As of 2025, the revenue code 0424 description refers to charges for a physical therapy evaluation or re‑evaluation on the UB‑04 (CMS‑1450) claim form. This code remains critical for accurate billing in hospital outpatient and facility claims.
Introduction
In 2025, understanding the revenue code 0424 description is essential for coders, billers, and revenue cycle teams. As healthcare payer policies evolve, usage of code 0424 continues to signal evaluation or re‑evaluation services for physical therapy. In this article, you’ll learn the correct definition, common compliance pitfalls, and practical billing tips tailored to current payer rules.
Overview of Revenue Code 0424
Revenue code 0424 is part of the 042X Physical Therapy section and specifically denotes evaluation or re‑evaluation services for physical therapy delivered in a facility setting :contentReference[oaicite:1]{index=1}.
- 0420 – General classification
- 0421 – Visit charge
- 0422 – Hourly charge
- 0423 – Group rate
- 0424 – Evaluation or re‑evaluation (target)
- 0429 – Other physical therapy services
Revenue code 0424 is essential when a therapist performs the initial evaluation or a periodic re‑evaluation of a patient’s status under a therapy plan of care :contentReference[oaicite:2]{index=2}.
2025 Updates and Payer Rules
However, in 2025, coders must be aware of current payer edits and coverage rules:
- Many commercial payers and Medicare still require a proper therapy plan of care and evaluation documentation to support 0424 :contentReference[oaicite:3]{index=3}.
- Moreover, outpatient claims with revenue code 0424 must include an appropriate HCPCS or CPT code on the same claim line (e.g., CPT 97001 or 97002) or risk denial :contentReference[oaicite:4]{index=4}.
- Claims lacking a matching HCPCS code may be returned with an error indicating missing CPT/HCPCS code requirements for revenue code 0424 :contentReference[oaicite:5]{index=5}.
Impact on Billing and Denials
Therefore, using revenue code 0424 description correctly can reduce denials and improve compliance. Consider the following common issues:
- Missing evaluation documentation or signed plan of care.
- No matching CPT/HCPCS code submitted with the revenue code.
- Re‑evaluation billed under incorrect revenue code or as general charge (e.g., 0420).
For more on handling billing denials and ensuring proper documentation, see our article on How to Bill Revenue Code 0424 in 2025 (Avoid Denials).
How to Adapt Billing Practices in 2025
To align with payer requirements in 2025, follow this checklist:
- Ensure clinical documentation supports the evaluation or re‑evaluation.
- Pair revenue code 0424 with a valid HCPCS or CPT code on the same service line (e.g., CPT 97001/97002).
- Verify payer-specific requirements for therapy code submission.
- Avoid using 0424 for routine visit charges or group therapy sessions.
- Audit claims regularly to catch mismatched codes or missing documentation.
Example Use Case
A hospital outpatient department performs an initial physical therapy evaluation using CPT 97001. The claim should report revenue code 0424 on the same service line, with detailed documentation confirming evaluation components and a signed plan of care.
Related Topics and Internal Resources
For additional in-depth information, see:
- ICD‑10 coding tips for documenting medical necessity
- common denial reasons and how to handle them
- HCPCS code updates for 2025 billing changes
External References
Key regulatory sources include:
- CMS 2025 official guidelines for revenue code and therapy reporting
- AHIMA best practices in therapy documentation and coding
FAQ
Is revenue code 0424 only for initial evals?
No. It applies to both initial evaluations and re‑evaluations under a certified physical therapy plan of care. Both situations require clear documentation.
What CPT codes typically pair with revenue code 0424?
Commonly CPT 97001 (initial evaluation) or 97002 (re‑evaluation). Always include a valid HCPCS or CPT code to match the revenue code.
Can I use 0424 without a CPT/HCPCS code?
No. Most payers and Medicare now require matching CPT/HCPCS on the same service line with 0424; missing codes often lead to denials.
Conclusion
In summary, the revenue code 0424 description in 2025 denotes physical therapy evaluation or re‑evaluation services. Proper pairing with CPT or HCPCS codes, solid documentation, and adherence to payer policies are keys to avoiding denials. Implement the checklist above, stay informed on coding updates, and review related internal resources to optimize your billing accuracy.
Continue monitoring CMS bulletins and payer updates to stay compliant in the evolving billing landscape.