CPT 97163 is used for billing purposes by physical and occupational therapists to indicate a high-complexity initial evaluation. This code is used to represent the therapist’s time and expertise when evaluating a patient with complex needs or multiple comorbidities. The evaluation typically includes an extensive examination of the patient, including patient history, systems review, and various tests and measurements to identify functional limitations and establish a treatment plan.
- A physical therapist is evaluating a 65-year-old patient who has recently suffered a stroke. The patient presents with hemiparesis, balance issues, and cognitive deficits. The therapist conducts a comprehensive examination, including a review of the patient’s medical history, cognitive and motor function assessments, and gait analysis. Due to the complexity of the case, the therapist bills the session using CPT 97163.
- An occupational therapist is assessing a 40-year-old patient with a recent spinal cord injury resulting in quadriplegia. The therapist evaluates the patient’s functional abilities, including activities of daily living (ADLs), upper extremity strength and range of motion, and adaptive equipment needs. The therapist also considers the patient’s psychological and social factors, as they impact the patient’s overall rehabilitation. Given the complexity of the case, the therapist uses CPT 97163 for billing purposes.
- A physical therapist is working with a 50-year-old patient who has been diagnosed with Parkinson’s disease and has multiple comorbidities, such as diabetes and hypertension. The therapist conducts a thorough examination, which includes a review of the patient’s medical history, assessment of motor function, balance, coordination, and gait, as well as a discussion of the patient’s goals for therapy. The high complexity of the case warrants the use of CPT 97163 for billing.