CATEGORY
Physical medicine and rehabilitation therapeutic Procedures
CODE TYPE
Untimed code Group therapy
ADD-ON CODE
No add-on code
GROUP THERAPY
CPT 97150 consists of all therapeutic services provided to a group of 2 or more people at the same time. These techniques may include water therapy, conditioning therapy, or exercise therapy with the constant presence of a doctor or licensed therapist, but not in individual contact with an individual patient. The purpose of therapeutic procedures is to improve, develop or restore body functions that may be impaired as a result of injury, disease or surgery.
CODING GUIDELINES
» Require the skills of qualified healthcare professionals that includes:
- Physical Therapist
- Occupational Therapist
- Chiropractors
- Physical Therapist Assistant
- Occupational Therapy Assistant
» Require physical therapy modifier (GP, GN, GO, CO, CQ)
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 the reimbursement of these CPTs following elements must be documented in the Physical Therapy Notes:
- Documentation of Direct contact of Physical Therapist or supervised support personnel with the group.
- Documentation of skilled interventions as required per individual patient’s needs.
- It is not necessary that all the patients perform the same activity simultaneously.
- Documentation of medical condition that justify medical necessity of massage therapy.
- Total direct time spent by the provider with patient.
- In order 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 case of maintenance therapy, therapy services cannot be carried out safely by patient himself or patient’s family or caregiver and require treatment by therapist to prevent further deterioration of patient condition.
- Therapy plan must be developed by a qualified/certified healthcare professional.
