CPT 97166 is a billing code used by occupational therapists to document the evaluation of patients with moderate complex needs.
The CPT 97166 code signifies a high-level, comprehensive evaluation that requires advanced clinical decision-making, typically for patients with multiple health or functional issues. During this evaluation, an occupational therapist will assess the patient’s medical history, current functional status, and develop a personalized treatment plan to address their unique needs and goals.
Three examples of cases in which an occupational therapist might use CPT 97166 include:
- Traumatic Brain Injury (TBI): A patient who has recently experienced a severe traumatic brain injury, resulting in cognitive impairments, physical limitations, and emotional or behavioral changes, may require a complex evaluation to determine the appropriate interventions and supports to facilitate recovery and optimize functional outcomes.
- Spinal Cord Injury (SCI): A patient with a high-level spinal cord injury may present with significant physical limitations, such as paralysis, reduced mobility, and loss of sensation. In this case, the occupational therapist will need to conduct a comprehensive evaluation to develop a tailored treatment plan that addresses the patient’s unique challenges, including adaptive equipment, functional training, and caregiver education.
- Complex Pediatric Cases: A child with multiple disabilities, such as cerebral palsy combined with a developmental disorder like autism, may require a detailed evaluation to understand the complex interplay of their conditions and develop an appropriate treatment plan. The occupational therapist will assess the child’s physical, cognitive, and social skills, as well as consult with other medical professionals, educators, and family members to develop a holistic intervention plan.