CPT® Code 97163

Official Description

Physical therapy evaluation: high complexity, requiring these components:

A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care;
An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
A clinical presentation with unstable and unpredictable characteristics; and
Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.

Typically, 45 minutes are spent face-to-face with the patient and/or family.

Common Language Description

The CPT® Code 97163 refers to a physical therapy evaluation characterized by high complexity. This evaluation is essential for establishing a comprehensive understanding of a patient's current physical condition and the factors influencing their treatment plan. During this evaluation, the physical therapist conducts a thorough history of the present problem, which includes gathering information about the onset of symptoms, any existing comorbidities, changes in the patient's condition since the onset, previous treatments received, and medications currently prescribed. This detailed history is crucial as it helps the therapist identify personal factors that may impact the patient's care plan.

In addition to the history, the evaluation involves a systematic examination of the patient's body systems. This examination utilizes standardized tests and measures to assess at least four elements related to body structures and functions, activity limitations, and participation restrictions. The complexity of the clinical presentation is also a significant aspect of this evaluation, as it is characterized by unstable and unpredictable features, which necessitate a high level of clinical decision-making. The therapist employs standardized patient assessment instruments and measurable assessments of functional outcomes to guide their clinical reasoning.

Typically, the physical therapy evaluation takes approximately 45 minutes of face-to-face interaction with the patient and/or their family. This time is dedicated to understanding the patient's condition, performing necessary assessments, and formulating a tailored plan of care that addresses the patient's unique needs and goals.