Occupational Therapy helps patients with cognitive or development injuries and/or disabilities. Prior to 2020, CPT 97127 and HCPCS code G0515 were the codes that described these therapies.
The description for CPT 97127 is “Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact”. (1)
The code was based on a session basis with no time associated with it. Medicare rejected CPT 97127 because there was no time element associated with the code. In its place came HCPCS G0515 with the description “Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes.” (2)
Effective January 1, 2020 there will be two new codes: CPT 97129 and CPT 97130.
They will essentially have an identical description to CPT 97127. Except, CPT 97129 Is for the first 15 minutes of treatment, and CPT 97130 will be each additional 15 minutes of treatment. In the past the American Speech-Language-Hearing Association (ASHA) lobbied the CMS to have cognitive therapy have therapy measured by time units. They will get their wish in 2020. They have also requested to have CMS delete G0515 on January 1, 2020. They anticipate CMS to fulfill their request in the final rule. (3)
As with other time-based codes, documentation for these new codes should include the amount time spent in cognitive development activities. Utilization of these codes would also incorporate the 8-minute rule. Per CMS, the rendering provider must have direct treatment for at least 8 minutes for one unit billed.
(1) CPT is copyright by 2018 American Medical Association. All rights reserved.
(2) CPT is copyright by 2018 American Medical Association. All rights reserved.
(3) Swanson, N (2019, OCT). Cognitive function intervention. Retrieved 10/16/2019 from https://leader.pubs.asha.org/doi/10.1044/leader.BML.24102019.36
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