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Physical Therapy Evaluation (low complexity)

This is the first physical therapy visit — the assessment that produces a diagnosis, goals, and a plan of care before any treatment begins. The "low complexity" label is a billing tier: it describes a straightforward problem with few complicating factors, not a short or lesser exam.

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What it is

Before a physical therapist treats anything, there is an examination and an evaluation, usually completed in one visit. The examination gathers a history — the problem, previous medical and surgical events, general health, living and working situation — and then a hands-on assessment covering movement, strength, range of motion, posture, skin, and a review of the body's systems, together with standardized tests and measures chosen to confirm or rule out what the therapist suspects. The evaluation is the judgement drawn from all of that: a diagnosis, a prognosis stating how much improvement is expected and over what time, and a plan of care with measurable goals. Physical therapy evaluations are billed at one of three complexity tiers; this code is the lowest of them, used when the history is stable, the findings are straightforward, and the clinical decision-making is uncomplicated.

Why it is done

  • To establish what is actually limiting function, which is not always what the referral says
  • To set measurable goals against which later visits are judged, and to document a starting point
  • To decide what treatment is appropriate and how often it is needed
  • To identify anything that should send the patient back to a physician rather than into therapy

What to expect

The visit is longer than a typical treatment session, commonly forty-five to sixty minutes, and most of it is questions and measurement. Clothing that allows the affected area to be seen and moved makes the exam possible. Treatment sometimes begins in the same visit once the evaluation is done, and sometimes waits for the next one. The therapist writes up the plan of care and, depending on state rules and the insurer, may need a physician's signature on it before treatment can continue.

Questions worth asking

  • Which complexity tier will this evaluation be billed at, and what is the price difference between the tiers at this practice?
  • If treatment is delivered in the same visit as the evaluation, are both billed, and what does the combined visit cost?
  • Does my plan require a physician referral or a signed plan of care before it will pay for the evaluation?
  • Does the evaluation visit count against my annual therapy visit allowance, or does the allowance apply only to treatment visits?

What Physical Therapy Evaluation (low complexity) costs by state

Physical Therapy Evaluation (low complexity) prices at hospitals

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Sources

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