2019 Workers' Compensation Part B Fee Schedule

95937-97016

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"Effective Jan. 1, 2017, CMS (Medicare) has deleted the PT and OT evaluation and re-evaluation HCPCS codes as follows:

97001 PT Evaluation
97002 PT Re-evaluation
97003 OT Evaluation
97004 OT Re-evaluation

CMS has added the following new HCPCS codes for these services:

97161 PT Eval Low Complex 20 min
97162 PT Eval Mod Complex 30 min
97163 PT Eval High Complex 45 min

97165 OT Eval Low Complex 30 min
97166 OT Eval Mod Complex 45 min
97167 OT Eval High Complex 60 min

97164 PT Re-eval Est Plan Care
97168 OT Re-eval Est Plan Care

The Pennsylvania Workers’ Compensation Part B Fee Schedule reimbursement for all new HCPCS codes have been calculated in compliance with 34 Pa. Code Section 127.153(c), which states on or after Jan. 1, 1995, payment rates under the act for new HCPCS codes will be based on the rates allowed in the Medicare fee schedule on the effective date of the new codes, and 34 Pa. Code Section 127.104, which requires payments to outpatient providers for services rendered under the act be calculated by multiplying the Medicare Part B reimbursement for the services by 113%. Furthermore, CMS has determined that the 2017 Medicare fee schedule reimbursement amounts will remain the same for all three levels of the physical and occupational evaluation services regardless of the time indicator or acuity of services rendered. The re-evaluation codes are not impacted by the newly-introduced tier complexity stratification."