Assistive technology assess
CPT 97755 covers the assessment performed by a therapist to determine what assistive devices, adaptive equipment, or technology a patient needs to improve their daily function. This includes evaluating patients for wheelchairs, communication devices, modified utensils, or other adaptive tools.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always append the appropriate therapy discipline modifier (GP, GO, or GN) on every claim for CPT 97755
Impact: Missing discipline modifiers result in 100% claim rejection or denial by Medicare and most commercial payers
Bill 97755 only once per patient encounter regardless of how many devices are evaluated during the assessment session
Impact: Duplicate billing on the same date of service will result in denial of the second unit; the code is per-session, not per-device
Document the specific assistive technology being evaluated, medical necessity, functional limitations, and how the device addresses those limitations
Impact: Vague documentation is the leading cause of denials; specific device documentation can reduce denial rates by 40-60%
For Medicare beneficiaries, track cumulative therapy costs to determine when KX modifier is required (threshold is $2,080 for 2025)
Impact: Claims exceeding threshold without KX modifier will auto-deny, delaying payment by 2-4 weeks during appeal process
Separate 97755 from initial therapy evaluations (CPT 97161-97163, 97165-97167, 97110) by documenting it as a specialized assessment beyond standard evaluation
Impact: When billed same day as initial evaluation without clear differentiation, bundling edits may reduce payment by $37.52
Verify that the assistive technology assessment is covered under the patient's specific insurance plan before providing service
Impact: Some Medicare Advantage and commercial plans have specific prior authorization requirements; failure to obtain authorization results in 100% payment denial
Common denials
Missing or incorrect therapy discipline modifier (GP, GO, or GN)
How to appeal: Submit corrected claim with appropriate modifier attached. Include documentation clearly identifying which therapy discipline performed the assessment. Most payers accept corrected claims without formal appeal if resubmitted within timely filing limits.
Medical necessity not established - documentation does not justify need for assistive technology assessment
How to appeal: Submit appeal with detailed clinical notes demonstrating functional limitations, failed conservative interventions, and how specific assistive technology will address documented deficits. Include physician referral/order and any supporting diagnostic test results showing the underlying condition necessitating assistive devices.
Bundled with evaluation code when billed on same date of service as initial therapy evaluation
How to appeal: Appeal with documentation clearly differentiating the assistive technology assessment as a separate, specialized service beyond the scope of the standard therapy evaluation. Include time documentation showing separate sessions and consider adding modifier 59 to indicate distinct procedural service if services were truly separate.
Services not covered under therapy benefit or exceeds therapy cap without KX modifier
How to appeal: For therapy cap issues, submit corrected claim with KX modifier and supporting documentation demonstrating medical necessity. For coverage denials, request reconsideration with documentation showing service meets LCD/NCD requirements for assistive technology assessment and is reasonable and necessary for the patient's condition.
Frequently asked questions
What is the 2025 Medicare reimbursement rate for CPT 97755?
The 2025 Medicare national average reimbursement rate for CPT 97755 is $37.52 for both facility and non-facility settings. This rate is based on a total RVU of 1.16 (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 a therapy evaluation?
Yes, but documentation must clearly differentiate the assistive technology assessment as a specialized service distinct from the standard therapy evaluation. The assistive technology assessment must address specific equipment needs beyond the scope of a routine evaluation. Consider using modifier 59 to indicate a distinct procedural service, and ensure separate documentation for each service with different time stamps.
How many times can you bill CPT 97755 for the same patient?
CPT 97755 can be billed once per date of service regardless of how many devices are evaluated. For the same patient over time, it can be billed again when there is a change in the patient's condition requiring re-assessment, when evaluating completely different categories of assistive technology, or when the patient's needs have changed significantly. Most payers require documentation justifying the medical necessity for repeat assessments.
What modifier is required when billing CPT 97755 for physical therapy?
Modifier GP is required when CPT 97755 is performed as part of a physical therapy plan of care. Similarly, use modifier GO for occupational therapy services and GN for speech-language pathology services. These modifiers are mandatory for Medicare and most commercial payers to properly attribute the service to the correct therapy discipline.
Does CPT 97755 require prior authorization from Medicare?
Traditional Medicare does not typically require prior authorization for CPT 97755, but the service must meet medical necessity criteria. However, Medicare Advantage plans may require prior authorization. Additionally, while the assessment itself may not require authorization, the actual assistive devices recommended often do require separate prior authorization before purchase or rental.
What is the difference between CPT 97755 and a standard therapy evaluation?
CPT 97755 is a specialized assessment focused specifically on determining appropriate assistive technology and adaptive equipment needs, while standard therapy evaluations (97161-97163 for PT, 97165-97167 for OT) assess overall functional status, impairments, and develop comprehensive treatment plans. The 97755 assessment involves detailed analysis of specific devices, trials of equipment, and technical recommendations that go beyond the scope of routine evaluation.
Can occupational therapists and physical therapists both bill CPT 97755 for the same patient?
Yes, different therapy disciplines can bill CPT 97755 for the same patient when evaluating different types of assistive technology within their scope of practice. For example, an OT might assess for adaptive feeding equipment while a PT evaluates mobility devices. Each assessment must be medically necessary, separately documented, and billed with the appropriate discipline modifier (GO for OT, GP for PT).