Always vs Sometimes Therapy Codes: What’s the Difference?

November 27, 2017
Rick Gawenda

The Centers for Medicare and Medicaid Services (CMS) has defined the CPT codes most commonly utilized by providers of outpatient physical and occupational therapy as well as speech-language pathologists as either “always therapy” codes or “sometimes therapy” codes. In this article, I will explain the following:

  1. The difference between “always therapy” and “sometimes therapy” codes
  2. Which CPT codes are “always therapy” codes
  3. Which CPT codes are “sometimes therapy” codes
  4. Which CPT codes does the Multiple Procedure Payment Reduction policy apply to
  5. Which CPT codes count towards the annual therapy cap dollar threshold

What is the between an “always therapy” code and a “sometimes therapy” code?

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  1. In a nutshell what are sometimes therapy codes? The explanation sounds like they are no different from always therapy but just rarely used.

  2. With the presence of both G0515 timed code and 97127 untimed code for cognitive therapy, can G0515 be used for other insurances besides medicare?

  3. If I have to make a new splint for a kid that outgrows the old one, do I go back to 97760 initial encounter or is it still a subsequent visit 97763 if I am just replacing an outgrown one?