97750 coverage policies: Medicare and commercial payers

10 active Medicare policies list 97750, and 13 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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Medicare policies listing 97750

LCD · CGS-J15-L34049

Outpatient Physical and Occupational Therapy Services

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L33631

Outpatient Physical and Occupational Therapy Services

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33631

Outpatient Physical and Occupational Therapy Services

JK · Effective Oct 1, 2015

Article · A53057

Billing and Coding: Home Health Occupational Therapy

National · Effective Oct 1, 2026

Article · A53058

Billing and Coding: Home Health Physical Therapy

National · Effective Oct 1, 2026

Article · A53064

Billing and Coding: Outpatient Occupational Therapy

National · Effective Oct 1, 2026

Article · A56566

Billing and Coding: Outpatient Physical and Occupational Therapy Services

J6 · Effective Apr 1, 2026

Article · A57067

Billing and Coding: Outpatient Physical and Occupational Therapy Services

National · Effective Jun 4, 2026

Article · A53065

Billing and Coding: Outpatient Physical Therapy

National · Effective Oct 1, 2026

Article · A57311

Billing and Coding: Physical Therapy - Home Health

Commercial payer policies listing 97750

13 policies from 9 payers

Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.

Aetna

Aetna policies listing 97750, with the code’s status in each
Policy	Effective	Status of 97750
Back Pain - Noninvasive TreatmentsPayerPolicy · AETNA-CPB-0232	Apr 26, 2023	Covered
Knee Ligament Arthrometer TestingPayerPolicy · AETNA-CPB-0397	Jun 6, 2023	Covered
Musculoskeletal Assessment SystemsPayerPolicy · AETNA-CPB-0212	Mar 9, 2023	Covered

Cigna

Cigna policies listing 97750, with the code’s status in each
Policy	Effective	Status of 97750
Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations and Re-evaluationsPayerPolicy · CIGNA-CPG111	Jul 15, 2026	Covered with conditions
Physical Performance Test or MeasurementPayerPolicy · CIGNA-CPG295

Policy	Effective	Status of 97750
The Health Plan MSK Chiro Code ListPayerPolicy · EVICORE-HPLAN-THE_HEALTH_PLAN-051854AF1B9B	Jan 1, 2026	Prior auth required
The Health Plan MSK PTOT Code ListPayerPolicy · EVICORE-HPLAN-THE_HEALTH_PLAN-E178D78B53BA	Jan 1, 2026	Prior auth required

97750 coverage policies: Medicare and commercial payers

Medicare policies listing 97750

Outpatient Physical and Occupational Therapy Services

Outpatient Physical and Occupational Therapy Services

Outpatient Physical and Occupational Therapy Services

Billing and Coding: Home Health Occupational Therapy

Billing and Coding: Home Health Physical Therapy

Billing and Coding: Outpatient Occupational Therapy

Billing and Coding: Outpatient Physical and Occupational Therapy Services

Billing and Coding: Outpatient Physical and Occupational Therapy Services

Billing and Coding: Outpatient Physical Therapy

Billing and Coding: Physical Therapy - Home Health

Commercial payer policies listing 97750

Aetna

Cigna

97750 coverage policies: Medicare and commercial payers

Medicare policies listing 97750

Outpatient Physical and Occupational Therapy Services

Outpatient Physical and Occupational Therapy Services

Outpatient Physical and Occupational Therapy Services

Billing and Coding: Home Health Occupational Therapy

Billing and Coding: Home Health Physical Therapy

Billing and Coding: Outpatient Occupational Therapy

Billing and Coding: Outpatient Physical and Occupational Therapy Services

Billing and Coding: Outpatient Physical and Occupational Therapy Services

Billing and Coding: Outpatient Physical Therapy

Billing and Coding: Physical Therapy - Home Health

Commercial payer policies listing 97750

Aetna

Cigna

The Health Plan

BCBS Illinois

BCBS Montana

BCBS New Mexico

BCBS Oklahoma

Carelon Medical Benefits Management

EOCCO / Moda Health