New Caregiver Training Services CPT Codes
Effective with dates of service on and after January 1, 2024, there will be 3 new CPT codes for caregiver training services (CTS). In this article, I will answer the following questions as they pertain to CTS:
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Can ABA Therapist use these codes?
Thank you for the explanation of these two codes. I want to make sure i understand the time needed to bill correct # units for 97551. 2 units would be 53 minutes to 67 minutes?
3 units 68 minutes (or does it have to be the whole 15 minutes – so 3 units has to be 75 minutes?
thanks
Please read my caregiver Training Services FAQs at https://gawendaseminars.com/faq/caregiver-training-services to obtain your answer.
Thank you for the update. Can SLP’s also use these codes?
Thank you
Yes
Is 96202 also a caregiver code for ST doing behavioral coaching to caregiver?
You would need to check with each insurance carrier if they will reimburse that code if billed by a SLP, OT, and/or PT.
Since the patient can not be present to bill these codes, How can these codes be utilized in an out patient setting? Would it be a separate appointment or can it be conjunction with a visit and have the patient wait in a separate area?
It could be either.
If these codes are allowed with MCD products would school staff be considered caregivers as they are not “paid” per se? I can see this being helpful training school staff in some situations for better carryover of the medical and educational services.
Thank you
I would say no as school staff are being paid by the school and/or school district.
We’ve been checking Palmetto GBA’s LCDs for PT, OT, and ST since 1/1/24 and so far these codes have not been added. Have you heard from any MACs (specifically PGBA) that they still may not cover these codes?
Does Medicare specify how training is to be completed? In person, via phone, or other forms of communication? We may educate family on various equipment needs via texting, email, or phone. Does that time qualify for these codes?
The codes state “face-to-face”.
In a SNF setting, could these codes be used for caregiver conferences?
In an SNF, could these codes be used for home visits?
Thanks for your response.
The codes are for outpatient therapy in all outpatient therapy settings. These are not caregiver conference codes. These codes require you provide specific caregiver training to the caregiver(s) without the patient being present.
Recently this was guidance provided by our NetHealth EMR- MACs have been delayed in adding Caregiver Training Services (CTS) codes in their billing and coding articles.
Is this accurate? I was under the impression the MAC did not approve for Medicare A however this was approved for Medicare B patients?
There are MACS that process both Part A and Part B claims.
For further clarification, these codes can only be used in outpatients settings? These codes cannot be used in SNF or Swing Bed settings for caregiver training? Thanks in advance!
CMS has not addressed the settings you are asking about.
Are any particular modifiers required? We are getting rejections from patients with Medicare as primary when the modifiers GP, GO and and GN are used. When we submit with no modifier, it says “a modifier” is required.
You would need to contact your MAC as perhaps they have an issue accepting these new codes.
How do the new codes work with the billing? Do we combined them in with the timed codes or the untimed codes?
In the SNF setting, can we use care conferences when a family member is present but the patient is not as billable time for the caregiver training code?
SNF paid under PDPM – No!
Can this be used for Pediatric Pt’s as well? I work in a clinic that see’s a lot of Peds and our therapists are doing this kind of education all the time with parents or other family members
Yes and in my opinion, will be the biggest utilization of these codes.
If I have a newborn in my clinic for feeding difficulties and during the session, the newborn (as they are want to do) falls asleep, can I then provide direct caregiver training to the parent (positioning and home programs) and bill 97550 because the newborn is no longer an active participant in the therapy?
You would need to determine if that meets the definition of “without the patient present”.
Does the Caregiver training count toward the 180 minutes of daily therapy in an IRF setting?
No!