Observation Stays No Longer Subject to Concurrent Review

2017 HCPCS Updates for Texas Medicaid Physical and Occupational Therapy

Tuesday, January 31, 2017

Effective for dates of service on or after January 1, 2017, physical therapy (PT) evaluation procedure code 97001 and re-evaluation procedure code 97002, and occupational therapy (OT) evaluation procedure code 97003 and re-evaluation procedure code 97004 are being discontinued by the 2017 Healthcare Common Procedure Coding System (HCPCS) code updates.
The new 2017 HCPCS physical therapy evaluation procedure codes 97161, 97162, and 97163 will replace discontinued procedure code 97001. Occupational therapy evaluation procedure codes 97165, 97166, and 97167 will replace discontinued procedure code 97003.
The three replacement evaluation codes for each discipline's previous single evaluation code reflect the complexity level of the evaluation performed. Providers may only choose one of the three codes. 
The therapist who performs the evaluation should use professional clinical judgement to decide which evaluation procedure code to use. The selection must be based on professional clinical judgement and may not be made by staff other than the rendering therapist.

Documentation of the therapist's evaluation must be kept in the client's record and must:

  • Include a signed and dated physician's order for the evaluation.
  • Support a medical need for the therapy evaluation.
  • Be available when requested.

For more information, please email your provider relations representative at Provider_Relations@firstcare.com or call the number below:
  • Abilene area:               1.325.670.3525
  • Amarillo area:              1.800.239.5650
  • Lubbock area:             1.806.784.4380
  • All other areas:            1.800.431.7737

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