cpt 97535

97535 CPT Code (2021)

CPT code 97535 is medically necessary only when it requires the professional skills of a therapist, is designed to address specific needs of the patient, and is part of an active treatment plan directed at a specific outcome.

CPT Code 97535 Description

Self-care/home management training. Direct one-on-one contact, each 15 minutes.

Examples of CPT Code 97535 are:

  • meal preparations;
  • ADL (activities of daily living);
  • compensatory training;
  • safety procedures;
  • instructions in use of assistive technology devices/adaptive equipment.

CPT Code 97535 – Usage & Reimbursement

  • Services provided concurrently by physicians, optometrists, physical therapists, and occupational therapists may be covered if separate and distinct goals are documented in the treatment plans.
  • This procedure is medically necessary only when it requires the professional skills of a provider, is designed to address specific needs of the patient, and must be part of an active treatment plan directed at a specific outcome.
  • The patient must have the capacity to learn from instructions. The patient must have a condition for which training in activities of daily living is medically reasonable and necessary, and such training must be reasonably expected to restore or improve the functioning of the patient.
  • Medical treatment may generally require up to 12 visits in 4 weeks. Coverage beyond 12 visits in 4 weeks may require documentation supporting the medical necessity of continued treatment.
  • Documentation must relate the training to expected functional goals that are attainable by the patient.
  • The medical record should document the distinct goals and service rendered when self-care/home management training is done during the same visit as gait training (97116), orthotics fitting and training (97504) or prosthetic training (97520).

Does CPT Code 97535 Need a Modifier?

The CPT code combinations 97530 (Therapeutic Activity) and 97535 (ADL) requires Modifier 59 to enable the codes to be billed individually on the same day.

Note: CPT code 97535 is usually reimbursed after a rate higher than TA, TE, NMR & MT.

For more information: check the AAPC website.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *