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CPT Codes Update: Three New and Valuable Codes for Outpatient Therapy

With the 2024 final rule, Center of Medicare & Medicaid Services (CMS) has provided for three very relevant CPT Codes for outpatient physical, occupational and speech therapy. For these outpatient services, a common aspect for some patients is for the therapists to provide training to caregivers who CMS defines as:

“an adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability, or functional limitation” or “a family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition”.

This training provides continuity for what the patient has learned during his/her outpatient service. Caregiver training teaches these people to carry-over techniques and strategies that are important to the patients’ maintenance or progress in their home environment.

CPT Codes Changes to Know

97550: Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., activities of daily living (ADLs), instrumental ADLs (IADLs), transfers, mobility, communication, swallowing, feeding, problem-solving, safety practices) without the patient present, face-to-face; initial 30 minutes.

97551: Each additional 15 minutes listed separately in addition to 97550 for primary services.

97552: Group caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community ((e.g., activities of daily living (ADLs), instrumental ADLs (IADLs), transfers, mobility, communication, swallowing, feeding, problem-solving, safety practices) without the patient present, face-to-face with multiple sets of caregivers.

Prior to these codes, there was not a provision for therapists to charge for caregiver training if the patient was not present. Instead, chargeable caregiver training was confined to when the patient was present. Even then, there was not a specific code for service. Instead, therapists generally would integrate that skilled time into the CPT code that most closely approximated the service provided.

Contact Blue & Co. about CPT Code Changes

Physical, Occupational, and Speech therapy all have access to these CPT codes. Make sure that your organization has integrated these codes into your chargemaster and have provided guidance to your therapists on how to use them. If you have any questions, please reach out to your local Blue & Co. Advisor or a member of our Hospital Operations team below.

John Britt, Senior Manager

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