Outpatient Physical and Occupational Therapy Services
J15 · Effective Oct 1, 2015
10 active Medicare policies list 95852, and 9 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J15 · Effective Oct 1, 2015
J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
National · Effective Oct 1, 2026
National · Effective Oct 1, 2026
National · Effective Oct 1, 2026
J6 · Effective Apr 1, 2026
National · Effective Jun 4, 2026
National · Effective Oct 1, 2026
9 policies from 7 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 95852 |
|---|---|---|
| Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations and Re-evaluations | Jul 15, 2026 | Covered with conditions |
| Physical Performance Test or Measurement | Nov 15, 2025 | Covered with conditions |
| Policy | Effective | Status of 95852 |
|---|---|---|
| The Health Plan MSK Chiro Code List | Jan 1, 2026 | Prior auth required |
| The Health Plan MSK PTOT Code List | Jan 1, 2026 |
National · Effective Aug 6, 2026
| Policy | Effective | Status of 95852 |
|---|---|---|
| Physical Therapy (PT) and Occupational Therapy (OT) Services | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 95852 |
|---|---|---|
| Physical Therapy (PT) and Occupational Therapy (OT) Services | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 95852 |
|---|---|---|
| Physical Therapy (PT) and Occupational Therapy (OT) Services | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 95852 |
|---|---|---|
| Physical Therapy (PT) and Occupational Therapy (OT) Services | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 95852 |
|---|---|---|
| EOCCO Specialty Therapies Code List | May 1, 2026 | Prior auth required |