CPT 97163 reports a high-complexity physical therapy evaluation, typically about 45 minutes, with an unpredictable history and four or more personal factors.
When to use 97163
Use 97163 for an initial PT evaluation of high complexity. Low- and moderate-complexity initial evaluations use 97161 and 97162, and re-evaluation uses 97164.
How to bill it
Select 97163 for a high-complexity initial PT eval with an unpredictable history and four or more personal factors; report one unit per evaluation.
Common pitfalls
- Under-coding as moderate (97162) when the case met high-complexity criteria.
- Selecting the code by time rather than clinical complexity.
Frequently asked questions
How is 97163 different from 97162?
97163 reflects high complexity with an unpredictable history and more personal factors; 97162 is moderate complexity.
How long is a 97163 evaluation?
A high-complexity PT eval is typically about 45 minutes, though complexity—not time—determines the code.