Eli's Rehab Report

Published on Tue Jan 27, 2004 PDF

Question: Our therapist often works with two patients simultaneously in a skilled nursing facility: The first is a Medicare Part A patient, and the second is Part B. Can we still report CPT 97150 for this service?

Texas Subscriber

Answer: If you perform therapy in a group setting, you are performing group therapy, regardless of who insures your patients. You should, therefore, report 97150 (Therapeutic procedure[s], group [2 or more individuals]) for your Part B patient.
 
According to CMS' 11 FAQs - Post 9/13/02 Open Door on Group Therapy, you should report one unit of 97150 for the Part B patient in this scenario, and 30 minutes of therapy on the Part A patient's minimum data set (MDS) because "Under Part A, therapy services are paid as part of the bundled PPS rate and do not result in a bill."
 
To read the full text of CMS' 11 FAQs, visit its Web  site at http://cms.hhs.gov/medlearn/therapy/faqinfo.asp.