How to Bill for Home Exercise Programs & Patient Education

June 5, 2017
Rick Gawenda

I am often asked what CPT code do we use to bill for the time we spend establishing, modifying and teaching a home exercise program or other education and training provided to a patient and/or their caregiver (ie. spouse, parent, etc.) that is receiving therapy services from our practice or organization? Caregiver training could include teaching the caregiver how to perform bed mobility and transfers with the patient. It could include teaching the caregiver how to assist the patient up and down the steps using an assistive device. It could include teaching the caregiver compensatory swallowing strategies to use with the patient when the patient is eating and/or drinking. The answer depends on the education and training you are providing.

First off, there is no home exercise or patient education CPT code. You are to bill for the time spent teaching the patient and/or caregiver the exercise program or other education provided under

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  1. What about CPT code 97535-Self Care? We have used this code for Home Exercise Program. Should we be billing it under all 97110-Therapuetic Exercise?

    1. It depends. Please read the article to see how to bill for the home exercise programs and patient education.

    1. Self care/home management includes, but is not limited to, ADLs such as bathing dressing, toileting, household chores, cooking, meal preparation, and teaching them how to use adaptive equipment.

  2. Do you have any thoughts about this code for rehab:98960, here is what I have read about it:

    CPT® sets four basic requirements for ordering and performing 98960-98962:
    1. The educational and training services are prescribed by a physician or other qualified healthcare professional.
    2. The services are provided by a qualified nonphysician healthcare professional using a standardized curriculum.
    3.The services are provided to an individual or a group of patients for the treatment of established illness(s)/disease(s) or to delay comorbidity(s).
    4. The nonphysician’s qualifications and the program’s contents “must be consistent with guidelines or standards established or recognized by a physician society, nonphysician healthcare professional society/association, or other appropriate source.”

    1. CPT code 98960 is not the CPT code to use for home exercise programs and patient/family education provided by a therapist.

    1. Your documentation would need to support the education provided, that it required the skills of a therapist to provide and it supports the CPT code(s) billed.

  3. If you’re training on lymphatic self care such as bandaging, compression pumps, etc then would this fall under 97140 (manual therapy) since lymphatic draining is a part of the CPT description, or 97535 (self-care/ADL) since equipment/assistive technology is a part of the education/management?