97530 CPT Code For Therapeutic Activity | Description & Billing Guidelines

The 97530 CPT code can be billed for therapeutic activity. This CPT code for therapeutic activity includes many rehabilitative procedures that use whole-body movement to gradually improve functional performance, such as bending, lifting, carrying, reaching, catching, transfers, and overhead activities.

Therapeutic Activity CPT Code Procedure Explained

97530 CPT code for therapeutic activity can be used to record therapy focused on increasing functional performance through dynamic movements.

If two procedures will conduct in two separate and independent 15-minute intervals, the 59 modifier is applicable. There are three steps you must follow to get paid.

The 97530 CPT code for therapeutic procedures is often invoiced using procedure code CPT 97140 (manual therapy techniques) and modifier 59 to avoid CCI changes. For example, movement exercises can target a particular body part or the complete body. The CTP code 95730 defines the therapeutic activities and can bill with other CTP codes like 97140 on the same day.

The key aims of these workouts are frequently mobility, strength, balance, and coordination. A licensed therapist must provide these treatments with specialized training to be effective. Active treatment must include dynamic exercises with a clear goal in mind. 

The physician engages in various activities while in direct touch with the patient to enhance the patient’s functional performance.

Enter the 97530 CPT code for therapeutic procedures per fifteen minutes of action. The physical therapist must communicate with the patient one-on-one to apply these tactics.

Coverage is available as long as the provider is directly involved in providing a service that relies on their abilities.

Patients participate in an activity on their own or using exercise equipment without the presence of a health care physician. The use of these strategies may expect to improve the limitations/deficits.

Under the CPT code for therapeutic activity (97530), Medicare covers the cost of time spent documenting services (creating medical records). The exercises may typically design for those who have lost or are at risk of losing mobility, strength, balance, or coordination. 

They may intend to meet a specific functional need of the patient and necessitate the professional skills of a competent specialist. It is possible to increase one’s functional abilities over time by engaging in practical tasks (e.g., bending, lifting, carrying, reaching, catching, and overhead exercises).  

The Canalith Rebalancing Technique (also known as the Epley procedure) may treat dizziness caused by benign positional vertigo (BPPV). Use code 97530 when performing the expiratory technique. Unfortunately, audiologists cannot be compensated directly for therapy services, as this is impossible.

97530 CPT Code Description

97530 CPT code can be used as a CPT code for therapeutic activities to charge individual therapists or therapy assistant services.

CPT 97530: The 97530 CPT code for therapeutic activity is officially described by CPT’s manual as: “Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), every 15 minutes.”

It is illegal for the same therapist or therapist’s assistant to administer identical or different treatments to the same patient simultaneously to avoid double billing (s).

 If both physical and occupational therapists deliver services to the same patient simultaneously, only one of them can bill for the entire treatment. For example, two therapists may work with one patient for 30 minutes on transfer tasks.

 Each PTs and OTs participating could bill one 97530 CPT code unit. Both units of the 97530 CPT code procedure for therapeutic activities can be billed, but not both, as long as one is a physical therapist (PT). For example, suppose two therapy assistants simultaneously deliver services to the same patient.

 In that case, the supervising therapist can bill only one therapy assistant’s services, or the service units can be split and billed by the supervising therapist (s).

The certified treatment practitioner’s line of thinking and expert decision-making will document for timed therapeutic CPT codes. Patients and clients require more than a list of surgeries in their medical records. 

Evidence of knowledge and skill in connection to the processes carried out may include in the documentation. It should also serve as proof of the author’s solid judgment. This clinical decision-making notion will consist of health records.

Manual therapy procedures such as manipulation, soft tissue mobilization, and joint mobilization may include in the CPT description for code 97140 (manual therapy). 

Billing Guidelines For CPT Codes For Therapeutic Activity

CPT codes such as 97112, 97113, 97116, and 97503 may indicate a wide range of therapeutic operations. The outcomes of the therapy plan may specify in the treatment plan.

If the results of these therapies are as expected, it will be easier to determine whether they are necessary. As a result, everyone can take part.

 A treatment plan may include a combination of various treatments, but documentation must support each procedure’s use for a specific therapeutic goal. For each visit, treatment records must help the billed codes and identify the particular exercise or activity conducted for each billed code.

When deciding whether or not the activity you’re having the patient do is therapeutic, consider the following factors:

Squatting, climbing/descending stairs, walking, bending, lifting, catching, tossing, pushing, and pulling are all therapeutic movements., it’s critical to understand that Medicaid only pays for the 97530 CPT code, not 97110, to guarantee correct reimbursement.

Therapeutic activities and exercises may combine various features (such as balance coordination, power, strength, and range of motion) into a single training or workout. When documenting, include the patient’s precise connection to functional movement.

Lifting a weight from the floor and placing it on a shelf, for example, strengthens your patient’s shoulders while allowing them to reach an upper cabinet quickly.

Before charging 97110 or 97530 CPT code for therapeutic activities, consider why you’re doing it and whether it addresses one or more parameters. Proper invoicing is critical since therapeutic activities will compensate more than therapeutic exercise.

Documentation is also required to support the incorporation of so many services and units in a single code. Each code typically requires no more than 1-2 services/units of time to function effectively.

A couple of days before the occasion, a regular visit will address no more than three of these codes. Each line of code and the documentation that goes with it may back up.

97530 CPT Code Modifiers

If the two operations perform in separate 15-minute time blocks, modifier 59 may be recorded with the 97530 CPT code for therapeutic activity. For example, the first 15 minutes of therapy could consist of one service, and the second 15 minutes could consist of the other.

Furthermore, the therapy time blocks are separate; 10 minutes of manual therapy could be followed by 15 minutes of therapeutic activities, followed by another 5 minutes. 

Modifier 59 will use when two timed procedures may conduct on the same day in different blocks of time.

If a more appropriate modifier is already in use, Modifier 59 will not be used. Modifier 59 is only required if no other descriptive modifiers are available and it best defines the scenario.

It is one of the most frequently misunderstood modifiers in the English language. 59 This is the most prevalent reason for using it if two or more treatments may conduct simultaneously but at distinct locations on the human body.

Unfortunately, it may frequently use to prohibit services from being combined or integrated under a single claim. It will never use exclusively to go around an insurance company’s edit system or avoid getting packaged.

Patients’ medical records should include documentation demonstrating that any services provided under the 59 modifier were distinct and unrelated to one another. The insurance company may request a medical record review before granting total compensation for the new CPT code.

Patients using the 59 modifiers don’t have to use a different diagnosis code for each billable service. However, new diagnosis codes may use for each service provided to avoid the 59 modifiers.

The 59 modifiers may legitimately use by a physical therapist who did both manual treatment and therapeutic activity in the same appointment. In most cases, all of these tactics may expect to be inclusive.

Modifier 59 will allow each code may include in the claim. The 59 modifier is necessary when two procedures will perform at 15-minute intervals. The 59 modifiers may avoid if the therapist conducts both operations simultaneously.

A nerve conduction study can alternatively describe using CPT codes 95900 and 95903. Use the 59 modifiers when performing two independent treatments on separate nerves. This alteration should not be applied when the coding may conduct on a single nerve.

Even if billers must be aware that invoicing the services without the 59 modifiers may result in bundling or denial, they should never use it. Only a practitioner or coder with access to the patient’s medical record should use the 59 modifiers.

Reimbursement For The CPT Code For Therapeutic Activity

The following conditions will complete getting compensation for the 97530 CPT code for therapeutic activity.

A doctor, eye doctor, or physical therapist must directly supervise the patient for them to engage in therapeutic activities. If the patient’s condition prevents them from engaging in therapeutic activities on their own, therapeutic exercises may expect to restore or improve functionality.

There is a clear link between the sort of exercise undertaken and the underlying medical condition for which the therapeutic activities will prescribe.

Example

For example, a physical therapist and an occupational therapist collaborate for 30 minutes to move a patient. Each PT and OT could bill one unit of the 97530 CPT code for therapeutic activity.

Both units of 97530 CPT code can be billed, but not both, as long as one is a physical therapist (PT). Two distinct therapy assistants can also serve the same patient simultaneously, and the supervising therapist can only bill for one of the service units (s).