Optimize Payment For Occupational Therapy With CPT 97530

You can use 97530 to report dynamic therapeutic activities in a one-on-one setting, in which the therapist examines and treats the patient's limbs and leads them in exercises to increase his/her strength, flexibility, etc.

What are therapeutic activities?

Therapeutic activities involve the use of such parameters as balance, strength, and range of motion, etc. for an improved everyday functionality, and these are advised to patients who require rehabilitative techniques. Through the use of graduated weights and using a series of movements (such as bending, lifting, carrying, reaching, catching, and overhead activities), therapeutic activities increase the body's flexibility, strength, and coordination. These can be specifically designed for a particular body part or they could work on improving the functioning of the entire body in a progressive manner.

Who can report 97530?

The code 97530 is intended for use only by trained occupational therapists, who design therapeutic activities; massage therapists are not eligible to report this code for their services.

Team therapy

Supercoder CMS says that when two or more therapists or therapy assistants work together as a "team" to treat a patient, you cannot bill separately for the same or different service provided at the same time to the same patient. Also, where a physical and occupational therapist both provide services to a patient at the same time, only one therapist can bill for the entire service or the PT and OT can divide the service units. For example, a PT and an OT work together for 30 minutes with one patient on transfer activities. The PT and OT could each bill one unit of 97530. Alternatively, the 2 units of 97530 could be billed by either the PT or the OT, but not both.

Coding confusion-97110 or 97530?

The similarities between CPT 97110 and CPT 97530 (both are time-based-billed per 15 units, focus on balance, strength, and range of motion, and need direct one-on-one contact by the provider) can lead to wrong code choice and a possible denial. Here's how you can pin down the appropriate code:

    Choose 97110 when the activity is performed to achieve only one of the following: strength, endurance, range of motion, or flexibility.

    Go for 97530 when the activity is performed to achieve multiple parameters and improved functional performance (e.g., lifting, pulling, and bending).