Therapy Billing 

97150 CPT code

97150 CPT code, CPT code 97150, 97150 CPT code example,

97150 CPT code is one of many Current Procedural Terminology (CPT) numerical codes describing diagnostic services, surgical services, medical services, or treatment services healthcare members provide. The CPT codes that the American Medical Association (AMA) sets are foundational for how healthcare procedures are studied, tracked, and reimbursed.

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This blog will focus on the 97150 CPT code (Group Therapy).

97150 CPT code

For the 97150 CPT code, clinicians supervise and direct therapeutic procedures like exercise therapy for a group of clients.

Furthermore, group therapy involves constant attendance by a qualified healthcare professional (e.g., therapist) but does not, by definition, require one-on-one patient contact by the same healthcare professional.

The AMA introduced the 97150 CPT code to describe group sessions as therapists increasingly utilized group therapy due to its significant value. Updates and revisions were made over time and as necessary.



Billing and documentation requirement guidelines

CPT 97150 is an important code for billing and documentation of group therapy sessions in healthcare. Understanding the proper application and compliance with regulations is crucial to ensuring adequate reimbursement for services provided. The critical components of CPT 97150 can be found below.

Components of 97150 CPT code

  • 97150 CPT code is designed for therapy sessions with two or more clients.

  • It is focused on a group therapy approach but also provides individual and personalized attention, and therapeutic activities may differ for each patient.

  • Therapists must provide continuous supervision with each client receiving appropriate interventions.

  • Keep track of accurate time spent. 97150 CPT code is time-based. Each unit of therapy is 15 minutes.

  • Ensure detailed documentation, including the client's name, description of services performed, description of therapist's involvement, patient participation, progress, medical necessity, and reasoning for group therapy.

Common billing pitfalls of billing for the 97150 CPT code

Insufficient documentation

  • How to avoid: Use templates to ensure detailed documentation for evaluations, daily notes, progress notes, and discharge summaries.

  • Insurance considerations: Understand payer policies, including requirements, frequency limitations, and modifier use. Include medical necessity and therapist involvement in the session. Understand and comply with regulation changes and guidelines.

Inconsistency with time

  • How to avoid: Clearly understand time-based codes and meticulously track therapy sessions' start and end times. Each procedure should be timed in the record, and clinicians must carefully calculate the accurate number of units.

  • Insurance considerations: Avoid using individual codes for group code activities.

No individualism

  • How to avoid: Include the client's individuality in group therapy regarding progress, participation, and needs.

Insurance considerations: Include individual therapy/treatment plans for the client.


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97150 CPT code example in occupational therapy

Example: A therapist works with clients and divides their time between two patients (patient one and patient two). The therapist goes back and forth between the two patients, offers verbal support to patient one's balance/coordination (Sensory/Vestibular) activities with an obstacle course and balance beam, and provides necessary adjustments to patient two's exercise regimen with resistance training bands. The therapist spends a few minutes with each patient at a time. Each patient receives one unit of 97150 CPT code.

Step-by-step process for planning and conducting group therapy

For group therapy to be effective, occupational therapy sessions require meticulous planning involving group components, management of group dynamics, and individualized treatment goals.

Below is a step-by-step guideline for planning and conducting group sessions, managing group dynamics, and ensuring individualized attention.
  • Conduct a needs assessment for each client

  • Develop a treatment plan for each client

  • Determine group size, group structure, and purpose

An optimal group size is between 2-6 clients per therapist to ensure individual attention and sufficient management by a therapist.

Considerations for group structure include age, therapy goals, and overall client compatibility.

Additionally, consider the functional and developmental level of each client and grade the activity for success.
  • Plan session
    • Consider goals
    • Choose activities
    • Organize materials and equipment

  • Hold session
    • Have specific activities for the session's beginning, middle, and end. This may include an introduction or ice-breaker, a main activity to work on skills and end with a cool-down activity to re-engage and talk about the session.

  • Documentation
    • Include detailed notes for each participant, assess the session, and plan accordingly for the next session.



Strategies for managing group dynamics

  • Set ground rules for groups and encourage open communication: Set clear expectations, encourage taking turns talking, listening to ideas, and supporting and encouraging each other. Address safety issues and create a fostering learning environment.

  • Conflict resolution: Utilize problem-solving techniques like open discussion and address conflicts promptly and equitably.

  • Engage members and encourage participation: Use motivating strategies such as positive reinforcement to engage all members.


Techniques for ensuring individualized attention within a group setting

  • Develop individualized goals and an individualized treatment plan.

  • Provide one-on-one individualized feedback and activity modifications.

  • Keep meticulous documentation of the client's progress in a group setting.


Ensuring ethical practice in group therapy

Ethical principles and maintaining confidentiality are significant in group therapy dynamics. Occupational therapists can provide effective group therapy by adhering to ethical and professional guidelines.

Ethical and professional considerations

  • Maintaining boundaries with clients

  • Ensure the individuality of clients

  • Have adequately trained therapists conducting group sessions


Maintaining patient confidentiality and privacy

  • Have clients sign confidentiality and informed consent documents

  • Keep documentation secured


Common challenges in using CPT 97150

Group therapy can present various challenges and limitations. However, these challenges can be overcome by carefully planning and implementing sessions.

Challenges and limitations of group therapy settings

  • Group therapy does not apply to all clients
    • Strategy: Clients must be carefully reviewed to be deemed an appropriate match for group therapy and within a group therapy dynamic.

  • Providing individualized attention can be difficult
    • Strategy: Include individualized time for each client.

  • Group dynamics can cause conflicts
    • Strategy: Despite careful planning, certain clients may not get along. It is important to have conflict resolution and establish ground rules for the group.


Future trends in group therapy

With emerging research and technology, there is great potential for group therapy. These advancements include telehealth, wearable devices, and virtual and augmented reality (VR/AR), improving the overall accessibility and effectiveness of group therapy in occupational therapy.

Furthermore, with increased research and development, evidence-based practice, and collaboration amongst healthcare teams and group therapy can be utilized as an effective form of treatment and can improve client outcomes.

Group therapy plays a pivotal role in occupational therapy and its clients. CPT codes allow therapists to address and meet individuals' needs, offer social support, provide cost-effective treatment approaches, and document services provided using a standardized method. By having a comprehensive understanding of the 97150 CPT code, therapists can contribute to improving client outcomes and occupational therapy practice.


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How EHR and practice management software can save you time with insurance billing for therapists

EHR with integrated billing software and a clearing house, such as TheraPlatform, offers significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.

What are automation and batching?

  • Automation refers to setting up software to perform tasks with limited human interaction.

  • Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.

Which billing and medical claim tasks can be automated and batched through billing software?

  • Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.

  • Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)

  • Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.

  • Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.

  • Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform'sTheraPlatform's EHR.

  • Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.

Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time regarding insurance billing for therapists.



Resources

TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including occupational therapists in group and solo practices.


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