Physical performance test
CPT 97750 covers physical performance testing that measures a patient's functional abilities, such as strength, balance, endurance, or movement patterns. These standardized tests help therapists establish baseline abilities and track progress during rehabilitation.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Bill 97750 per each distinct standardized test performed, not per unit of time; multiple tests may warrant multiple units if each represents a separate validated assessment tool
Impact: Can increase reimbursement from $33.32 to $66.64 or more when multiple distinct performance tests are medically necessary and documented
Document the specific name of the standardized test, the score/measurement obtained, normative comparison data, and clinical interpretation to differentiate from evaluation codes (97161-97163)
Impact: Prevents downcoding to evaluation codes or denials for lack of medical necessity; evaluation codes may reimburse differently
Do not bill 97750 on same date as initial evaluation (97161-97163) unless testing represents additional standardized assessments beyond those included in evaluation; append modifier 59 when appropriate
Impact: Avoids bundling denials that would reduce total reimbursement by $33.32 per test
Verify payer-specific policies on 97750 coverage as some commercial payers bundle performance testing into evaluation codes or have strict medical necessity criteria
Impact: Prevents claim denials and appeals; some payers may not recognize 97750 separately, resulting in $0 reimbursement
For work-related injuries, coordinate with case managers before performing extensive functional capacity evaluations as pre-authorization may be required
Impact: Workers' compensation rates often exceed Medicare rates by 50-200%, but lack of authorization can result in complete denial
Ensure testing is performed in addition to, not as part of, therapeutic exercise or other treatment codes; performance testing is assessment, not intervention
Impact: Improper coding can trigger audits and recoupment of payments; clear time-based documentation separates testing from treatment
Common denials
Bundled with evaluation codes (97161-97163) when billed on same date of service without clear documentation of separate, additional testing
How to appeal: Submit appeal with detailed documentation showing specific standardized tests performed beyond evaluation components, time stamps demonstrating separate sessions, and modifier 59 justification. Include test protocols, scoring sheets, and clinical rationale for additional testing.
Medical necessity not established - payer deems testing experimental, not reasonable/necessary, or duplicative of evaluation
How to appeal: Provide evidence-based literature supporting the specific test's validity and clinical utility, physician order for testing, and documentation explaining how test results directly impact treatment planning or outcomes measurement beyond standard evaluation
Lack of documentation specifying which standardized test was performed, with objective scores and interpretation
How to appeal: Submit complete testing documentation including test name, administration protocol, raw scores, normative data comparisons, therapist interpretation, and how results modified treatment plan. Include copies of actual assessment forms/scoring sheets.
Frequency limitations exceeded - payer denies repeat testing as not medically necessary within specific timeframe
How to appeal: Document significant change in patient status, clinical indicators requiring re-assessment, physician recommendation for re-testing, or payer-specific requirements for progress documentation. Show how re-testing impacts discharge planning or treatment modification.
Frequently asked questions
What is CPT code 97750 used for in physical therapy?
CPT 97750 is used to bill for standardized physical performance tests that objectively measure functional abilities such as balance, gait speed, endurance, or strength using validated assessment tools. These tests provide quantifiable baseline measurements and progress tracking separate from the general evaluation process.
How much does Medicare pay for CPT 97750 in 2025?
Medicare pays $33.32 for CPT 97750 in 2025 based on the national average non-facility rate. This rate is consistent across both facility and non-facility settings and is calculated using 1.03 total RVUs multiplied by the 2025 conversion factor of 32.3465.
Can you bill 97750 with an evaluation code on the same day?
Yes, but documentation must clearly demonstrate that 97750 represents additional standardized testing beyond the tests included in the evaluation (97161-97163). Modifier 59 should be appended to indicate a distinct procedural service, and documentation must justify the medical necessity of separate performance testing with specific test names, scores, and clinical rationale.
What is the difference between 97750 and 97161?
CPT 97161 is a physical therapy evaluation that includes history, systems review, and clinical decision-making, while 97750 is specifically for administering standardized performance tests with quantifiable scores. Evaluations include assessment components; 97750 represents additional formal testing using validated instruments like the Berg Balance Scale or Timed Up and Go that may be performed separately from or in addition to evaluation.
How many units of 97750 can you bill per day?
There is no specific Medicare limit on units per day, but each unit must represent a distinct standardized test that is medically necessary and properly documented. Multiple units are appropriate only when multiple separate validated assessment tools are performed, not for repeated trials of the same test. Medical necessity and payer policies govern reasonable frequency.
What documentation is required to bill CPT 97750?
Documentation must include the specific name of the standardized test performed, objective scores or measurements obtained, comparison to normative data, clinical interpretation of results, medical necessity justification, time spent testing, and how results impact treatment planning. Generic descriptions like 'balance testing' are insufficient; specific validated tool names (e.g., 'Berg Balance Scale score: 42/56') are required.
Does CPT 97750 require a physician order?
Yes, like all physical therapy services, Medicare requires a physician order or referral for services billed under 97750. The order should specify the need for physical therapy services, and documentation should support why specific standardized performance testing is medically necessary for the patient's condition and treatment planning.