Outpatient Physical and Occupational Therapy Services
J15 · Effective Oct 1, 2015
7 active Medicare policies list 97799, and 33 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
J6 · Effective Apr 1, 2026
National · Effective Jun 4, 2026
National · Effective Oct 1, 2026
33 policies from 10 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 97799 |
|---|---|---|
| Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses | Jun 15, 2026 | Covered |
| High Intensity Laser Therapy for Chronic Musculoskeletal Pain Conditions and Bell’s Palsy | Oct 15, 2025 | Covered |
| Outpatient Pulmonary Rehabilitation | Sep 15, 2026 | Covered |
| Physical Therapy (PT) and Occupational Therapy (OT) Services | Jan 1, 2026 | Covered |
| Surface Electromyography and Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain | Oct 1, 2025 | Covered |
| Policy | Effective | Status of 97799 |
|---|---|---|
| Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses | Jun 15, 2026 | Covered |
| High Intensity Laser Therapy for Chronic Musculoskeletal Pain Conditions and Bell’s Palsy | Oct 15, 2025 | Covered |
| Outpatient Pulmonary Rehabilitation | Sep 15, 2026 | Covered |
| Physical Therapy (PT) and Occupational Therapy (OT) Services | Jan 1, 2026 | Covered |
| Surface Electromyography and Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain | Oct 1, 2025 | Covered |
| Policy | Effective | Status of 97799 |
|---|---|---|
| Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses | Jun 15, 2026 | Covered |
| High Intensity Laser Therapy for Chronic Musculoskeletal Pain Conditions and Bell’s Palsy | Oct 15, 2025 | Covered |
| Outpatient Pulmonary Rehabilitation | Sep 15, 2026 | Covered |
| Physical Therapy (PT) and Occupational Therapy (OT) Services | Jan 1, 2026 | Covered |
| Surface Electromyography and Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain | Oct 1, 2025 | Covered |
| Policy | Effective | Status of 97799 |
|---|---|---|
| Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses | Jun 15, 2026 | Covered |
| High Intensity Laser Therapy for Chronic Musculoskeletal Pain Conditions and Bell’s Palsy | Oct 15, 2025 | Covered |
| Outpatient Pulmonary Rehabilitation | Sep 15, 2026 | Covered |
| Physical Therapy (PT) and Occupational Therapy (OT) Services | Jan 1, 2026 | Covered |
| Surface Electromyography and Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain | Oct 1, 2025 | Covered |
| Policy | Effective | Status of 97799 |
|---|---|---|
| Chiropractic Care | Dec 15, 2025 | Covered with conditions |
| Complementary and Alternative Medicine | Feb 15, 2026 | Not covered |
| Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations and Re-evaluations | Jul 15, 2026 | Covered with conditions |
| Physical Therapy | Dec 15, 2025 | Not covered |
| Sensory and Auditory Integration Therapy - Facilitated Communication | Jun 15, 2026 | Not covered |
| Policy | Effective | Status of 97799 |
|---|---|---|
| Biomagnetic Therapy | Jul 1, 2026 | Not covered |
| Biomechanical Footwear Therapy | Apr 15, 2026 | Not covered |
| Quantitative Muscle Testing Devices | Oct 1, 2026 | Not covered |
| Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State | Apr 15, 2026 | Not covered |
| Policy | Effective | Status of 97799 |
|---|---|---|
| Chiropractic Services | Mar 23, 2023 | Covered |
| Policy | Effective | Status of 97799 |
|---|---|---|
| EOCCO Specialty Therapies Code List | May 1, 2026 | Prior auth required |
| Policy | Effective | Status of 97799 |
|---|---|---|
| The Health Plan MSK PTOT Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 97799 |
|---|---|---|
| Skilled Nursing Facility, Rehabilitation, Long-Term Acute Care Hospital, and Private Duty Nursing | Not recorded | Covered |