Exploring Current Procedural Terminology Codes for Physical Therapist Evaluations in the United States: Results of a...

Physical therapy evaluation Current Procedural Terminology (CPT) codes have been in practice for 8 years in the United States with limited understanding of their accuracy, reliability, and utilization. This creates challenges for physical therapists (PT) to justify their services and demonstrate their impact on patient outcomes, while also hindering systematic international comparisons with other physical therapy coding systems. Therefore, the aim of this study was to examine the feasibility of assessing evaluation CPT code metrics in outpatient physical therapy and to determine preliminary accuracy and reliability of these codes.

Outpatient PTs from an academic health care institution were recruited to review 15 patient evaluations and select the CPT code they deemed most appropriate at baseline and again for the same cases 1-2 weeks later. Gold standard answers were created by expert consensus based on national guidelines to calculate accuracy for each case. Krippendorff's alpha was used to assess inter- and intra-rater reliability.

The study was successful in recruiting and retaining 20 PTs (median age: 34 years [IQR 29, 37], median experience: 7 years [IQR 3, 12]). Regarding preliminary results, participants were 49% accurate in choosing the correct CPT code, had poor inter-rater reliability (α = 0.58 [95% CI 0.55-0.61]) and moderate intra-rater reliability (α = 0.67 [95% CI 0.58-0.75]).

Assessing the reliability and accuracy of PTs' determination of evaluation CPT codes is feasible; a larger multisite study is recommended to generalize results. There was a broad range of variability in evaluation CPT coding relative to what is deemed accurate. Refining coding reliability and accuracy within the U.S. system may enable meaningful international comparisons of coding and reimbursement frameworks, supporting the identification of strengths, gaps, and best-practice models to advance high-value physical therapy services globally.