Reader Question: Therapy Evaluation Codes

Question: Can physical/occupational therapy evaluation codes be broken into timed units, and if so, can different charges be applied to identical CPT codes depending on the length of the evaluation? For example, 97001 (physical therapy evaluation) and 97003 (occupational therapy evaluation) would be set up in the charge master with three separate charges (15-30 minutes, 31-45 minutes, 46+ minutes) and different dollar amounts given to each. It is my understanding that the evaluation code is paid at one rate regardless of the length of the evaluation. Is this correct?

Gloria Peterson
Sheboygan Memorial Medical Center
Sheboygan, Wis.

Answer: The timed approach is perfectly valid for charging purposes in both the above examples, and should be used if you have many percentage-based third-party contracts and/or private pay business. For Medicare and Medicaid, of course, you will only be paid according to the fee for the single-visit code, regardless of the time spent. The amount of the patients coinsurance will be affected by your timed approach, however.

The codes you are asking about are exempt from the outpatient prospective payment system and are paid under the resource-based relative value scale fee schedule. Coinsurance under the fee schedule is not determined by HCFA, and continues to be based on 20 percent of hospital charges.

- Published on 2001-02-01