CPT 1170F: Functional Status Assessment for Rheumatoid Arthritis

CPT code 1170F captures a clinician’s assessment of functional status in patients with rheumatoid arthritis, documenting limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Nationally, functional assessments are important for care planning, monitoring disease impact on daily functioning, and supporting medical necessity for therapies and supportive services. This summary frames 1170F in clinical and payer contexts and outlines what stakeholders can expect from an analysis.

Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, typical sites of service, and the kinds of benchmarks and policy considerations that influence coverage and documentation practices. The report highlights common use cases in rheumatology clinics and ambulatory settings, discusses documentation elements tied to ADL and IADL assessment, and summarizes policy updates or payer trends when available.

The content is intended to inform clinicians, coders, and policy analysts about billing and administrative implications of documenting functional status for RA using 1170F, and to identify areas where documentation supports clinical decision-making and reimbursement pathways.

Billing Code Overview

CPT code 1170F documents the provider’s assessment of functional status for patients with rheumatoid arthritis (RA). The assessment evaluates a patient’s ability to perform activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs) to characterize functional limitations related to RA.

Service type: Functional status assessment for rheumatoid arthritis, typically delivered as a clinical evaluation focused on daily functioning and activity limitations.

Typical site of service: Outpatient clinic or office-based rheumatology practice, and may also occur in home health or other ambulatory care settings when the provider assesses ADL/IADL performance.

Data not available in the input.

Clinical Context

A typical patient is a 62-year-old female with established rheumatoid arthritis who presents to a rheumatology clinic for routine follow-up. The patient reports increasing difficulty with dressing, bathing, and preparing meals over the past 3 months. The rheumatology nurse or provider performs a structured functional status assessment to document activities of daily living (ADL) and instrumental activities of daily living (IADL), evaluating mobility, self-care, fine motor tasks related to hand function, need for assistive devices, and the impact of joint pain and morning stiffness on daily function. The workflow includes review of current medications, focused history on function, brief physical exam emphasizing joint range of motion and hand grip, administration or documentation of a validated ADL/IADL instrument if used, and formulation of a problem-focused plan (for example, referral to occupational therapy, assistive devices, or medication adjustment). The assessment is documented in the medical record to support medical decision-making and functional status monitoring over time, and is billed using 1170F to indicate that the provider assessed functional status related to rheumatoid arthritis.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service on the same day	Use when a separate E/M visit is performed in addition to the functional status assessment on the same date of service

Taxonomy Code	Specialty	Notes
`207RH0000X`	Rheumatology	Primary specialty that assesses functional status for RA patients
`207K00000X`	Family Medicine	May perform functional assessments in primary care follow-up
`207Q00000X`	Internal Medicine	Hospital and clinic-based physicians performing chronic disease assessments
`163W00000X`	Occupational Therapy	Performs detailed ADL/IADL evaluations and training related to functional limitations
`261QM0800X`	Nurse Practitioner	Advanced practice providers who commonly document functional assessments

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M06.9`	Rheumatoid arthritis, unspecified	Common diagnosis linked to `1170F` as it documents functional status for RA patients
`M05.79`	Rheumatoid arthritis with rheumatoid factor of multiple sites, without organ or systems involvement	Used when RA with seropositive features affects multiple joints and functional assessment is needed
`M06.0`	Rheumatoid arthritis with rheumatoid factor	Applicable for documenting functional limitations related to seropositive RA
`M24.5`	Contracture of joint	Relevant when RA-related joint contractures impair ADLs and IADLs
`M19.90`	Unspecified osteoarthritis, unspecified site	Included because degenerative joint disease may coexist and contribute to functional limitations
`R26.2`	Difficulty in walking, not elsewhere classified	Symptom code often used when gait impairment is part of the functional assessment
`R26.89`	Other abnormalities of gait and mobility	Used to document specific mobility impairments identified during the assessment
`Z74.01`	Need for assistance with personal care (dressing, bathing)	Social determinant/functional status code documenting need for assistance relevant to ADL assessment

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Often billed for the E/M visit during which the functional status assessment `1170F` is documented
`99406`	Smoking and tobacco-use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Example of a counseling service that may be provided during the same visit when behavioral risk factors affecting function are addressed
`97165`	Occupational therapy evaluation, low complexity	May be used when the provider refers the patient for a formal OT evaluation after identifying ADL/IADL limitations
`97001`	Physical therapy evaluation	Used when functional limitations prompt referral for physical therapy assessment
`95831`	Electrodiagnostic testing; needle electromyography, 1 extremity with or without related paraspinal areas	Occasionally used when differential diagnosis of neuropathy contributing to functional loss is considered
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	May be used when ongoing care coordination is provided for complex RA patients with functional impairment

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Summary & Overview