CPT 97530 - Therapeutic Activities

 

CPT 97530 - Therapeutic Activities

 

(Time-based Code)

 

CPT Code 97530:  Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes.

 

This is a therapeutic procedure, a manner of effecting change through the application of clinical skills and/or services that attempt to improve function. This procedure requires direct (one-on-one) patient contact by a physician or licensed therapist.

 

All time-based therapies are reported in 15-minute increments. If the service is provided for less than 8 minutes, it should not be billed to the payor.

 

Reporting Therapeutic Activities
Therapeutic activities (97530, each 15 minutes) use functional activities (e.g., bending, lifting, carrying, reaching, catching, and overhead activities) to improve functional performance in a progressive manner.

 

The activities are usually directed at a loss or restriction of mobility, strength, balance, or coordination. They require the professional skills of a provider and are designed to address a specific functional need of the patient. These dynamic activities must be part of an active treatment plan and directed at a specific outcome.

 

An example of 97530 might be to increase flexibility of the quadratus lumborum muscles while activating and stretching the hamstring muscles to improve the patient's capacity for walking and standing.

 

(AAPC Knowledge Center July 1,2021)
https://www.aapc.com/blog/22462-document-chiropractic-group-and-individual-therapy-differences/

 

Medicare notes that this procedure involves using functional activities to improve functional performance. Some functional activities include bending, lifting, carrying, reaching, catching and overhead activities. The activities should be targeted at a loss or restriction of mobility, strength, balance or coordination.

 

Checks:

  • Does my patient have a clearly documented functional impairment?

  • Do I have clearly stated, objective treatment goals to improve this functional impairment?

  • Did we perform functional activities to reach this goal?

 

Documentation Requirements for this Specific CPT Code
In order for therapeutic activity (CPT Code 97530) to be covered, the following requirements must be met and evidence substantiating coverage must be clearly documented in the healthcare record, including but not limited to that:

  • the patient has a condition for which therapeutic activities can reasonably be expected to restore or improve functioning;

  • the patient's condition is such that he/she is unable to perform therapeutic activities except under the direct supervision of a physician, or physical therapist;

  • and there is a clear correlation between the type of exercise performed and the patient's underlying medical condition for which the therapeutic activities were prescribed.

  

(Coding Ahead - CPT Code 97530 - Therapeutic Activity & Exercise (2021)
"CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.")
https://www.codingahead.com/97530-cpt-code-description-guidelines-reimbursement-modifiers-example/

 

HNS Policies: Documentation/Billing
When performed and billed to a payor, modalities/therapies must be properly documented in the health care record and accurately reported using the most appropriate code.

 

When performed and billed to a payor, modalities/therapies must be medically necessary and consistent with the chief complaint/clinical findings, diagnoses and treatment plan.

 

Documentation in the health care record must include the rationale for each therapy and must clearly establish the medical necessity for each therapy billed to the payor.

 

For ALL modalities and therapies, documentation must include:

  • Type of modality

     

  • Rationale

     

  • Area of application (specific region treated)

     

  • Setting and frequency (as applicable)

     

  • If time based code, actual time service performed

  

During the initial phase of care, no more than two therapies or modalities per visit are considered usual and customary.

 

There should be a reduction in the use of therapies as the patient's condition improves.

 

Modifiers Needed:
Importantly, when reporting 97530 to BCBSNC, NC State Health Plan (SHP), MedCost, or any plan which utilizes Zelis edits, you must append 97530 with modifier GP.

 

Please click here
for the HNS NCCI Edit - Modifier Help Sheet,
which is a list of therapy codes requiring special modifiers.