CPT Code 95852: Range of Motion (ROM) Test of the Hand

Introduction: 

CPT Code 95852 is a medical billing code used to document and bill for a Range of Motion (ROM) test of the hand. This test is a critical component in physical therapy, rehabilitation, and musculoskeletal evaluations, helping physiotherapists assess joint function, stiffness, and mobility impairments in patients recovering from injuries or suffering from chronic conditions.

Understanding CPT 95852 is essential for accurate medical billing and reimbursement, ensuring that physical therapists receive proper compensation for their services while maintaining compliance with insurance policies.

What is CPT Code 95852?

Definition and Purpose

CPT 95852 is a diagnostic procedure used to measure the hand's active and passive range of motion (ROM), including fingers and the wrist. The purpose of this test is to:

• Identify mobility limitations caused by injury, arthritis, or neurological conditions.
• Tracked patient progress in physical therapy rehabilitation programs.
• Guided treatment plans based on objective measurements of hand function.

Importance of CPT Code 95852 in Medical Billing and Coding

• Ensure standardized documentation of ROM assessments.
• Allows physiotherapists to bill appropriately for services rendered.
• Helps in securing insurance reimbursements from Medicare, Medicaid, and private payers.
• Supports treatment justification for continued therapy sessions.

Common Medical Conditions Treated with CPT Code 95852

Physiotherapists commonly perform ROM assessments under CPT 95852 for patients with:

• Arthritis (Osteoarthritis, Rheumatoid Arthritis) – Evaluating stiffness and progression.
• Post-Surgical Rehabilitation – Monitoring mobility after hand/wrist surgeries.
• Carpal Tunnel Syndrome – Assessing nerve function and joint mobility.
• Tendon and Ligament Injuries – Measuring recovery in trigger finger, sprains, and fractures.
• Neurological Disorders (Stroke, Parkinson’s, Multiple Sclerosis) – Checking functional motor control.
• Chronic Pain Syndromes (Fibromyalgia, CRPS) – Determining movement limitations.

Who Can Bill CPT Code 95852?

Healthcare Professionals Eligible to Use This Code

• Physiotherapists (PTs) and Occupational Therapists (OTs)
• Physicians (Orthopedic, Neurologists, Rheumatologists)
• Chiropractors (in some cases)
• Hand Therapists and Rehabilitation Specialists

Settings Where This Code is Applicable

• Outpatient Physical Therapy Clinics
• Hospitals and Rehabilitation Centers
• Private Physiotherapy Practices
• Telemedicine & Home Health Therapy Services (if properly documented)

Related CPT Codes with 95852 (Respective Treatments)

Codes Frequently Billed Together

Comparison with Similar CPT Codes

Step-by-Step Billing Method for CPT Code 95852

1. Confirm Medical Necessity – Ensure the test is required for diagnosis or treatment planning.
2. Perform ROM Testing – Document passive and active motion measurements.
3. Use the Correct CPT Code – Code 95852 only if testing was focused solely on the hand/wrist.
4. Attach Supporting Documents – Include patient history, diagnosis codes, and test results.
5. Submit Claim with Proper Modifiers (if applicable).

Reimbursement Guidelines for CPT Code 95852

Insurance and Medicare/Medicaid Policies

• Medicare typically covers CPT 95852 if deemed medically necessary for functional assessment.
• Private insurers may require prior authorization or supporting documentation.
• Medicaid coverage varies by state, so verify requirements before billing.

Documentation Requirements for Successful Claims

• Detailed clinical notes stating why ROM testing was performed.
• Objective measurements (e.g., degrees of movement in each joint).
• Diagnosis codes (ICD-10) linked to the medical condition.

How to Maximize Reimbursement for CPT Code 95852

Best Practices to Ensure Full Compensation

• Always link CPT 95852 to a relevant ICD-10 code (e.g., M19.041 – Primary osteoarthritis of the hand).
• Document ROM results before and after therapy for continued care justification.
• Use electronic health records (EHRs) to avoid errors and claim denials.

Commonly Approved Modifiers & Documentation Tips

• Modifier 59 – When ROM testing is separate from other therapy services.
• Modifier GP – Indicates services provided under a physical therapy plan of care.

Case Studies

Real-World Examples of CPT Code 95852 in Medical Billing

Case Study 1: Gait Analysis in Post-Stroke Rehabilitation

A 65-year-old patient recovering from a stroke presented with asymmetrical gait and balance issues. The physiotherapist performed a dynamic surface EMG (96002) to analyze muscle activation patterns while walking. The results identified weakness in the affected leg, leading to a targeted rehabilitation program. The findings provided objective data for insurance reimbursement, ensuring continued therapy coverage.

Case Study 2: Sports Injury Recovery

A 25-year-old runner recovering from an ACL tear complained of persistent knee instability despite initial rehabilitation. The clinician used CPT 96002 to assess muscle activation in the quadriceps and hamstrings during movement. The EMG findings revealed delayed muscle activation, prompting neuromuscular retraining exercises. The insurer approved additional therapy sessions, preventing premature discharge.

Common Billing Mistakes and How to Avoid Them

Frequent Coding Errors and Claim Denials

• Billing CPT 95852 with general therapy codes (e.g., 97110) without proper documentation.
• Failing to demonstrate medical necessity (leading to insurance rejections).
• Using incorrect modifiers or omitting required documentation.

Strategies to Prevent Billing Mistakes

• Always link CPT 95852 with a primary diagnosis code.
• Double-check insurance policies for reimbursement requirements.
• Maintain clear documentation of ROM measurements and clinical justification.

Conclusion

CPT 95852 (Range of Motion Test of the Hand) is crucial in physiotherapy assessments and medical billing. Proper documentation and billing practices help maximize reimbursements, prevent claim denials, and ensure compliance with insurance policies. By following best practices, physiotherapists can seamlessly integrate ROM testing into their patient evaluations while optimizing their billing workflows.

FAQs

Is CPT 95852 reimbursed by Medicare?

Yes, Medicare covers CPT 95852 if it is deemed medically necessary and appropriately documented.

Can CPT 95852 be billed alongside therapeutic exercises (97110)?

Yes, but proper documentation is required to show that the ROM test was performed separately.

What are the common ICD-10 codes used with CPT 95852?

Common ICD-10 codes include M19.041 (Osteoarthritis of hand) and G56.01 (Carpal Tunnel Syndrome, Right Hand).

How often can CPT 95852 be billed?

This depends on the patient's condition, but it is typically billed once per evaluation period.

Can telehealth providers bill for CPT 95852?

Some insurance providers allow it if ROM testing is performed using remote assessment tools. Always check payer policies.

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