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2017 Physical Therapy and Occupational Therapy Codes

Each year, the American Medical Association (AMA) editorial board updates the list of CPT® codes by adding new codes and revising or deleting certain existing codes.1

Effective January 1, 2017, the AMA replaced CPT codes 97001, 97002, 97003 and 97004 with the new codes listed below. These new codes allow billers to account for the severity and complexity of treatment provided to patients.

Code Category

Eval./Low

Eval./Moderate

Eval./High

Re-evaluation

Physical Therapy

97161

97162

97163

97164

Occupational Therapy

97165

97166

97167

97168

The Centers for Medicare & Medicaid Services (CMS) did not recommend that carriers establish different reimbursement rates for the three evaluation levels. Horizon BCBSNJ’s allowance for low, moderate and high level evaluations will be the same allowance. The new codes are still subject to Horizon BCBSNJ’s “per day” maximums and that amount has not changed for 2017.

If you have questions, contact your Network Specialist.

1 Information on new and updated CPT codes is available on the AMA website.

CPT® is a registered mark of the American Medical Association.

Published on: March 23, 2017, 11:41 a.m. ET
Last updated on: March 23, 2017, 11:42 a.m. ET