Physical Therapy Evaluation (high complexity)

What it is

Before a physical therapist treats anything, they have to work out what is actually limiting you and what is safe to push on. That is the evaluation: a history of the problem and of your general health, hands-on testing of the joints and muscles involved, and measurements of things like strength, range of motion, balance, coordination and how you walk or rise from a chair. From that the therapist sets goals with you and writes a plan of care — how often you will come, what will be done, and what you will do at home.

The evaluation is billed separately from treatment, and it is graded rather than timed. The grade reflects how much there was to sort out: how many body systems are involved, how stable the findings are, and how much clinical judgment the plan took. This is the top grade of that scale. It does not mean the visit was longer or that your condition is worse than someone else's — it means the reasoning behind the plan was more involved.

Why it is done

• To establish a baseline that later visits are measured against, since progress in therapy is judged against the first measurements
• To identify which of several possible causes is driving the limitation, when a patient has multiple conditions interacting
• To decide whether therapy is appropriate at all, or whether something should be sent back to the referring clinician first
• To produce the written plan of care that insurers generally require before they will pay for a course of treatment

What to expect

Plan on a longer appointment than a follow-up — often most of an hour. Wear or bring clothing that lets the therapist see and move the area in question. You will be asked a lot of questions, including about work, sleep, past injuries and what you are trying to get back to doing. Much of the visit is measurement rather than treatment, though many therapists start some treatment in the same session. Most people leave knowing the plan: the goals, the expected number of visits, and what to do between them.

Questions worth asking

• Will the first visit be billed as an evaluation only, or as an evaluation plus treatment units on the same day? The second is usually two charges.
• Which complexity level is being billed, and what would the difference in price be if a lower one were used?
• Does my plan require prior authorization or a physician referral before the evaluation, or only before the treatment visits that follow?
• Is there a visit limit per year, and does the evaluation itself count against it?