CPT code 97150 (Group Therapy) remains one of the most confusing CPT codes for physical therapists, physical therapist assistants, occupational therapists, and occupational therapy assistants to understand. In this article, I will answer the following questions:
Lets say you spend 15 minutes one-on-one with Patient A teaching her shoulder strengthening exercises using theraband. After 15 minutes, you feel the patient is doing the exercises correctly so you instruct her what you want her to do and let her know you will be over with Patient B and you will be back.
You now move over to Patient B and spend 12 minutes doing manual therapy on her right knee to improve knee range of motion while Patient A is performing her shoulder exercises independently. After 12 minutes of manual therapy on Patient B, you instruct her to do her knee stretch that she has been doing independently at home and that you are now going over to Patient A and you will be back.
You are now back with Patient A and you now spend 10 minutes teaching the patient 2-3 new exercises for shoulder strengthening using theraband while Patient B is performing her knee stretching independently. After 10 minutes, you feel Patient A is doing the exercises correctly so you instruct her what you want her to do and let her know you will be over with Patient B and you will be back.
You are now back with Patient B and you now spend 13 minutes instructing Patient B in strengthening exercises for her lower extremity while Patient A is performing her shoulder exercises independently. After 13 minutes with Patient B, you instruct her what you want her to do and let her know you will be over with Patient A and that you will be back.
I will stop here at this point. You can go back and forth however many times you want, between however many patient’s you want for however long you want. What you are doing is keeping track approximately how many minutes you were with each patient each time you were with them. You will add those minutes up for each patient and that total time you spent with each patient one-on-one will determine how many time-based units that require direct one-on-one patient contact you can bill to each patient.
Using the above example, you spent 25 minutes with Patient A teaching/instructing the patient in shoulder strengthening exercises (15 minutes first time and then 10 minutes second time). For this 25 minutes of one-on-one time with Patient A, you would charge them 2 units of 97110 (therapeutic exercise).
With Patient B, you spent 12 minutes doing manual therapy and 13 minutes doing lower extremity strengthening exercises for a total of 25 minutes one-on-one time. This allows you to charge 2 time-based units. In this example, you would charge 1 unit of 97110 (therapeutic exercise) and 1 unit 97140 (manual therapy).
Now for the million dollar question! What do you bill each patient for the time they were doing their exercises and stretching independently? It’s the answer you didn’t want to read; nothing! You do not get to bill for the time the patient is exercising independently as you are not one-on-one with them and you are also not providing any skilled services.
You were probably thinking in the above example, you would charge group therapy when the patient is exercising by themselves? No! Group requires constant attendance of the therapist or assistant with 2 or more people still providing a skilled service. If you are saying you are one-on-one with Patient A, you can’t be somewhere else doing group of 2 or more patient’s. You can’t bill Patient A for one-on-one time and Patient B group during the same time period. The time Patient B is exercising by themselves in the example above is not billable time.
You may also think while you are doing strengthening exercises on Patient A for 10 minutes to their shoulder and Patient B is on the next treatment table doing their knee stretching exercises that you are supervising during that 10 minute period, that you can also bill Patient B for the 10 minutes of exercise. No you can’t. Since you are one-on-one with Patient A instructing them in shoulder strengthening exercises, you can’t also be one-on-one with Patient B at the same time. You can’t bill for 20 minutes of one-on-one time in only a 10 minute period.
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.