balance exams.

Special Musculoskeletal Tests: Focus on specific frame regions.

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Coding Guidelines for CPT Code 97750

Healthcare providers need to comply with strict pointers while billing CPT 97750 to make certain accurate repayments:

Direct Contact: The issuer should spend a minimum of eight minutes in direct patient touch for one unit of 97750 to be billed.
Modifier Requirements: Appropriate modifiers (e.g., GP, GO, GN) must be used primarily based on the plan of care.

Documentation: The report must include:
- Tests performed.
- Data collected.
- Influences on the patient’s plan of care.
CMS 8-Minute Rule: A unit is billed for every 15 minutes, starting from 8 minutes of service.

Bill in 15-Minute Increments

The 97750 CPT code is scheduled and is billed in 15-minute blocks. Providers must report one unit when the performance test lasts up to 22 minutes, with additional units added based on the total time spent with the patient.

Billing Units	Test Duration	Details
1 unit	8-22 minutes	Direct contact testing lasts at least 8 minutes and can go up to 22
2 units	23-37 minutes	Direct contact testing lasts at least 23 minutes and can go up to 37 minutes.
3 units	38-52 minutes	Direct contact testing lasts at least 38 minutes and can go up to 52 minutes
4 units	53-67 minutes	Direct contact testing lasts at least 53 minutes and can go up to 67 minutes.
5 units	68-82 minutes	Direct contact testing lasts at least 68 minutes and can go up to 82 minutes.
6 units	83-97 minutes	Direct contact testing lasts at least 83 minutes and can go up to 97 minutes.
7 units	98-112 minutes	Direct contact testing lasts at least 98 minutes and can go up to 112 minutes.
8 units	113-127 minutes	Direct contact testing lasts at least 113 minutes and can go up to 127 minutes.

Append Appropriate Physical Therapy Modifiers

Modifiers are essential for accurately billing the 97750 CPT code and providing additional information about the service. Below are some common modifiers used with this code:

GO: Used for services at an outpatient occupational therapy centre.
GP: Used for services at an outpatient physical therapy centre.
76: The same procedure was repeated by the same doctor.
77: The same procedure was repeated by a different doctor.
KX: The therapy is medically necessary and exceeds the annual threshold set by Medicare (e.g., $2,330 for 2025).

59: Used when another separate service was performed on the same day.

Common Applications of 97750 CPT Code

The 97750 CPT code definitions include several scenarios where physical performance tests are necessary:

Pre-Employment Screening
Used by employers to assess candidates’ physical readiness for demanding roles, such as law enforcement or healthcare workers.
Workers’ Compensation Cases
Evaluate whether injured employees can resume work and identify potential limitations.
Rehabilitation Progress Evaluation
Tracks recovery milestones during physical rehabilitation to refine treatment plans.
Disability Assessments
Supports disability claims by documenting the patient’s inability to perform work-related tasks.

Common Applications of 97750 CPT Code

The 97750 CPT code definitions include several scenarios where physical performance tests are necessary:

Pre-Employment Screening
Used by employers to assess candidates’ physical readiness for demanding roles, such as law enforcement or healthcare workers.
Workers’ Compensation Cases
Evaluate whether injured employees can resume work and identify potential limitations.
Rehabilitation Progress Evaluation
Tracks recovery milestones during physical rehabilitation to refine treatment plans.
Disability Assessments
Supports disability claims by documenting the patient’s inability to perform work-related tasks.

Reimbursement Guidelines

To ensure successful reimbursement for services billed under the 97750 CPT code, providers should:

Maintain accurate documentation of the time spent and tasks performed.
Verify payer-specific rules to avoid claim denials.
Use appropriate modifiers, such as GP or GO, depending on the therapy provided.

Benefits of Using CPT Code 97750

By employing the 97750 CPT codes, healthcare providers can:

Accurately measure a patient’s functional capabilities.
Develop tailored rehabilitation plans.
Ensure compliance with insurance and reimbursement standards.

Conclusion

The 97750 CPT codes are essential for measuring physical performance, helping in rehabilitation, and ensuring patients receive comprehensive care. Whether it’s a pre-employment screening, workers’ compensation case, or rehabilitation development assessment, this code ensures accurate reporting and powerful treatment planning. Remember to partner with skilled specialists like Cures Medical Billing for streamlined billing and coding services to control your claims effectively.

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