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    v1.0.28
    OpenPayerPolicy UpdatesPhysical Medicine, Rehab & TherapiesAmerican Specialty Health ROM Policy | OpenPayer
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    CurrentAmerican Specialty HealthPolicy N/A

    Range of Motion Testing (CPG 146)

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    This policy governs coverage and reimbursement for CPT range of motion testing performed for complex conditions affecting multiple extremities and trunk musculature. Providers must meet the medical-necessity, testing-scope, interpretation, reporting, and coding requirements; applicable benefit plan terms supersede this policy.

    Policy Summary
    PayerAmerican Specialty Health
    PolicyRange of Motion Testing (CPG 146)
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJune 15, 2026
    Next Review DateJune 15, 2027
    Key ActionProvide a separate, distinct, dated, and signed written report with the test purpose, results, interpretation, and impact on the treatment plan.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2CPT codes designated as medically necessary when criteria are met
    4Examples of qualifying complex neurologic or movement conditions

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    1
    Separate, distinct, dated, and signed written report required
    5Policy pages

    Coverage Criteria

    Medically Necessary ROM Testing

    Covered as medically necessary when all of the following are met:

    Medical necessity for separate ROM testing

    • Clinical complexity and purpose: The condition impacts multiple extremities and trunk musculature, and testing beyond what is included in the E/M service or standard physical therapy, occupational therapy, or athletic training evaluation or reevaluation is required to develop a plan of care.
    • Pertinence to care: The testing is pertinent to the patient's diagnosis and plan of care.
    • Reporting and interpretation: A written report with interpretation of the results is provided.
    • Examples of potentially qualifying conditions: Examples include spinal cord injury, traumatic brain injury, neurologic conditions such as multiple sclerosis or stroke, and movement disorders such as Parkinson's disease or cerebral palsy.

      These are examples and are not an exhaustive list.

    Testing Scope for Reported Region

    When reporting CPT 95851 or 95852, all applicable anatomic units within the coded region must be tested.

    Complete anatomic assessment: Every muscle or joint in the affected extremity or trunk section described by the code descriptor must be tested.

    For CPT 95851, testing only one joint of an extremity, such as the shoulder, is insufficient. CPT 95852 applies to the hand.

    Baseline range-of-motion (ROM) measurements performed as part of an initial or follow-up E/M, physical therapy, or occupational therapy evaluation or reevaluation are included in that service. They are incidental to the evaluation or reevaluation and should not be separately reported with CPT 95851 or 95852.

    A digital device that generates a ROM report does not, by itself, establish medical necessity or support separate billing of CPT 95851 or 95852. Separate reporting requires the applicable clinical rationale, complete testing, practitioner interpretation, and required documentation.

    Routine performance of CPT 95851 or 95852 is not reasonable or necessary. This includes monthly testing and routine use of these codes for all patients, rather than performing the testing for a specific medically necessary purpose.

    CPT 95851 or 95852 should not be used in place of a standard therapy reevaluation or E/M code. When ROM measurement is part of the usual evaluation or reevaluation service, it remains included in that service rather than being reported as a separate ROM testing procedure.

    Reporting CPT 95851 for an extremity tested at only one joint, such as the shoulder, is not appropriate. The code requires testing of every applicable joint in the affected extremity, with documentation explaining why the thorough assessment was warranted.

    Covered and Referenced Codes

    CPT Codes considered medically necessary when applicable criteria are metCPTCovered
    95851Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine).
    95852Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side.
    Referenced standard therapy evaluation and reevaluation codesCPT
    97161-97163Physical therapy evaluation codes referenced as including necessary objective measurement tools, including ROM.
    97164Physical therapy reevaluation code referenced as including necessary objective measurement tools, including ROM.
    97165-97167Occupational therapy evaluation codes referenced as including necessary objective measurement tools, including ROM.
    97168Occupational therapy reevaluation code referenced as including necessary objective measurement tools, including ROM.

    Provider Documentation and Billing Actions

    Documentation Required

    Submit the required ROM testing report

    Provide a separate, distinct, dated, and signed written report for CPT 95851 or 95852. The report must state the purpose and rationale for the test, the tests performed and their results, the interpretation of the results, and how the information affects the treatment plan.

    Denial Risk

    Use covered codes and diagnoses

    Claims may be denied when services are billed for diagnoses or conditions not covered under the policy, are not accompanied by covered procedure or diagnosis codes, or do not use the most appropriate codes effective on the submission date.

    Policy Background

    ROM measurements are ordinarily included in an E/M, physical therapy, or occupational therapy evaluation or reevaluation, which generally provides the objective measurements needed for clinical decision-making. Separate ROM testing is reserved for uncommon or complex situations in which specialized, thorough testing beyond the included assessment is needed to develop or modify the plan of care, is relevant to the diagnosis, and is supported by practitioner interpretation and a separate written report.

    Definitions

    Range of Motion Testing
    ServiceRange of motion (ROM) testing is designated as a separate procedure under CPT codes 95851–95852.
    Practitioner interpretationThe procedure requires the practitioner’s interpretation of the ROM results.
    Required reportA separate, distinct, dated, and signed written report is required.
    E/M
    ServiceEvaluation and Management (E/M) is an evaluation and management service for the patient’s condition.
    Typical patientsFor the typical patient, the E/M service includes all necessary objective measurement tools, including ROM.
    Separate ROM billing
    Policy Summary
    PayerAmerican Specialty Health
    PolicyRange of Motion Testing (CPG 146)
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJune 15, 2026
    Next Review DateJune 15, 2027
    Key ActionProvide a separate, distinct, dated, and signed written report with the test purpose, results, interpretation, and impact on the treatment plan.
    SourceLink
    On This Page
    Coverage CriteriaCovered and Referenced CodesProvider Documentation and Billing ActionsPolicy BackgroundDefinitions
    Billing Rule

    Test the complete coded region

    When reporting CPT 95851 or 95852, test every muscle or joint in the affected extremity or trunk section described by the code descriptor. Do not submit CPT 95851 when only a single joint, such as the shoulder, was tested.

    Denial Risk

    Avoid routine or substitute use

    Do not report CPT 95851 or 95852 for routine testing, including monthly testing or routine use for all patients, or in place of a standard therapy reevaluation or E/M code. Digital devices that provide reports do not by themselves justify separate billing of these codes.

    Billing Rule

    Separate ROM testing from included evaluations

    For typical patients, ROM measurements are included in the E/M, physical therapy, or occupational therapy evaluation or reevaluation and are not separately reportable with CPT 95851 or 95852. Separate ROM testing applies when a complex condition warrants specialized testing beyond the included assessment.

    Documentation Required

    Document testing scope and rationale

    Document that the testing is relevant to the patient’s diagnosis and plan of care. For an extremity or trunk section, document testing of every muscle or joint included in the applicable code descriptor and explain why the thorough assessment was warranted.

    Baseline ROM measurements performed during an initial E/M service are incidental and included in that service rather than separately reported.
    Standard Therapy Evaluation or Reevaluation
    Physical therapy evaluationPT evaluation services include CPT codes 97161–97163 and include necessary objective measurement tools, including ROM.
    Physical therapy reevaluationPT reevaluation services include CPT code 97164 and include necessary objective measurement tools, including ROM.
    Occupational therapy evaluation and reevaluationOT evaluation and reevaluation services include CPT codes 97165–97167 and 97168, respectively, and include necessary objective measurement tools, including ROM.