MedicaidBilling CodesHigh impact
Current Procedural Terminology (CPT) Codes and Reimbursement Rates for Physical and Occupational Therapy Evaluations Effective January 1, 2017
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy·Provider Notice
Effective date
Jan 1, 2017
We identified it
Jun 20, 2026
Summary
Illinois Medicaid replaced four therapy evaluation CPT codes (97001-97004) with six new complexity-based codes (97161-97167) for PT/OT evaluations and updated re-evaluation codes (97164, 97168) effective January 1, 2017. Billing must now reflect the appropriate complexity level and time spent in 15-minute increments.
Action Required
Immediately: Billing team must stop using deleted codes 97001-97004 and update billing system to use new complexity-based codes 97161-97167 for evaluations and 97164/97168 for re-evaluations. Update encounter forms to help providers select appropriate complexity level. Document key components and time spent in medical records for audit purposes. Submit replacement claims for any services billed with incorrect codes before this notification.