CPT Code 95851: Range of Motion testing

Introduction: 

CPT Code 95851 is a medical procedure code used for the range of motion measurements for multiple joints. This code is primarily utilized by physical therapists, occupational therapists, and physicians to evaluate a patient's joint mobility and function. It plays a crucial role in diagnosing musculoskeletal impairments and tracking patient progress in rehabilitation.

Proper documentation and billing of CPT 95851 are essential for accurate reimbursement and ensuring compliance with Medicare, Medicaid, and private insurance providers.

What is CPT Code 95851?

Definition and Purpose

CPT 95851 refers to manual range of motion (ROM) measurements for multiple joints. It is used when a healthcare provider performs an assessment to determine the degree of movement available in various joints.

This procedure is often performed:

• Pre-treatment: To establish a baseline measurement of joint function.
• During rehabilitation: To track improvements in flexibility and mobility.
• Post-treatment: To assess recovery and the effectiveness of therapeutic interventions.

Importance of CPT Code 95851 in Medical Billing and Coding

• Ensures accurate reimbursement for range of motion assessments.
• Supports medical necessity for physical and occupational therapy.
• Prevents claim denials by documenting functional limitations and improvements.
• Assists in treatment planning by evaluating joint dysfunction and progress.

Common Medical Conditions Treated with CPT Code 95851

CPT 95851 is used for patients experiencing joint mobility limitations due to various conditions, such as:

• Osteoarthritis (M19.90) – Degeneration of joint cartilage leading to stiffness and pain.
• Rheumatoid Arthritis (M06.9) – Autoimmune condition causing inflammation and reduced joint movement.
• Post-Surgical Recovery (Z47.1, Z47.89) – Assessing ROM following joint replacement or reconstructive surgery.
• Fractures and Dislocations (S82.899A, S42.401A) – Evaluating recovery after orthopedic injuries.
• Neurological Disorders (G35, G20) – Conditions like multiple sclerosis or Parkinson’s disease affecting mobility.
• Rotator Cuff Injuries (M75.100) – Measuring ROM to track shoulder rehabilitation progress.

Who Can Bill CPT Code 95851?

Healthcare Professionals Eligible to Use This Code

CPT Code 95851 can be billed by:

• Physical Therapists (PTs) – Performing ROM evaluations for rehabilitation.
• Occupational Therapists (OTs) – Assessing mobility for functional independence.
• Physicians (Orthopedic Surgeons, Neurologists, Rheumatologists, Physiatrists) – Diagnosing and tracking joint conditions.
• Chiropractors – Measuring ROM for spinal and joint mobility improvements.
• Athletic Trainers – Evaluating athletes' joint performance and recovery.

Settings Where CPT Code 95851 is Applicable

• Hospitals (Outpatient and Inpatient Rehabilitation)
• Private Physical Therapy and Occupational Therapy Clinics
• Chiropractic and Sports Medicine Clinics
• Skilled Nursing Facilities (SNFs)
• Home Health Therapy Services
• Telemedicine (if appropriate documentation is provided)

Related CPT Codes with CPT 95851 (Respective Treatments)

Codes Frequently Billed Together

• CPT 95852 – Range of motion measurements, single joint.
• CPT 97110 – Therapeutic exercise to improve strength, endurance, and ROM.
• CPT 97140 – Manual therapy (e.g., joint mobilization) for improving mobility.
• CPT 97750 – Physical performance testing and functional capacity evaluation.

Comparison with Similar CPT Codes

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Step-by-Step Billing Method for CPT Code 95851

1. Confirm Medical Necessity – Ensure that ROM testing is required for diagnosis or treatment planning.
2. Verify Insurance Coverage – Check with the payer regarding coverage policies and prior authorization requirements.
3. Conduct the Measurement – Perform manual ROM testing for multiple joints.
4. Use Proper Documentation – Record joint measurements, clinical findings, and treatment plans.
5. Submit Claim – Ensure correct CPT and ICD-10 codes are included on the claim form.

Reimbursement Guidelines for CPT Code 95851

Insurance and Medicare/Medicaid Policies

• Medicare – Typically reimburses if ROM measurement is necessary for therapy planning or diagnosis.
• Medicaid – Coverage varies by state; prior authorization may be required.
• Private Insurance – May require documentation of medical necessity.

Documentation Requirements for Successful Claims

• Physician’s order for the ROM assessment
• Clinical justification and diagnosis (ICD-10 codes)
• Detailed measurement results
• Progress reports showing improvement over time

How to Maximize Reimbursement for CPT Code 95851

Best Practices to Ensure Full Compensation

• Verify insurance coverage before performing the procedure.
• Use correct ICD-10 codes related to the joint condition.
• Document ROM values clearly with baseline and follow-up measurements.
• Avoid overuse – Insurance may deny repeated ROM measurements if not medically justified.

Commonly Approved Modifiers and Documentation Tips

• Modifier -59 – If billed with other therapy services on the same day.
• Modifier -GP – Indicates services were provided under a physical therapy plan.
• Modifier -25 – Used when ROM testing is performed alongside an E/M service.

Case Studies

Case Study 1: Post-Operative Knee Rehabilitation

• Patient: 65-year-old male, post-total knee replacement.
• Diagnosis: Osteoarthritis (M17.10) leading to knee joint dysfunction.
• Therapy Provided: CPT 95851 was used to measure knee flexion/extension over six weeks.
• Outcome: The patient showed improved ROM from 45° to 110°; therapy was continued based on documented progress.

Case Study 2: Rotator Cuff Injury Recovery

• Patient: 40-year-old female, post-arthroscopic rotator cuff repair.
• Diagnosis: Shoulder impingement syndrome (M75.41).
• Therapy Provided: ROM measurements tracked shoulder abduction improvements.
• Billing Issue: Initial denial due to missing documentation; approved after resubmission with progress notes.

Common Billing Mistakes and How to Avoid Them

1. Incorrect CPT Code Usage – Confusing 95851 (multiple joints) with 95852 (single joint).
2. Lack of Supporting Documentation – Ensure all assessments and justifications are well-documented.
3. Missing Modifiers – Use appropriate modifiers when billing alongside other therapy services.
4. Unnecessary Repetitive Billing – Avoid billing 95851 too frequently without medical necessity.

Conclusion

CPT 95851 is a valuable code for assessing the range of motion in multiple joints. Proper documentation, coding, and adherence to reimbursement guidelines are essential for maximizing payment and avoiding denials.

FAQs

1. Who can bill CPT 95851? 

Physical therapists, occupational therapists, physicians, and chiropractors.‍

2. Is CPT 95851 covered by Medicare?

         Yes, when medically necessary and properly documented.

3. Can CPT 95851 be billed with CPT 97110? 

 Yes, but Modifier -59 may be required to indicate distinct services.

4. How often can CPT 95851 be billed? 

     As medically necessary, but excessive billing may trigger audits.

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