97755
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
0.62
Facility
$37.74
Non-Facility
$37.74
Documentation Required
- A written report explaining the nature and complexity of the assistive technology needed must accompany CPT 97755 claims.
- Documentation should include testing results of multiple components/systems and justification of appropriateness of commercial/off-the-shelf components when applicable.
- Claims for CPT 97755 should comply with the related LCDs: L34428 (Outpatient Physical Therapy), L34427 (Outpatient Occupational Therapy), L34560 (Home Health-Occupational Therapy), and L34564 (Home Health-Physical Therapy).
- Documentation for CPT 97010, 97018, 97022, and 97026 must reflect medical necessity and be made available to the MAC upon request.
Key Coverage Criteria
- CPT 97755 is covered for assistive technology assessments performed to restore, augment, or compensate for existing function, optimize functional tasks, and/or maximize environmental accessibility.
- CPT 97755 is covered when delivered as direct 1-on-1 contact and billed per each 15-minute unit with an accompanying written report.
- CPT 97755 is covered for patients who have lost the use of their limbs and can benefit from new assistive technology advancements.
- Assessments may include testing multiple components/systems to determine optimal interface between client and technology and determining appropriateness of commercial (off-the-shelf) components/systems.
- CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
- CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
20 Active Policies
L33631 — Outpatient Physical and Occupational Therapy Services
J06
A56566 — Billing and Coding: Outpatient Physical and Occupational Therapy Services
J06
A53058 — Billing and Coding: Home Health Physical Therapy
A53064 — Billing and Coding: Outpatient Occupational Therapy
A53065 — Billing and Coding: Outpatient Physical Therapy
Related Codes
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