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PT Group Code

  1. #1
    Overland Park, KS
    Default PT Group Code
    Medical Coding Books
    I have received a few questions regarding the use of the 97150 CPT for group treatment.

    PT's are asking if this in only excluseive to medicare patients or if it is also aplicable to our respective 3rd party carriers (Cigna, BCBS, etc)?

    The question are based on many of our schedules where patients overlap, patient are scheduled for 30min intervals but are typically seen for a total of 60mins total of treatment including time and service based charges. I am not sure we will use the 97150 as much here as though our patients overlap, most are doing a service based charge (ice, heat, stim) while the other patient is receiving/performing the time based treatment and it is my understanding the use of 97150 is only used during each 15min interval where patients overlap with the time based codes.

    Can you confirm for us if this is applicable for all of our sites including those where we don't treat medicare and if my above understanding is correct?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  2. #2
    97150 is not time based. You can only use 1 unit per person per day, whether they are there for 15 min or 60 min. Each person in the group is charged 97150 once each day the group therapy takes place. You do have to have at least 2 people at the same time doing some type of therapy that involves skilled intervention but they don't necessarily have to be doing the same thing. So if one person is getting estim while the other is working with therabands you do not have a group.

    I no longer have therapy practices but I did research this code in 2008 and the commercial carriers covered it. This was in Ohio and West Virginia.

    Hope this helps,

    Laura, CPC

  3. #3
    Overland Park, KS
    Thanks so much for the reply!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

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