Summary & Overview
CPT 97750: Physical Performance Test or Measurement, Outpatient Rehabilitation
CPT code 97750 represents a physical performance test or measurement, commonly used in physical medicine and rehabilitation to assess musculoskeletal function or overall functional capacity. This procedure is essential for evaluating patient progress and determining appropriate therapeutic interventions. The code is billed in 15-minute increments and requires a written report documenting the findings.
Major national payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and reimbursement benchmarks for 97750 are relevant for outpatient therapy providers, particularly those working within physical therapy or occupational therapy care plans. Readers will gain insight into payer coverage, typical clinical scenarios, and policy updates related to this code. The publication also addresses common modifiers, associated provider taxonomies, and relevant ICD-10 diagnoses, offering a comprehensive overview for stakeholders in outpatient rehabilitation services.
This summary provides a clear understanding of the clinical context, billing requirements, and payer landscape for CPT code 97750, equipping readers with the information needed to navigate policy changes and benchmark utilization in physical performance testing.
CPT Code Overview
CPT code 97750 is used to report a physical performance test or measurement, such as musculoskeletal or functional capacity assessments, with a written report for each 15-minute interval. This service falls under Physical Medicine and Rehabilitation and is typically performed in an outpatient therapy setting, often as part of a physical therapy (PT) or occupational therapy (OT) plan of care. The code is designed to capture the time and expertise required to evaluate a patient's physical abilities, which can inform treatment planning and progress tracking.
Clinical & Coding Specifications
Clinical Context
A patient presents to outpatient physical therapy with complaints of low back pain and difficulty walking. The physical therapist evaluates the patient's musculoskeletal and functional capacity using standardized physical performance tests. These tests may include timed walking assessments, strength measurements, or balance evaluations. The therapist documents the results in a written report, spending 15 minutes per test session. This process is typically performed under a physical therapy or occupational therapy plan of care, and may be repeated as needed to monitor progress or response to treatment.
Coding Specifications
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Modifiers:
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Modifier
59: Distinct Procedural Service. Used when a physical performance test is performed separately from other services, indicating it is not part of a bundled procedure. -
Modifier
76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Used when the same physical performance test is repeated during the same encounter or on a different date by the same provider.
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Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
225100000X | Physical Therapist |
225200000X | Occupational Therapist |
208100000X | Physical Medicine & Rehabilitation Physician |
Related Diagnoses
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M54.5: Low back pain- Relevant for patients undergoing physical performance testing to assess functional limitations due to back pain.
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M25.561: Pain in right knee- Indicates knee pain, which may impact physical performance and require measurement of mobility or strength.
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M25.562: Pain in left knee- Similar to right knee pain, affecting physical function and necessitating performance testing.
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R26.2: Difficulty in walking, not elsewhere classified- Used for patients with gait disturbances, making physical performance tests essential for evaluating walking ability.
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M62.81: Muscle weakness (generalized)- Indicates generalized muscle weakness, often assessed through physical performance tests to determine severity and impact on function.
Related CPT Codes
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97161: Physical Medicine and Rehabilitation Evaluation (initial) – example- Used for the initial evaluation of a patient before physical performance testing. Commonly performed prior to
97750to establish baseline and plan of care.
- Used for the initial evaluation of a patient before physical performance testing. Commonly performed prior to
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97760: Physical Medicine and Rehabilitation Tests and Measurements – assistive technology assessment (related section)- Used for assessment related to assistive technology, such as fitting and training for orthotics or prosthetics. May be performed in conjunction with
97750when evaluating functional capacity with assistive devices.
- Used for assessment related to assistive technology, such as fitting and training for orthotics or prosthetics. May be performed in conjunction with
Both codes may be used together in a comprehensive rehabilitation workflow, with 97161 for evaluation, 97750 for performance testing, and 97760 for assistive technology assessment as needed.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 97750 under Medicare is $35.01, while the BUCA (average commercial) mean rate is $38.27. Commercial payers such as Blue Cross Blue Shield, Cigna, and UnitedHealth Group all report mean rates above $40, with Cigna at $44.14, UnitedHealth Group at $42.86, and Blue Cross Blue Shield at $41.15. Aetna's mean rate is notably lower at $30.68.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare shows the tightest range at $3.00, indicating relatively consistent reimbursement. In contrast, Cigna has the widest range at $27.50, followed by Blue Cross Blue Shield at $21.00, reflecting greater variability in commercial reimbursement rates. UnitedHealth Group and Aetna have moderate ranges of $12.00 and $10.00, respectively.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 97750, with UnitedHealth Group showing the highest mean rate at $85.15 and Medicare the lowest at $33.98. The rate spread, measured by the difference between the 75th and 25th percentiles, is most pronounced for Cigna ($41.80), indicating substantial variability among commercial payers. Other payers, such as Aetna, display minimal spread, with all percentiles at $65.00, suggesting uniformity in contracted rates.
Compared to national averages, Alaska's commercial payers consistently offer higher mean rates, with UnitedHealth Group's mean rate more than double the national benchmark. The table and chart below present the full breakdown of payer-specific reimbursement rates for CPT code 97750 in Alaska.
Key Insights for Alaska
- UnitedHealth Group is the highest paying payer in Alaska for CPT 97750, with a mean rate of $85.15.
- Medicare is the lowest paying payer, with a mean rate of $33.98, notably below the commercial payers.
- All Alaska commercial payer rates are significantly higher than their respective national averages, with UnitedHealth Group's mean rate more than double the national benchmark.
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