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
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.
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.
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.