CPT® Code 97166

Official Description

Occupational therapy evaluation, moderate complexity, requiring these components:

An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance;
An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and
Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component.

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

Common Language Description

Occupational therapy evaluation, as defined by CPT® Code 97166, involves a comprehensive assessment of a patient's functional abilities and challenges. This evaluation is characterized by moderate complexity, which necessitates a thorough understanding of the patient's occupational profile and medical history. The occupational therapist conducts an extensive review of the patient's medical and therapy records, alongside an in-depth examination of physical, cognitive, or psychosocial factors that may influence the patient's current functional performance. The evaluation aims to identify specific performance deficits—typically ranging from three to five—that contribute to limitations in daily activities and participation in various life roles. These deficits may relate to physical capabilities, cognitive functions, or psychosocial interactions. The clinical decision-making process during this evaluation is of moderate analytic complexity, requiring the therapist to analyze the occupational profile and detailed assessment data while considering multiple treatment options. It is important to note that patients may present with comorbidities that can impact their occupational performance, necessitating a tailored approach to their evaluation. The occupational therapist may need to provide minimal to moderate modifications or assistance, whether physical or verbal, to facilitate the patient's completion of the evaluation components. Typically, this evaluation process involves approximately 45 minutes of face-to-face interaction with the patient and/or their family, ensuring a comprehensive understanding of the patient's needs and challenges in achieving independent functioning and enhancing overall health and well-being.