97150 CPT Code: Know Your Codes
97150 CPT Code Basics
97150 CPT Code Description: Therapeutic procedure(s), group (2 or more individuals), untimed. When the therapist is working with several patients at the same time, then CPT code 97150 should be reported. 97150 is not a timed (untimed) 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 for PTs and OTs and CPT 92508 for SLPs), regardless of how much time was spent in the session. The specific type of therapy (e.g., 97110) should not be billed in addition to the group therapy code.
Group therapy procedures involve constant attendance of the physician or other qualified health care professional (i.e., therapist), but by definition do not require one-on-one patient contact by the same physician or other qualified health care professional.
Group therapy consists of simultaneous treatment to two or more patients who may or may not be doing the same activities. If the therapist 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, 97150 (untimed).
Group Therapeutic Procedures
Therapeutic procedures performed in a group of 2 or more individuals can include aquatic therapy, conditioning therapies, or exercise therapy with a physician or licensed therapist in constant attendance but not in one-on-one contact with the individual patient. The purpose of the therapeutic procedure(s) should be to improve, develop, or restore body function(s) 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.
The physician or licensed therapist provides introductory instructions to each individual or to the whole group and then continues to observe and give clinical expertise and feedback during the session, making modifications or progressions to the program as necessary. Code 97150 is applied to an untimed period of observation and assistance. If it is used with additional therapeutic procedure code(s), there must be clear documentation to support that the group and the individual therapeutic procedures were performed during separate periods of activity.
Example of 97150
In a 25-minute period, a therapist works with two patients, A and B, and divides his/her time between two patients. The therapist moves back and forth between the two patients, spending a minute or two at a time, and provides occasional assistance and modifications to patient A’s exercise program and offers verbal cues for patient B’s gait training and balance activities in the parallel bars. The therapist does not track continuous or notable, identifiable episodes of direct one-on-one contact with either patient and would bill each patient one unit of group therapy (97150) corresponding to the time of the skilled intervention with each patient.
Documentation to support the reporting of timed procedure codes is required. The time reported should reflect direct one-on-one contact time with the patient. Supervised treatment in the absence of skilled intervention is not billable time. Billable time should reflect the time that the provider spent face-to-face between the patient and the licensed practitioner providing the service and not just the time the patient spent receiving supervised procedures in the clinic.
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