In healthcare, particularly in physical medicine and rehabilitation (PM&R), Current Procedural Terminology (CPT) codes are essential for billing, reporting, and maintaining consistent inpatient services. One such code is CPT 97750, which refers to “Physical performance test or measurement with a written report.”
This CPT code is primarily used by medical professionals, including physical therapists, occupational therapists, and other rehabilitation specialists, to document and bill for the services provided during functional performance evaluations. In this blog, we’ll explore the 97750 CPT code, when and how it is used, and the key components for accurate billing.

What is the 97750 CPT code?

A comprehensive assessment, CPT 97750, is the code to be used by the healthcare provider when giving a physical performance test or measurement to a patient. It encompasses tests and measurements to assess a patient’s strength, endurance, mobility, and capability to accomplish certain tasks or movements.
A written report with test results, recommendations for treatment or rehabilitation, and other related findings about the patient’s overall care plan usually accompanies this.
Such tests can be conducted during the first evaluation or as part of a progress evaluation to follow the changes within a patient’s rehabilitation over time. Results can also be used to direct clinical decision-making, enhance personalization of treatment plans, and provide an objective score that can be used for tracking patient progress.

When Is CPT Code 97750 Applied?

CPT 97750 can be applied to a variety of situations:

• Baseline Measurements: In a patient’s first physical therapy or rehabilitation visit, this test can be applied to evaluate baseline function and ability.
• Progress Assessments: Throughout treatment, healthcare providers can apply this code to track changes in strength, mobility, or function.
• Return-to-work assessments: In cases where the goal of rehabilitation is to return the patient to work (such as following an injury), a physical performance test can be applied to determine if the patient can return to work.
• Pre- and Post-surgical Assessments: For patients with musculoskeletal or neurological conditions who undergo surgery, a performance test may be used to assess their physical readiness for surgery and subsequent recovery.
• Disability and Insurance Evaluations: Performance tests may offer objective evidence to substantiate workers’ compensation, personal injury, or disability claims.

Key components of CPT 97750

Healthcare providers must know certain elements of CPT 97750 to ensure correct coding and proper billing.

Performance Test or Measurement:

It is necessary for the providing healthcare professional to conduct the performance test or measurement. These tests usually measure one of the following physical areas of performance:

• Range of motion (ROM)
• Muscle strength
• Balance and coordination
• Gait analysis
• Endurance
• Functional movement
• Flexibility

Documented Report:

The writing report after the performance test is one of the necessities of CPT 97750. This written report should consist of the actual results of the test plus the following:

• A clear elaboration of the patient’s performance on the test.
• Any identified limitations or impairments during the assessment
• Based on the findings, recommendations for treatment or rehabilitation
• A summary of the current physical condition of the patient in strength, mobility, and functionality

Purpose of the Test:

The physical performance test is not only a means of measuring the patient’s progress. It also serves as a tool to decide whether or not a patient is ready for rehabilitation. This is either for formulating a specific treatment plan for an individual or measuring their improvement toward certain rehabilitation goals. The data that it collects is meant to yield useful information.

Billing and Coding Tips for CPT 97750

When billing using the 97750 CPT code, providers need to be mindful of the following factors:

• Accurate Documentation: Documentation is crucial for justifying CPT 97750. It should be clear, objective, and well-recorded regarding measurements and outcomes.
• Distinct from Other Tests: CPT 97750 is specifically a code for physical performance testing and must not be confused with other tests or procedures that may be associated with physical therapy, such as modalities, evaluation, or other therapeutic interventions with their respective CPT codes.
• Avoid Overbilling: CPT 97750 should only be used for tests that meet the necessary criteria. Do not use this code for routine physical exams or assessments that do not involve a detailed performance measurement.
• Insurance and Payer Guidelines: Different insurance carriers have requirements for when this code can be used. Be sure to familiarize yourself with payer guidelines, especially for commercial and government plans like Medicare or Medicaid, as reimbursement rates vary.
• Multiple Tests: If multiple performance tests are performed, each test should be billed separately, but services should only be duplicated if distinct performance measurements are involved.

Advantages of Using CPT 97750

• Holistic Care: This code enables the healthcare provider to provide more holistic care by assessing a patient’s functional abilities. This enables the development of individualized rehabilitation programs tailored to the patient’s needs.
• Objective Data for Monitoring Progress: Performance tests allow healthcare providers to monitor a patient’s rehabilitation progress objectively. This aids in decision-making, changing treatment plans, and setting realistic goals.
• Facilitates Communication with Insurance Companies: CPT 97750 allows for clear documentation to support the argument to insurance companies that a continued therapy or rehabilitation program is needed. It can prove helpful in obtaining continuing approvals for treatment.
• Improves Patient Outcomes: Physical performance tests help providers identify specific areas of concern that need improvement through accurate measurements and detailed reports. Treatment plans are thus rendered more efficient and effective.

How does Medatron streamline the use of CPT Code 97750?

Medatron helps healthcare providers efficiently use the 97750 CPT code in its services by streamlining the whole process of documentation for the physical performance tests. With the aid of technology, Medatron gives its healthcare professionals real-time access to data related to several physical performance tests. The platform then produces detailed, standardized reports that include test results, patient progress, and recommendations, ensuring accurate and consistent documentation. This saves time and reduces the possibility of errors in coding and billing, which ultimately improves the workflow for providers and ensures compliance with insurance requirements for CPT 97750.

Conclusion

97750 CPT code is an important tool in physical medicine and rehabilitation. It helps measure, document, and guide treatments for patients based on their physical performance assessment. Whether used for initial evaluations, progress monitoring, or return-to-work assessments, this code ensures that patients obtain the care they need for recovery, strength gain, and optimal functional outcomes.
Using 97750 CPT code is thus considered effective only if the tests are comprehensive, results are properly documented, and the evaluation purpose aligns with the overall care plan for the patient. With Medatron’s innovative solutions, conducting assessments and creating accurate, standardized reports is much more efficient and does not burden healthcare providers as much. This streamlined approach ensures the exact billing and coding and enhances patient care by providing a more effective and time-saving method for tracking progress and outcomes.