Here at WebPT, we receive a lot of questions about the typical payment amounts for the most commonly used physical therapy Current Procedural Terminology (CPT) codes. So, we pulled some stats and turned it into a nifty one-sheet download. For reference, WebPT has more than 83,000 therapy professionals using our system (as of August 2018)—and that means we have a robust amount of data showing how therapists use CPT codes in real life. As a reminder, CPT codes are created, updated, and copyrighted by the American Medical Association (AMA). These codes represent medical, surgical, and diagnostic services. CPT codes are similar to ICD codes in that they enable providers to communicate standardized information about patients to payers. However, CPT codes represent the medical, surgical, and diagnostic services practitioners provide, whereas ICD codes represent patient diagnoses.
While most payers have their own fee schedule—and their own guidelines for CPT code reporting—many use the one from the Centers for Medicare and Medicaid Services (CMS) as a baseline. Thus, we’ve pulled data from this CMS resource to provide you with the average national payment amount for each of the top 20 most-used CPT codes in WebPT.
Interestingly enough, re-evaluations continue to fill a top spot. As a reminder, providers should only bill for a re-eval if very specific criteria are met. As WebPT President Heidi Jannenga, PT, DPT, ATC, wrote in this post, it is not appropriate to bill a re-eval for a routine progress note: “If you do bill [for a re-eval], you are indicating that some kind of significant change has taken place regarding the patient’s progress, and therefore, his or her plan of care (POC).”
Now, you’ll have to download the full resource to see the entire list. In the meantime, though, here are the top five most commonly used rehab therapy CPT codes—and their average national payment amounts.
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