Physical Therapy Coding Changes

Physical Therapy Coding Changes

2017 Coding Changes

Every specialty is impacted by the 2017 coding changes but physical therapy coding changes are drastic.  Over the next few weeks, Onpoint Medical Solutions will highlight some of the changes by specialty.  This week we’ve summarized the coding changes for physical therapy.

There are major changes for the Physical Therapy evaluation and re-evaluation codes for 2017.  The current codes 97001, 97002, 97003, 97004 have been deleted and replaced with 3 new evaluation codes, CPT 97161, 97162, 97163.

You are likely aware that Medicare and most commercial carriers required the switch as of January 1st.   But did you know that workers compensation and auto insurance carriers are not mandated by HIPAA to use the new CPT codes?  This means that you will still have to use the old codes for these carriers while remembering to use the new codes for all other carriers.  For your reference, we have included an easy to read summary of the new physical therapy CPT codes.

For physical therapy, the new evaluation codes will include different components of complexity and severity.  For instance:

  1. Patient history, medical and functional, including relevant comorbidities and personal factors;
  2. Examination AND the use of standardized tests and measures;
  3. Clinical presentation of the patient; and
  4. Clinical decision making including standardized patient assessment instrument and or measurable assessment of functional outcome.


Changing what you’ve done and how to do it is always challenging.  Don’t let your practice suffer.  Make sure you capture all services, all codes and enter the correct number of units.  Now is the time to work with your biller to implement edits to catch and correct the coding errors before the claims go out.  This will ensure that your cash flow won’t be negatively impacted.  The physical therapy coding changes don’t have to jeopardize your practice.

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