CPT 97162: PT Evaluation, Moderate Complexity
Physical therapy evaluation: moderate complexity. Requires a history with 1-2 personal factors and/or comorbidities, examination of body systems with standardized tests, and evolving or presents with changing characteristics.
Why CPT 97162 Claims Get Denied
Claims billed under CPT 97162 are frequently denied or downcoded for the following reasons. Understanding these patterns helps your practice reduce denial rates and recover revenue faster.
Evaluation level not supported by documentation
Prior authorization not obtained
Duplicate evaluation in short timeframe
Missing physician referral
Billing Tips for CPT 97162
Moderate complexity requires documentation of 1-2 comorbidities or personal factors affecting the plan of care, and clinical presentation that is evolving. Document the factors that increase complexity. This is the most commonly billed PT evaluation level.
Documentation Requirements
To support a clean claim for CPT 97162, your clinical documentation should include:
History identifying 1-2 personal factors/comorbidities
Examination of body systems with standardized tests
Clinical decision making of moderate complexity
Treatment plan with goals
Baseline functional measures
Physician referral
Common Modifiers for CPT 97162
Reduce CPT 97162 Denials by 60%
RediClaim's pre-submission scrubber catches documentation gaps and coding errors before you submit, while the appeal generator handles denials that slip through.