Caregiver Training Services CPT Codes Coming in 2024
Beginning with dates of service on and after January 1, 2024, there will be 3 new CPT codes describing caregiver training services. In this article, I will answer the following questions:
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Hello Rick,
To clarify, these codes can only be billed in outpatient settings? Not SNF or hospital acute/swing bed settings?
Thank you!
In SNF Part A and hospital inpatient, you do not bill via CPT codes and are not paid via CPT codes.
Will these codes only be approved for use in the OP setting or will Home Health, Sub-Acute Rehab and Acute care be able to utilize the codes? We do a lot of caregiver training and education in these settings as well (especially speech) and can’t bill for our services.
In the settings you mention, you are not reimbursed via CPT codes. You are reimbursed via DRG’s, PDPM, PDGM, etc.
I am seeing the words without patient present included in the description in parenthesis. Are we only able to bill this if the patient is not present?
Correct
Are these codes time or service based? How does the 8-min rule apply to 9X015 if it is 30 minutes? Thanks.
The 8-minute rule only applies to 15 minute time-based CPT codes.
If you bill Part B OPT as an “institution” vs “private practice”, do these CPT codes apply?
yes, since that is outpatient therapy.
can these codes be billed by OTA, PTA?
Yess, under the direction and applicable supervision of a therapist.
Are the new care giver training cpt codes timed or untimed?
Please look at the article and the description of each code.
Hello Rick
Can I use the care giver training CPT codes for care giver training when the patient is not in the treatment room but in the waiting area? Thank you
The patient is not present with you and the caregiver when you are providing the caregiver training services.
Hi Rick, The CMS literature on this code indicates it can be used for “certain diseases or illnesses”. Any insights on what diseases they are talking about? How much of a limiting factor will this be?
We will need to wait until the final rule is released.
One more question about this, I’m also reading in CMS literature that, “CMS is proposing to pay for certain caregiver training services in specified circumstances, so that practitioners are appropriately paid for engaging with caregivers to support people with Medicare in carrying out their treatment plans.” What do you think “certain caregiver trainings” implies? And what would constitute “specified circumstances”? Lastly, how quickly do you think commercial payors will adopt these codes?
We will need to wait until the final rule is released. Regarding commercial payers, the only thing I can say is that it will help us with them since Medicare will pay in 2024.
Hi Rick,
Does the caregiver have to make an in person appt in order to bill these codes, and if so, are these billed under the patient even though the patient is not present?
The services will be billed under the patients insurance. Have to wait for the final rule to see if these codes can also be delivered via telehealth.
Thank you. will wait for final rule.
Is it known if these encounters count as a visit for the patient if the patient isn’t there? I’m thinking of insurances that have visit limits (i.e. 20 visits/year).
You can read the last question in this link for your answer.
https://gawendaseminars.com/faq/caregiver-training-services/