CPT 97755Physical Therapy

Assistive technology assess

CPT code 97755 covers an assessment where a therapist evaluates a patient to determine what assistive technology devices (like wheelchairs, communication devices, or adaptive equipment) would help them perform daily activities more independently.

Showing rates for

National Average

Base Medicare rate

$37.52

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

0.62

PE RVU (NF)

0.52

MP RVU

0.02

Total RVU

1.16

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

NCCI bundling edits

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Billing tips

Bill 97755 only once per comprehensive assistive technology assessment, regardless of the number of devices evaluated during the session
Impact: Prevents denials for duplicate services; the $37.52 covers the entire assessment session, not per-device evaluation
Document specific device recommendations with justification in the clinical record, including why simpler or less expensive alternatives were ruled out
Impact: Critical for complex rehab technology (CRT) claims and DME prior authorizations that rely on this assessment; missing specificity can delay equipment approval by 2-4 weeks
Do not bill 97755 on the same day as initial evaluation codes (97161-97163, 97165-97167) without modifier 59 and clear documentation of separate, medically necessary services
Impact: CCI edits may bundle these services; improper use results in denial of one service, losing $37.52 in revenue, while proper modifier use with documentation preserves both payments
Verify patient meets functional limitation reporting (FLR) requirements and ensure G-codes or appropriate functional measures are submitted with the claim
Impact: Missing functional reporting can trigger automatic claim rejection or suspend payment pending additional documentation; adds administrative burden and delays payment by 15-30 days
Coordinate billing with DME suppliers when assessment is performed for seating/mobility equipment to ensure proper documentation flows to support HCPCS claims
Impact: Prevents DME denials that cite lack of qualified assessment; poor coordination can result in $5,000-$40,000 in denied wheelchair/seating claims that depend on this $37.52 assessment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 97755 in 2025?

The 2025 Medicare national average reimbursement for CPT 97755 is $37.52 for both facility and non-facility settings. This rate is based on 1.16 total RVUs (0.62 work RVU, 0.52 practice expense RVU, 0.02 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 97755 be billed on the same day as an initial therapy evaluation?

CPT 97755 can be billed with an initial evaluation (97161-97163, 97165-97167) on the same day only if the services are distinct and separately identifiable, with modifier 59 appended to 97755. Documentation must clearly demonstrate that the assistive technology assessment addressed different needs or required separate clinical decision-making beyond the scope of the standard initial evaluation.

Who can perform and bill for assistive technology assessments under CPT 97755?

CPT 97755 must be performed by or under the direct supervision of licensed physical therapists, occupational therapists, or speech-language pathologists. Some payers require specialized training or ATP (Assistive Technology Professional) certification for complex assessments, particularly for seating and mobility systems or augmentative communication devices.

How often can CPT 97755 be billed for the same patient?

There is no specific frequency limitation in CPT guidelines for 97755, but medical necessity must be documented for each assessment. Repeat assessments are typically justified by significant change in patient condition, equipment failure requiring new device selection, change in living environment, functional decline or improvement, or growth in pediatric patients. Most payers question assessments performed within 6-12 months without documented change.

What modifiers are required when billing CPT 97755?

The therapy discipline modifier (GP for physical therapy, GO for occupational therapy, or GN for speech-language pathology) is required for Medicare and most payers to identify the therapy type. Modifier KX may be needed when therapy caps are exceeded. Modifier 59 is necessary when billing with other evaluation codes on the same day. The specific modifier depends on the clinical context and payer requirements.

Does CPT 97755 cover the actual provision of assistive technology devices?

No, CPT 97755 covers only the professional assessment and recommendation process for assistive technology. The actual devices are billed separately using appropriate HCPCS codes (E-codes for DME, K-codes for wheelchairs, etc.) by DME suppliers. The 97755 assessment documentation typically supports medical necessity for the subsequent equipment claims.

What documentation is needed to support billing CPT 97755?

Documentation must include the patient's functional limitations, specific devices evaluated, clinical reasoning for recommendations, measurements taken, environmental considerations, contraindications assessed, and detailed device specifications recommended. The note should demonstrate skilled professional assessment beyond simple equipment ordering, typically including comparison of multiple options and justification for the recommended technology over simpler alternatives.