CPT-97533

“Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, 15 minutes.”

Code Type

Timed-based code Billed in 15 minutes increment

Add-On Code

No add-on code

SENSORY INTEGRATIVE TECHNIQUES

Patients with Sensory processing disorder (SPD) are not able to process sensory information coming from different sensory organs (touch, movement, smell, touch, taste and hearing) correctly.

There are 3 types of SPD:

Sensory modulation Disorder
Sensory Discrimination Disorder
Sensory Based Motor Disorder

Sensory Integration Therapy works by exposing the patients to sensory stimulation (vestibular, proprioceptive and tactile) in a structured and repetitive manner so that overtime the brain will adapt and will learn to response to sensations appropriately and in an organized way. They are especially useful in children with autism spectrum disorders. Children with SPD may be hypersensitive or under sensitive to certain stimuli like noise.

Sensory Integration Therapy may include techniques:

Textured mitts
Balance treatments
Movement therapy
Sensory diet plan
Structured exposure to sensory input
Accommodations and adaptations
Deep Pressure joint Compression Exercises
Weighted vests
Body massage
Body brushing
Oral motor Exercise
Social Stimulation

Coding Guidelines

One-on-one therapy code
Initial 15 minutes of cognitive therapy
Require a therapy modifier (GP, GN, GO, CO, CQ)
CMS 8-minute and AMA rule of Eights are applied

Total No. of Billable Units

04 units are allowed per date of service by CMS but more can be billed if justified by medical notes.

Medical Necessity

Medically necessity is considered in diseases or illness which cause functional physical/cognitive disabilities in patients:

Autism
Developmental delay
Attention deficit disorder
Brain injuries
Other neurological condition

CMS 8-Minute Rule:

A minimum of 8 minutes of direct contact with the patient must be provided for a single unit of 97533 to be billed.

Units	Number of Minutes
1 unit	≥ 08 minutes through 22 minutes
2 units	≥ 23 minutes through 37 minutes
3 units	≥ 38 minutes through 52 minutes
4 units	≥ 53 minutes through 67 minutes
5 units	≥ 68 minutes through 82 minutes
6 units	≥ 83 minutes through 97 minutes
7 units	≥ 98 minutes through 112 minutes
8 units	≥ 113 minutes through 127 minutes

The pattern remains the same for treatment times of more than 2 hours.

AMA RULE OF EIGHTS:

“AMA guidelines state that incremental intervals of treatment performed on the same session may be added together when determining total time in direct contact of a qualified healthcare provider with the patient is necessary. Each unique timed service is counted separately instead of combining the time from multiple units”

Physical Therapy Modifiers

Below mentioned modifiers are used when services are provided for the respective plan of care:

MODIFIERS	PLAN OF CARE
GP	Outpatient Physical Therapy
GO	Outpatient Occupational Therapy
GN	Outpatient Speech-Language Pathology
CQ	Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially)
CO	Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially)

Reimbursement Guidelines

For reimbursement following elements must be documented the Physical Therapy Notes:

Documentation of medical condition to justify medical necessity of Sensory Integration Therapy
Total direct time spent by the provider with patient
In order to meet coverage criteria, therapy services must have these requirements in common:

- Patient condition has the potential to improve
- Documentation of improvement from therapy using objective assessment tools and measurements and functional accomplishments
- Therapy is not being provided to treat loss of function in conditions that are transient and expected to resolve spontaneously reversible
- Therapy plan must be developed by a qualified/certified healthcare professional

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CPT-97533

Category

Code Type

Add-On Code

SENSORY INTEGRATIVE TECHNIQUES

There are 3 types of SPD:

Sensory Integration Therapy may include techniques:

Coding Guidelines

Total No. of Billable Units

Medical Necessity

CMS 8-Minute Rule:

AMA RULE OF EIGHTS:

Physical Therapy Modifiers

Reimbursement Guidelines

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CPT-97533

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