CPT 97750Physical Therapy

Physical performance test

CPT code 97750 covers physical performance testing, which evaluates a patient's functional abilities like strength, endurance, flexibility, and movement patterns. These tests measure how well someone can perform everyday activities or specific physical tasks.

Showing rates for

National Average

Base Medicare rate

$33.32

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.45

PE RVU (NF)

0.57

MP RVU

0.01

Total RVU

1.03

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document the specific standardized test(s) performed by name (e.g., Timed Up and Go, Six-Minute Walk Test, Berg Balance Scale) along with numerical results and interpretation
Impact: Increases clean claim rate by 65-75%; prevents denials for lack of specificity and medical necessity documentation
Bill 97750 only once per testing session regardless of how many individual tests are performed, as it represents the entire performance testing battery
Impact: Prevents upcoding denials and potential fraud allegations; avoids recoupment of $33.32 per duplicate unit billed
Always append the appropriate therapy discipline modifier (GP, GO, or GN) on Medicare claims before submitting
Impact: Prevents automatic claim rejections; delays payment by 14-30 days if omitted and requires resubmission
Link 97750 to appropriate ICD-10 diagnosis codes that support medical necessity for functional testing (e.g., R26.2 for difficulty walking, M62.81 for muscle weakness, Z96.6- for orthopedic joint replacement aftercare)
Impact: Reduces denial rate by 40-50%; ensures payment is not denied for lack of medical necessity
Do not bill 97750 on the same date as the initial evaluation (97161-97163 for PT or 97165-97167 for OT) unless the performance test is clearly distinct and separately documented
Impact: Avoids bundling denials; when improperly billed together, the $33.32 for 97750 is typically denied as included in the evaluation
For workers compensation cases, verify payer-specific policies as some states require pre-authorization for functional capacity evaluations or have different fee schedules

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 97750 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 97750 is $33.32 for both facility and non-facility settings. This rate is based on 1.03 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the Geographic Practice Cost Index (GPCI).

How many times can you bill CPT 97750 per day?

CPT 97750 should typically be billed only once per day regardless of the number of individual performance tests included in the battery. The code represents the entire performance testing session, not each individual test. Billing multiple units on the same day requires exceptional documentation of medical necessity and distinct testing sessions separated by time and clinical purpose.

Can CPT 97750 be billed with an evaluation code on the same day?

Generally, 97750 should not be billed separately on the same day as initial evaluation codes (97161-97163, 97165-97167) as performance testing is typically considered part of the comprehensive evaluation. However, if the performance test is distinct, uses different standardized instruments, serves a different purpose, and is separately documented, it may be billable with modifier 59. Re-evaluation codes (97164, 97168) and 97750 are more commonly billed together when progress measurement is needed.

What documentation is required to bill CPT code 97750?

Required documentation includes the specific names of standardized tests performed (not just 'balance test'), quantitative results with units, interpretation of findings, comparison to norms or baselines, explanation of how results inform treatment, medical necessity justification, time spent testing, and the qualified professional's signature. Vague documentation like 'functional testing performed' will likely result in denial.

What is the difference between CPT 97750 and evaluation codes?

Evaluation codes (97161-97163 for PT, 97165-97167 for OT) represent comprehensive assessments including history, examination, clinical decision-making, and plan of care development. CPT 97750 specifically covers standardized physical performance testing with measurable, objective outcomes using validated instruments. Performance tests are often included in evaluations but can be billed separately when performed as distinct services for progress monitoring or specialized functional capacity assessment.

Which modifiers are required for CPT 97750 on Medicare claims?

Medicare requires therapy discipline modifiers: GP (physical therapy plan of care), GO (occupational therapy plan of care), or GN (speech-language pathology plan of care). Additionally, modifier KX is required when services exceed therapy threshold amounts with documented medical necessity. Modifier 59 may be needed to indicate a distinct procedural service when billed with other codes that might otherwise bundle.

What are examples of physical performance tests that qualify for CPT 97750?

Common examples include: Six-Minute Walk Test, Timed Up and Go (TUG), Berg Balance Scale, Functional Gait Assessment, Five Times Sit-to-Stand Test, 10-Meter Walk Test, Dynamic Gait Index, Tinetti Performance-Oriented Mobility Assessment, Four Square Step Test, and Y-Balance Test. The key is using standardized, validated instruments with objective scoring systems—not subjective clinical observations.