CPT 97150 - Therapeutic Procedure(s), Group

 

CPT 97150 - Therapeutic Procedure(s), Group 

(2 or more individuals)

 

(Not a Time-based Code)

 

CPT Code 97150 is not a timed code and should be reported once for each group participant.

 

The specific type of therapy (e.g., 97110)
should not be billed in addition to the group therapy code.

 

Group therapy consists of simultaneous treatment for two or more patients who may (or may not) be doing the same activities. Group therapy procedures involve constant attendance of the physician or therapist, but by definition do not require one-on-one patient contact.

 

The purpose of the therapeutic procedure should be to improve, develop or restore body functions that may be impaired due to injury, illness or surgery. The individuals in the group may perform identical or different activities but there should be a common unifying element.

 

Reporting Therapeutic Procedure(s), Group (2 or more individuals)
Again, 97150 is not a time-based code. This means that each individual patient in the group is going to be charged for one unit of the group therapy code (CPT 97150), regardless of how much time was spent in the session. (The specific type of therapy (e.g., 97110 Therapeutic exercises) should NOT be billed in addition to the group therapy code.)

 

If a Doctor of Chiropractic (DC) is dividing attention among the patients, providing only brief, intermittent personal contact, or giving the same instructions to two or more patients at the same time, it is appropriate to bill each patient one unit of group therapy using CPT 97150 Therapeutic procedure(s), group (2 or more individuals). Again, the specific therapeutic procedure should not be reported in addition to this group therapy code.

 

For example: In a 25-minute period, a DC works with two patients, A and B. The DC moves back and forth between the two patients, spending a minute or two at a time with each, providing occasional assistance and modifications to patient A's exercise program and offering verbal cues for patient B's balance activities. The proper coding for both patients is 97150.

  

Documentation Requirements Specific to this CPT Code:
Documentation in the healthcare record must:

  • identify the specific treatment technique(s) used in the group, and

  • clarify how the treatment technique will restore function, and

  • clarify the frequency and duration of the particular group setting, and

  • specify the number of persons in the group, and

  • be consistent with the treatment goal in the individualized plan. 

 

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:
When reporting 97150 with an E/M Code or with CMT, you must append the code with modifier 59 to make clear the service is distinct or separate from other services performed on the same day.

 

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