CPT-97130

“One-on-one Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, Initial 15 minutes”

97129

Only 1 unit is allowed per DOS, however, additional time spent by the therapist is billed using add-on code 97130 .

97130

07 units are allowed per date of service by CMS but more can be billed if medical notes justify the extra time .

CODING GUIDELINES

  • CPT 97129 and 97130 are used to bill for a one-on-one cognitive therapy furnished by a qualified healthcare professional or physician to a patient with learning disabilities or an individual who has lost cognitive skills as a result of illness or brain to assist in the development of cognitive skills.

    Cognitive skill development may consist of mental exercises that assist the patient in areas such as:

    1. Attention
    2. Memory
    3. Perception
    4. Language
    5. Reasoning
    6. Planning
    7. Problem-solving
    8. Executive functioning, and related skills

MEDICAL NECESSITY

  • It May be considered medically necessary if one of the following conditions is present and documented:

    • Stroke
    • Traumatic brain Injury (TBI)
    • Other neurological and medical conditions such as Epilepsy, brain cancer, autism spectrum, brain degenerative disease

REIMBURSEMENT GUIDELINES

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

    1. Documentation of medical conditions that justify the medical necessity of massage therapy
    2. Total direct time spent by the provider with the patient

INSURANCES COVERAGE CRITERIA

  1. To meet coverage criteria, therapy services 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.
    • In the case of maintenance therapy, therapy services cannot be carried out safely by the patient himself or the patient’s family or caregiver and require treatment by the therapist to prevent further deterioration of the patient’s condition
  2. Therapy plan is developed by a qualified/certified healthcare professional

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)

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CPT-97130