Local Coverage Article Billing and Coding

Billing and Coding: CPT Code 97755 - Assistive Technology Assessment

A53053

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Contractor Information

Article Information

General Information

Article ID
A53053
Article Title
Billing and Coding: CPT Code 97755 - Assistive Technology Assessment
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
05/19/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2022 American Dental Association. All rights reserved.

Copyright © 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA), §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim

Article Guidance

Article Text

CPT® code 97755, assistive technology assessment (for example, to restore, augment or compensate for an existing function, optimize functional tasks and/or maximize environmental accessibility), direct 1-on-1 contact with written report, each 15 minutes, is related to the following local coverage determinations (LCDs):

· Outpatient Physical Therapy (L34428)
· Outpatient Occupational Therapy (L34427)
· Home Health-Occupational Therapy (L34560)
· Home Health-Physical Therapy (L34564)

This is an assessment code, per each 15 minutes, and must be accompanied by a written report explaining the nature and complexity of the assistive technology needed by the patient. This can include: testing multiple components/systems to determine optimal interface between client and technology applications and determining the appropriateness of commercial (off the shelf) components/systems. If the service provided by a physical or occupational therapist is more clearly defined by another CPT® code (for example, 97535 self-care/home management training), it should be used instead.

It would be inappropriate to use the CPT® code 97755 for services other than for those who have lost the use of their limbs and who can benefit from new technology advancements. CPT® 97755 should only be billed by occupational and physical therapists that have the additional knowledge and expertise of the assistive technology that is required for these individuals.

For rationale, clinical example and description of CPT® 97755, please refer to CPT® 2004 Changes: An Insider's View, American Medical Association (2003©).

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
97755 ASSISTIVE TECHNOLOGY ASSESSMENT (EG, TO RESTORE, AUGMENT OR COMPENSATE FOR EXISTING FUNCTION, OPTIMIZE FUNCTIONAL TASKS AND/OR MAXIMIZE ENVIRONMENTAL ACCESSIBILITY), DIRECT ONE-ON-ONE CONTACT, WITH WRITTEN REPORT, EACH 15 MINUTES

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
05/19/2022 R9

Under CMS National Coverage Policy added the regulation “Title XVIII of the Social Security Act (SSA), §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.” CPT® was inserted throughout the article where applicable. Formatting, punctuation and typographical errors were corrected throughout the article.

10/10/2019 R8

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles.

02/08/2018 R7

Under Associated Contract Numbers added contract number 1104 as this was inadvertently omitted.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

 

01/29/2018 R6 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this article begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
01/26/2017 R5 Annual validation performed-no changes made.
01/28/2016 R4 Under Article Text italicized language quoted from the CPT 2004 Changes: An Insider’s View, American Medical Association (2003 ©) and deleted “is” from the third sentence of the second paragraph.
10/01/2015 R3 Under Article Text deleted “by provider” in the first paragraph. The home health local coverage determinations titles listed in the first paragraph were corrected. In the second paragraph, the description was cited for CPT code 97535. The title of the reference cited in the fourth paragraph was corrected. Under CPT/HCPCS Codes deleted CPT code 97535.
10/01/2015 R2 Annual Validation
10/01/2015 R1 Article verification

Associated Documents

Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
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Public Versions
Updated On Effective Dates Status
05/12/2022 05/19/2022 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Assistive Technology
  • Therapy
  • Home Health
  • Outpatient
  • PT
  • OT
  • Physical Therapy
  • Occupational Therapy