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The CPT® Code 97150 refers to therapeutic procedures conducted in a group setting involving two or more individuals. These procedures are designed to enhance, develop, or restore bodily functions that may have been compromised due to various factors such as injury, illness, or surgical interventions. The therapeutic activities can encompass a range of modalities, including aquatic therapy, conditioning therapies, or exercise therapy. Importantly, while a physician or licensed therapist is present to oversee the session, they do not engage in one-on-one contact with any individual patient. Instead, they provide guidance and support to the entire group. Each participant may engage in similar or distinct activities, but there is a cohesive element that unites the group’s efforts. The therapist or physician initiates the session by offering introductory instructions to the participants, followed by ongoing observation and clinical feedback throughout the procedure. This oversight allows for necessary adjustments to be made to the therapeutic program, ensuring that each individual's needs are met effectively. The application of code 97150 indicates an untimed period of observation and assistance, which is crucial for accurate billing. It is essential to document clearly if this code is used alongside other therapeutic procedure codes, as it must be evident that the group activities and individual therapeutic procedures occurred during separate times to support proper coding and billing practices.
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The therapeutic procedures represented by CPT® Code 97150 are indicated for individuals who require rehabilitation or enhancement of bodily functions that may be impaired due to various conditions. These conditions can include, but are not limited to, the following:
The procedure associated with CPT® Code 97150 involves several key steps that ensure effective therapeutic intervention in a group setting. Each step is crucial for the overall success of the therapy session.
After the completion of the therapeutic session, participants may receive additional instructions for home exercises or activities to continue their rehabilitation process. The physician or licensed therapist may also provide recommendations for follow-up sessions or further evaluations if needed. It is important for documentation to reflect the activities performed during the session, as well as any modifications made, to support the use of CPT® Code 97150 and ensure accurate billing. Participants are encouraged to report any discomfort or concerns during the session to facilitate timely adjustments and enhance their recovery experience.
| Short Descr | GROUP THERAPEUTIC PROCEDURES | Medium Descr | THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS | Long Descr | Therapeutic procedure(s), group (2 or more individuals) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 7 - Physical Therapy Service, for which Payment may not be Made | Multiple Procedures (51) | 5 - Special payment adjustment rules on the RVU practice expense component of multiple therapy service applies... | 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) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 213 - Physical therapy exercises, manipulation, and other procedures |
This is a primary code that can be used with these additional add-on codes.
| 0770T | Add-on Code MPFS Status: Carrier Priced APC E1 Virtual reality technology to assist therapy (List separately in addition to code for primary procedure) |
| GP | Services delivered under an outpatient physical therapy plan of care | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | KX | Requirements specified in the medical policy have been met | 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. | GO | Services delivered under an outpatient occupational therapy plan of care | 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 | CO | Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant | 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. | 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | 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 | U5 | Medicaid level of care 5, as defined by each state | UB | Medicaid level of care 11, as defined by each state | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 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. | CA | Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | GN | Services delivered under an outpatient speech language pathology plan of care | GQ | Via asynchronous telecommunications system | GT | Via interactive audio and video telecommunication systems | GX | Notice of liability issued, voluntary under payer policy | GZ | Item or service expected to be denied as not reasonable and necessary | HQ | Group setting | KK | Dmepos item subject to dmepos competitive bidding program number 2 | KW | Dmepos item subject to dmepos competitive bidding program number 4 | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | U8 | Medicaid level of care 8, 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 |
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| 2013-01-01 | Changed | Guideline information changed. |
| 1995-01-01 | Added | Code added |
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