97129 CPT Code: Know Your Codes
New Cognitive Function Intervention Code
Effective January 1, 2020, CPT code 97127 (cognitive function intervention, per day) and Healthcare Common Procedure Coding System (HCPCS) code G0515 are deleted and replaced with two new timed codes: a base code for the initial 15 minutes of cognitive function intervention (97129 CPT Code) and an add-on code for each additional 15 minutes (97130).
97129 CPT Code Description: Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem-solving and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes.
+97130 CPT Code Description: Each additional 15 minutes. Code 97130 is an add-on code. It will need to be billed in addition to 97129 whenever more than one 15-minute unit is performed. Code 97129 will only ever be billed once per visit. Code 91730 will never be billed alone.
CPT codes 97129 and 97130 are time-based codes. 97129 represents the first 15 minutes of treatment and can only be billed once per day. Bill 97130 in conjunction with 97129 for each additional 15 minutes of therapy. As an add-on code, 97130 must always be billed in conjunction with 97129 for each additional 15 minutes of therapy, when appropriate. 97130 may not be billed as a stand-alone code.
Code 97129 is limited to 1 per day and code 97130 is limited to 3 per day. As per NCCI Medically Unlikely Edit (MUE), only one hour of cognitive intervention will be paid per day by Medicare and other insurances that follow NCCI guidelines
As with other 15-minute time-based codes, think of 97129 as the first 15-minute unit and 97130 as subsequent 15-minute units. To bill the first unit (97129 base code), you must complete at least 8 minutes of face-to-face therapy. Any therapy less than 8 minutes total is not billable. To bill for a second unit (97130 add-on code) you must first complete a full 15 minutes of therapy (billed under 97129) plus at least 8 additional minutes (23 minutes total) to qualify to bill for 97130.
To bill any subsequent add-on units, you must always complete the full time of the previous unit and exceed the halfway point of time to bill for the next unit, as outlined below. Keep in mind that only direct face-to-face therapy time may count towards billable units.
- 1 unit (97129): 8 minutes to 22 minutes
- 2 units (97129 + 97130): 23 minutes to 37minutes
- 3 units (97129 + 97130 + 97130): 38 minutes to 52 minutes
- 4 units (97129 + 97130 + 97130 + 97130): 53 minutes to 67 minutes
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We hope that this article has provided basic guidelines about the 97129 CPT code. If you are looking for overall billing and coding services you can refer to E2E Medical Billing Services. Our accurate and affordable billing services will eliminate billing and coding errors and will increase your practice collection. To know more about our medical billing and coding services, call us at 888-552-1290 or write to us at [email protected]