CPT Code 97530, CPT 97530, 97530 CPT code

(2022) CPT Code 97530 – Description, Guidelines, Reimbursement & Modifier

The 97530 CPT code can be reported for therapeutic activities to improve functional performance with dynamic activities.

The 59 modifier is approriate if two different procedures are performed in two distinct and separate 15 minute intervals. Three requirements must be met in order to be reimburst.

97530 CPT Code Description

CPT 97530 can be reported for therapeutic activities and requires direct (one-on-one) patient contact.

How: Use of dynamic activities to improve functional performance.
Time: 15 minutes

Coding Guidelines & Modifier

The 97530 CPT code is commonly billed with procedure code CPT 97140 (manual therapy techniques) with modifier 59 to override CCI edits.

According to CCI guidelines, it is only appropriate to report these procedures separately when performed in two distinct and separate 15-minute intervals.

Documentation should clearly indicate the two distinct 15-minute increments.

cpt 97530
97530 CPT Code Summary

Medical Necessity

Therapeutic activities (CPT 97530) are considered medically necessary for patients needing a broad range of rehabilitative techniques that involve movement.

Movement activities can be for a specific body part or could involve the entire body.

The 97530 CPT code involves the use of functional activities (e.g., bending, lifting, carrying, reaching, catching, and overhead activities) to improve functional performance in a progressive manner.

The activities are usually directed at a loss or restriction of mobility, strength, balance, or coordination. They require the professional skills of a therapist and are designed to address a specific functional need of the patient.

These dynamic activities must be part of an active treatment plan and be directed at a specific outcome.

Reimbursement

In order for therapeutic activity (CPT Code 97530) to be reimburst, the following requirements must be met:

the patient’s condition is such that he/she is unable to perform therapeutic activities except under the direct supervision of a physician, optometrist or physical therapist;

the patient has a condition for which therapeutic activities can reasonably be expected to restore or improve functioning;

and there is a clear correlation between the type of exercise performed and the patient’s underlying medical condition for which the therapeutic activities were prescribed.

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