© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 97530 refers to therapeutic activities that involve direct, one-on-one patient contact, specifically utilizing dynamic activities aimed at enhancing functional performance. This procedure is designed to address the unique functional limitations of each patient through tailored therapeutic activities. The term "dynamic activities" encompasses a range of movement-based exercises, also known as kinetic activities, which are strategically developed and modified to meet the individual needs of the patient. These activities may include, but are not limited to, lifting, bending, pushing, pulling, jumping, and reaching. For instance, a patient recovering from an injury may engage in specific therapeutic activities that focus on improving their ability to sit, stand, and safely get out of bed, all while minimizing the risk of strain or reinjury. It is important to note that this code is billed for each 15-minute interval of direct therapeutic activity provided to the patient, ensuring that the time spent on these essential interventions is accurately captured for billing and reimbursement purposes.
© Copyright 2025 Coding Ahead. All rights reserved.
The CPT® Code 97530 is indicated for patients who require therapeutic activities to improve their functional performance due to specific limitations. These limitations may arise from various conditions, including but not limited to:
The procedure associated with CPT® Code 97530 involves several key steps that ensure effective therapeutic intervention. Each step is designed to facilitate the patient's recovery and improve their functional performance through direct engagement in therapeutic activities.
After the therapeutic activities have been completed, the provider may offer guidance on post-procedure care, which can include recommendations for continued practice of the activities at home, strategies for managing any discomfort, and scheduling follow-up sessions to assess progress. The expected recovery may vary based on the individual patient's condition and adherence to the therapeutic regimen. It is important for the patient to engage in any prescribed home exercises to reinforce the gains made during the therapy sessions and to facilitate optimal recovery.
| Short Descr | THERAPEUTIC ACTIVITIES | Medium Descr | THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN | Long Descr | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | 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 | 6 | 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 | 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. | KX | Requirements specified in the medical policy have been met | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | GO | Services delivered under an outpatient occupational therapy plan of care | CO | Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant | 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. | 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. | GW | Service not related to the hospice patient's terminal condition | 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 | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | GN | Services delivered under an outpatient speech language pathology plan of care | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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. | 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. | GX | Notice of liability issued, voluntary under payer policy | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 5K | Mjd, commonly called ataxin-3 (spinocerebellar ataxia, type 3, machado-joseph disease) | 6F | Mttl1, commonly called trnaleu (mitochondrial encephalomyopathy, melas) | 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. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 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. | 56 | Preoperative management only: when 1 physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number. | 57 | Decision for surgery: an evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of e/m service. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only 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 away 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 is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | 99 | Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. | A1 | Dressing for one wound | AF | Specialty physician | AH | Clinical psychologist | AJ | Clinical social worker | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | 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) | CD | Amcc test has been ordered by an esrd facility or mcp physician that is part of the composite rate and is not separately billable | CG | Policy criteria applied | CK | At least 40 percent but less than 60 percent impaired, limited or restricted | CP | Adjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification (c-apc) procedure, but reported on a different claim | CR | Catastrophe/disaster related | EX | Expatriate beneficiary | F3 | Left hand, fourth digit | F4 | Left hand, fifth digit | F7 | Right hand, third digit | F9 | Right hand, fifth digit | FA | Left hand, thumb | FX | X-ray taken using film | G0 | Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke | G5 | Most recent urr reading of 75 or greater | G9 | Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition | GB | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration | GC | This service has been performed in part by a resident under the direction of a teaching physician | GF | Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital | GG | Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day | GK | Reasonable and necessary item/service associated with a ga or gz modifier | GQ | Via asynchronous telecommunications system | GT | Via interactive audio and video telecommunication systems | GU | Waiver of liability statement issued as required by payer policy, routine notice | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | HA | Child/adolescent program | HM | Less than bachelor degree level | HN | Bachelors degree level | JK | One month supply or less of drug or biological | JZ | Zero drug amount discarded/not administered to any patient | K0 | Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. | KA | Add on option/accessory for wheelchair | KC | Replacement of special power wheelchair interface | KH | Dmepos item, initial claim, purchase or first month rental | KJ | Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen | KK | Dmepos item subject to dmepos competitive bidding program number 2 | KL | Dmepos item delivered via mail | KP | First drug of a multiple drug unit dose formulation | KQ | Second or subsequent drug of a multiple drug unit dose formulation | KS | Glucose monitor supply for diabetic beneficiary not treated with insulin | KU | Dmepos item subject to dmepos competitive bidding program number 3 | KV | Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service | KW | Dmepos item subject to dmepos competitive bidding program number 4 | KY | Dmepos item subject to dmepos competitive bidding program number 5 | LT | Left side (used to identify procedures performed on the left side of the body) | 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 | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | 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 | QC | Single channel monitoring | QH | Oxygen conserving device is being used with an oxygen delivery system | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional | RT | Right side (used to identify procedures performed on the right side of the body) | SA | Nurse practitioner rendering service in collaboration with a physician | SH | Second concurrently administered infusion therapy | SW | Services provided by a certified diabetic educator | TA | Left foot, great toe | TL | Early intervention/individualized family service plan (ifsp) | U5 | Medicaid level of care 5, as defined by each state | U7 | Medicaid level of care 7, as defined by each state | U8 | Medicaid level of care 8, as defined by each state | UA | Medicaid level of care 10, as defined by each state | UB | Medicaid level of care 11, as defined by each state | V1 | Demonstration modifier 1 | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Changed | Description Changed |
| 2001-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.