Is CPT code 97150 as simple as it looks? Or are there any hidden details that you should be aware of? Many healthcare providers, including physical and occupational therapists, offer group therapy to people with similar conditions.
In fact, it is sometimes more effective than individual counseling sessions. Unfortunately, due to unique coding requirements, many therapists struggle to maximize reimbursements for these sessions. To apply the correct codes in different scenarios, you must be deeply familiar with all of them. Let’s uncover all the mysteries behind the most frequently used CPT code for group therapy, 97150.
97150 CPT Code – Description
The Current Procedural Terminology (CPT) code 97150 highlights therapeutic sessions provided to a group of patients (two or more people) with similar problems. These services usually target a specific problem, such as chronic pain and reduced muscle control, to achieve set therapy goals.
These group therapy sessions are generally supervised by an experienced healthcare provider. However, the procedures or services performed within these sessions don’t require one-on-one contact between patients and therapists.
In short, billing teams use the 97150 CPT code to claim reimbursements for group therapies within physical medicine and rehabilitation fields. This code is important for all types of therapists, including physical or occupational therapists, because it impacts their cash flow.
The most important thing to remember? Unlike others, CPT code 97150 is not time-based. Hence, you can use it to bill an entire session, regardless of duration.
Scenarios Where CPT Code 97150 is Applicable
Still unsure about the correct application of CPT code 97150? Let us help you by highlighting the scenarios where this code is applicable.
Stress Management in Rehabilitation
Stress is a common problem among chronic patients. Many rehabilitation centers offer stress management programs. If an occupational therapist teaches relaxation techniques (e.g., breathing exercises) to two or more patients simultaneously, he can use CPT code 97150 to claim reimbursement for that session.
Fall Prevention Programs
Did you know that around 3 million older people (aged 65 or above) visit emergency centers each year due to falls? Therefore, fall prevention therapies, focusing on education and improving coordination, are quite popular. So, a physical therapist can use CPT code 97150 if he guides two or more elderly patients in a group setting.
Neurological Occupational Group Therapy
Patients with neurological disorders, like Alzheimer’s or Parkinson’s disease, also require active support. Occupational therapists (OTs) aim to restore both cognitive and physical abilities in these people. They use CPT code 97150 to bill for task-oriented sessions that focus on improving the impaired motor functions of two or more patients.
CPT Code 97150 – Billing Challenges
The application of this code might seem simple by now, but group therapies are quite tricky. They have their own challenges and limitations. Hence, you can face the following issues while billing CPT code 97150.
Insufficient Documentation
Insurance companies require complete documentation with CPT code 97150 to evaluate the therapeutic value of a group session. If you fail to offer details like group size, therapy goals, or information about the participating healthcare provider, they will automatically deny your claim.
Payer-Specific Requirements for Group Therapy
You should know by now that every insurance company has specific rules for everything, including group therapy (CPT code 97150). Medicare has also defined policies for these sessions, including its 25% rule—group therapies should be limited to a quarter of the total patient’s treatment time.
Medicare Administrative Contractors (MACs) further clarify these policies in local coverage determinations (LCDs). Some insurance companies also limit group sizes, session frequencies, and services. You might face claim rejections if you don’t pay attention to these specific requirements.
Code Misinterpretation
CPT code 97150 is billed as one unit regardless of the session duration. In simple words, it is an untimed code. Some healthcare providers and practices face claim denials because they mistakenly use it multiple times for longer sessions.
Inappropriate Bundling
Since the 97150 is an untimed CPT code, it cannot be combined with others. Providers face billing issues when they bundle this code with other CPT codes for various therapeutic services performed within the same session.
Medical Necessity
You should always justify the medical necessity of group therapies. Insurers can deny CPT 97150 if they find that group therapy is unnecessary for patients’ treatment or does not meet the appropriate goals.
97150 CPT Code – Reimbursement Guidelines
Can you tackle all the coding challenges of group therapies? Rehabilitation centers and physical medicine have significantly higher denial rates than the national average of 15%. The primary reasons? Coding complexities and insufficient documentation.
That’s why many practices and therapists often outsource physical therapy billing services. But if finding a reliable name feels too much of a hassle, follow our reimbursement guidelines to file accurate CPT code 97150 claims.
Bill Once per Group Session
The best part about this code is that it does not have a time limit. So, whether you conducted a 15-minute or an hour-long group therapy, use CPT code 97150 only once per session.
Justify Medical Necessity with Proper Documentation
Reimbursement for CPT code 97150 heavily relies on complete documentation. This includes all the details that support the medical necessity of group therapy, including therapeutic goals, group therapy reasons, qualified healthcare provider’s involvement, and group details.
Our advice? Instead of using vague terms like group exercises, be more specific. The best way to do that is by documenting all the interventions (exercises and activities) performed during group therapy.
Follow Payer-Specific Guidelines
As we mentioned in the billing challenges, coverage and group size can vary from payer to payer. Therefore, verify each insurance company’s policies for CPT code 97150 before filing any claim to avoid denials.
Use Appropriate Modifiers (If Necessary)
Modifiers can help you receive timely reimbursements, but only if you use them appropriately. Physical therapy often involves the following modifiers:
| Modifier | Description |
|---|---|
| GP | Guidance provided at an outpatient physical therapy center |
| GO | Session conducted at an outpatient occupational therapy center |
| CQ | Physical therapist assistant supervised outpatient physical therapy (completely or partially) |
| CO | An OT assistant supervised a session (completely or partially) at an outpatient occupational therapy center |
While you can usually use the 97150 CPT code by itself, some insurance companies may require specific modifiers to identify the type of group therapy provided to patients. You can also use modifier 59 to report CPT code 97150 with other services like Chiropractic Manipulative Treatment (CMT) or E/M.
This modifier helps insurers understand that group therapy is unrelated to other treatments provided on the same day.
Conclusion
In short, CPT code 97150 addresses group therapy sessions supervised by a qualified professional. This code is quite popular among rehabilitation, physical, and occupational therapy centers. It is also quite easy to use since it does not have a specified time limit.
However, its successful billing depends on complete documentation and compliance with payer-specific demands. We have covered every little detail about this common therapeutic code so you can avoid common mistakes and receive timely payments.
Frequently Asked Questions
