2025 CPT code 96004
(Active) Effective Date: N/A Revision Date: N/A Medicine - Motion Analysis Interpretation Medicine Services and Procedures > Neurology and Neuromuscular Procedures Feed
Physician or qualified professional's review and interpretation of one or more motion analysis tests, with a written report. This code covers only the professional component.
Modifiers 52 (reduced services), 53 (discontinued procedure), and 76 (repeat procedure by the same physician) may be applicable under certain circumstances, depending on the specific clinical situation.
Medical necessity for motion analysis is established when clinical findings suggest a need to quantify gait and movement abnormalities to inform appropriate management. This may be indicated by unexplained falls, persistent pain, functional limitations, or the need to objectively assess the effectiveness of treatment interventions.
The physician or qualified healthcare provider reviews the patient's medical history, examination, and relevant imaging studies. They obtain the results of the motion analysis test(s) (reported separately using codes 96000-96003), analyze these results (looking for causes of abnormalities in joint motion and forces, analyzing stride and gait measurements), and create a treatment plan based on their interpretation.
- Medicine Services and Procedures > Neurology and Neuromuscular Procedures
- Medicine Services and Procedures > Neurology and Neuromuscular Procedures
In simple words: The doctor reviews the results of motion tests (like how you walk or move) and writes a report explaining what the tests show and suggesting ways to improve movement.
This CPT code encompasses the professional component of reviewing and interpreting comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, culminating in a written report.The physician or qualified healthcare professional analyzes the patient's medical history, physical examination findings, and relevant imaging studies in conjunction with the motion analysis test results. The interpretation involves identifying causes of abnormalities in joint motion and forces, analyzing stride characteristics, and quantifying gait parameters to generate treatment recommendations.This code should only be reported once, regardless of the number of studies reviewed.It does not include the technical component of performing the tests (reported separately using codes 96000-96003).
Example 1: A patient presents with persistent knee pain following an ACL reconstruction. Motion analysis is performed to evaluate gait and joint mechanics. Code 96004 is reported for the physician's interpretation of the motion analysis study, guiding rehabilitation efforts., An athlete sustains a lower extremity injury.Dynamic electromyography and motion capture are used to assess muscle activation patterns during athletic movements. Code 96004 is used to report the physician's interpretation of this comprehensive assessment, informing surgical or non-surgical management., A patient experiences recurrent falls due to balance problems. Motion analysis is used to identify gait deviations and postural instability. Code 96004 is reported for the physician's interpretation of these findings, leading to recommendations for physical therapy and assistive devices.
* Patient's medical history, including the reason for referral.* Physical examination findings relevant to musculoskeletal function.* Results of the motion analysis test(s) (including raw data and graphical representations).* Detailed interpretation of the motion analysis results, identifying specific abnormalities and quantifying their severity.* Physician's assessment of the overall clinical picture, considering other diagnostic information.* Treatment plan with specific recommendations.
** This code is typically reported by physicians or other qualified healthcare professionals who specialize in musculoskeletal medicine, neurology, or rehabilitation medicine.The specific types of motion analysis tests included in the interpretation will vary based on the clinical indication.Appropriate documentation is crucial for accurate coding and reimbursement.
- Revenue Code: T2D (OTHER TESTS - OTHER)
- Payment Status: Active
- Modifier TC rule: Modifier TC (technical component) is not applicable to this code, as it only represents the professional interpretation component.
- Specialties:Physical Medicine and Rehabilitation, Orthopedics, Neurology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center