How To Use CPT Code 97130

CPT 97130 describes therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 97130?

CPT 97130 can be used to describe therapeutic interventions that aim to improve cognitive functions such as thinking, remembering, reasoning, and problem-solving. It also focuses on developing the ability to plan, organize, and carry out tasks in a practical and timely manner. These interventions are provided through direct one-on-one contact between the healthcare provider and the patient.

2. Official Description

The official description of CPT code 97130 is: ‘Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact; each additional 15 minutes (List separately in addition to code for primary procedure).’ This code should be used in conjunction with CPT code 97129.

3. Procedure

1. The healthcare provider works directly with the patient to improve cognitive functions and develop compensatory strategies for managing activities.
2. The provider helps the patient enhance cognitive skills such as thinking, remembering, reasoning, problem-solving, studying, and learning.
3. Additionally, the provider assists the patient in developing executive functions, including the ability to plan, organize, and carry out tasks.
4. Pragmatic function, which refers to being practical and sensible, is also addressed to help patients adjust to their environment.
5. The provider spends one-on-one time with the patient to develop or improve their ability to manage the performance of an activity, such as managing time or schedules and initiating, organizing, and sequencing tasks.
6. Compensatory skills are taught to patients with learning disabilities or those who have experienced cognitive function loss due to brain injury or illness.

4. Qualifying circumstances

CPT 97130 is appropriate for patients who require therapeutic interventions to improve cognitive function and compensatory strategies. These interventions are beneficial for individuals with learning disabilities, cognitive impairments resulting from brain injuries or illnesses, or those who need assistance in managing activities. The interventions are provided through direct one-on-one contact between the healthcare provider and the patient.

5. When to use CPT code 97130

CPT code 97130 should be used when a healthcare provider provides therapeutic interventions to improve cognitive function and compensatory strategies through direct one-on-one contact with the patient. It is important to note that this code should be used in conjunction with CPT code 97129 for the initial 15 minutes of service.

6. Documentation requirements

To support a claim for CPT code 97130, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for therapeutic interventions
• Specific cognitive functions targeted and compensatory strategies employed
• Date, start and end time of the session
• Details of the activities performed during the session
• Progress made by the patient and any additional sessions scheduled
• Signature of the healthcare provider providing the service

7. Billing guidelines

When billing for CPT code 97130, ensure that the therapeutic interventions are provided through direct one-on-one contact between the healthcare provider and the patient. It is important to use CPT code 97129 for the initial 15 minutes of service and report CPT code 97130 for each additional 15 minutes. Do not report CPT code 97129 or 97130 in conjunction with CPT codes 97153 or 97155.

8. Historical information

CPT code 97130 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Examples

1. A speech therapist providing therapeutic interventions to improve cognitive function and compensatory strategies for a patient with a traumatic brain injury.
2. An occupational therapist assisting a patient with learning disabilities in developing strategies to manage time and organize tasks.
3. A psychologist working with a patient with Alzheimer’s disease to enhance memory and problem-solving abilities.
4. A special education teacher providing one-on-one interventions to a student with attention deficit hyperactivity disorder (ADHD) to improve focus and executive functions.
5. A physical therapist helping a patient with a stroke regain cognitive abilities and develop compensatory strategies for daily activities.
6. A neuropsychologist working with a patient with multiple sclerosis to address cognitive impairments and develop strategies for managing activities.
7. An educational therapist assisting a child with dyslexia in improving reading comprehension and developing compensatory strategies.
8. A rehabilitation counselor providing therapeutic interventions to a patient with a spinal cord injury to enhance cognitive function and develop strategies for independent living.
9. A behavior analyst working with a child with autism spectrum disorder to improve social skills and develop compensatory strategies for communication.
10. A cognitive rehabilitation therapist assisting a patient with a brain tumor in regaining cognitive abilities and developing strategies for daily functioning.