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The CPT® Code 97537 refers to a specialized service known as community/work reintegration training. This training is designed to assist patients in transitioning back into their communities and workplaces, promoting independence in daily activities. The training encompasses a variety of essential skills, including shopping, utilizing public transportation, managing finances, and engaging in avocational activities. Additionally, it involves analyzing and modifying the work environment to ensure that patients can effectively perform job-related tasks. The training may also include instruction on the use of assistive technology devices and adaptive equipment, which are tools aimed at enhancing the functional capabilities of patients in both community and work settings. This code is billed based on direct one-on-one contact with the patient, with each unit representing 15 minutes of training provided. The focus of this service is to empower patients to navigate their environments confidently and independently, thereby improving their overall quality of life.
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The community/work reintegration training represented by CPT® Code 97537 is indicated for patients who require assistance in adapting to their community and work environments following an injury, illness, or disability. This training is particularly beneficial for individuals who may struggle with daily activities such as:
The procedure for community/work reintegration training involves several key steps, each aimed at providing comprehensive support to the patient. The following outlines the procedural steps involved:
After the completion of community/work reintegration training, patients are expected to demonstrate improved skills in navigating their community and workplace environments. Post-procedure care may include follow-up sessions to reinforce skills learned and address any ongoing challenges. Patients may also receive additional resources or referrals to support services that can assist them in maintaining their independence. It is important for patients to continue practicing the skills acquired during training to ensure long-term success in their reintegration efforts.
| Short Descr | COMMUNITY/WORK REINTEGRATION | Medium Descr | COMMUNITY/WORK REINTEGRATION TRAING EA 15 MIN | Long Descr | Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, 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 | 215 - Other physical therapy and rehabilitation |
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) |
| 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. | GP | Services delivered under an outpatient physical therapy plan of care | KX | Requirements specified in the medical policy have been met | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | CO | Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | 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. | GN | Services delivered under an outpatient speech language pathology 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2013-01-01 | Changed | Description Changed |
| 2004-01-01 | Changed | Code description changed. |
| 2001-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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