97002 Procedure Code

Having trouble with this physical therapy re evaluation code 97002 being denied with a few insurance plans. Do I need a modifier? Does anyone have any input.

re: 97002 Procedure Code

According to CMS publication 100-102 (chapter 15, covered medical and other health services, section 220.3 C), a re-evaluation may be indicated due to new clinical findings, a patient's failure to respond to therapeutic interventions outlined in the plan of care or a significant change in the patient's condition. In addition, in Section 220 under the definition of re-evaluation, CMS states, "a re-evaluation is separately payable and is periodically indicated during an episode of care when the professional assessment of a clinician indicates a significant improvement or decline or change in the patient's condition or functional status that was not anticipated in the plan of care for that interval."
CPT® codes are developed by the American Medical Association (AMA) and the majority of third party payers, including Medicare, follow the descriptors developed by the AMA. Private payers may have it's own requirements, talk to them