- Outpatient Occupational and Physical Therapy Services Billing Guide
- Introduction to Outpatient OT and PT Services
- Outpatient Occupational and Physical Therapy Coverage
- Caregiver Training Services
- KX Modifier Threshold
- 2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring
- Annual Update to the Therapy Code List
- Targeted Medical Review
- Functional Reporting - Using the G Codes
- What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy
- Maintenance Programs
- Multiple Procedure Payment Reduction
- The National Correct Coding Initiative
- Comprehensive Error Rate Testing Program
- Recovery Auditor
- Common Billing Errors and Remittance Message
- Medical Review Therapy Documentation Checklist for Additional Development Request Letters
- Common Questions and Answers
- Related Content
- Related Articles
Caregiver Training Services
Effective 1/1/2024, payment will be made when practitioners train caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan.
A caregiver is defined as a family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition.
During the face-to-face service time, caregivers are taught by the treating practitioner how to facilitate the patient's activities of daily living, transfers, mobility, communication, and problem-solving to reduce the negative impacts of the patient's diagnosis on the patient's daily life and assist the patient in carrying out a treatment plan.
Medicare will pay for these services when furnished by a physician or a nonphysician practitioner (nurse practitioners, clinical nurse specialists and physician assistants) or therapist (physical therapist, occupational therapist, or speech language pathologist) as part of the patient’s individualized treatment plan or therapy plan of care.
Three new HCPCS codes:
- 97550
- Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., ADLs, iADLs, transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; initial 30 minutes. (One or more caregiver[s] for a single patient).
- 97551
- each additional 15 minutes (List separately in addition to code for primary service). (One or more caregiver[s] for a single patient).
- 97552
- Group caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (e.g., ADLs, iADLs, transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face with multiple sets of caregivers. (Different patients).
These services are designated as “sometime therapy” services. This means these services may be furnished by physicians and certain NPPs, including nurse practitioners, physician assistants, and clinical nurse specialists outside a therapy plan of care, under treatment plan.
However, when services are provided by PTs, OTs and SLPs these services are always furnished under therapy plans of care and must be accompanied by the appropriate therapy modifier (GP, GO or GN) to reflect they are provided under a PT, OT, or SLP plan of care, respectively.
The treating practitioner must obtain the patient's (or representative's) consent for the caregiver to receive the CTS. Also, consent for one or more specific caregivers to receive CTS must be documented in the patient's medical record.
Medicare payment will be made under the MPFS only to enrolled physicians and other practitioners, not to caregivers.
Services are not available through telehealth.
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Posted 1/25/2024