Document Evaluation Complexity

Effective January 2017, the single CPT codes for physical and occupational therapy evaluation are each being replaced by three complexity-based evaluation codes.

The information in this topic helps you decide whether an evaluation is low, moderate, or high complexity. You should select the least-complex code described by all of the applicable factors.

Warning: Do not use the legacy evaluation codes for any dates of service after January 1, 2017 unless the legacy codes are specifically required by the payer. All payers that are required to use HIPAA compliant data sets, which includes Medicare and most commercial payers, require the new codes. The legacy codes will still be required for a limited set of worker’s comp and auto insurers.

Physical therapy evaluation codes

Occupational therapy evaluation codes

Manage evaluation codes in templates

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