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Therapeutic interventions that focus on cognitive function are designed to enhance or maintain cognitive abilities such as attention, memory, reasoning, executive function, problem solving, and pragmatic functioning. These interventions are particularly beneficial for individuals recovering from brain injuries or experiencing cognitive decline due to aging or degenerative diseases. The therapy may involve engaging patients in activities that require cognitive processing, which can include specific training exercises that utilize practice and repetition to develop new compensatory strategies for performing daily functions. Additionally, therapists may work with patients on personal goals by integrating external aids, such as calendars, diaries, memory books, and electronic devices, to support cognitive functioning. The aim is to help individuals leverage their residual cognitive skills to compensate for areas of weakness, focusing on selected activities and adapting their environment to maximize success. The CPT® code 97130 specifically reports direct, one-on-one patient contact for these cognitive function therapeutic interventions, with the code being applicable for each additional 15 minutes of therapy provided after the initial 15 minutes, which is reported using CPT® code 97129.
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The therapeutic interventions represented by CPT® code 97130 are indicated for patients who require support in cognitive function due to various conditions. These include:
The procedure for delivering therapeutic interventions focusing on cognitive function involves several key steps:
After the therapeutic interventions, patients may require ongoing support to reinforce the skills learned during therapy. This may include follow-up sessions to monitor cognitive function and adjust strategies as needed. Patients and caregivers are often provided with resources and recommendations for continued practice at home, utilizing the external aids introduced during therapy. The expected recovery may vary based on the individual's condition, but the goal is to enhance the patient's ability to manage daily activities independently and effectively.
| Short Descr | THER IVNTJ EA ADDL 15 MIN | Medium Descr | THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES | Long Descr | Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | none | MUE | 7 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 97129 | Telehealth Service (Medicare) MPFS Status: Active Code APC A Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes |
| GN | Services delivered under an outpatient speech language pathology plan of care | KX | Requirements specified in the medical policy have been met | GO | Services delivered under an outpatient occupational therapy plan of care | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GW | Service not related to the hospice patient's terminal condition | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | GP | Services delivered under an outpatient physical therapy plan of care | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | CO | Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant | GT | Via interactive audio and video telecommunication systems | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | KK | Dmepos item subject to dmepos competitive bidding program number 2 | KL | Dmepos item delivered via mail | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | U5 | Medicaid level of care 5, as defined by each state | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2020-01-01 | Added | Code added. |
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