Understanding the 97110 CPT Code for Occupational Therapists
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If you’re looking for information about the 97110 CPT code, you’ve come to the right place.
As occupational therapy practitioners, CPT codes are a part of service delivery. It’s important for occupational therapists to know the various occupational therapy CPT codes to accurately reflect what’s happened in sessions with clients and receive proper reimbursement for services rendered.
In this article, we will look at the 97110 CPT code for occupational therapy, 97110 CPT code reimbursement rates, and more.
What are CPT codes?
Current Procedural Terminology (CPT) is a coding system that is updated yearly by the American Medical Association (AMA).
CPT codes are universal five-digit codes for procedures, services, treatment, and evaluation. For occupational therapists, CPT codes are used to identify and document services rendered. They are also used for insurance reimbursement and to delineate the time spent treating or evaluating patients.
This article will dive into the 97110 CPT code for occupational therapy.
What is the 97110 CPT code in occupational therapy?
The 97110 CPT code is a code frequently used by occupational therapists to describe treatment.
Specifically, the 97110 CPT code is described as a “therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility” in one area for 15 minutes each.
This is a time-based code that should be used for one one-on-one direct treatment of a client..
For example, an occupational therapist might use the 97110 CPT code when using resistance bands to help clients with their range of motion of their right upper extremity following a stroke.
The 97110 CPT code can also be used for telehealth, however, it is important to keep an eye on this, as it’s not yet a permanent change.
97110 CPT code reimbursement rate examples
Reimbursement rates vary by insurance provider, including Medicaid and Medicare. Medicare has a fee calculator, the Medicare Physician Fee Schedule (MPFS), that you can use to help determine rates. Typically, Medicare reimburses 80% and patient responsibility is 20%.
Many other companies use Medicare as a guideline for their reimbursement rates. Currently, reimbursement rates for CPT code 97110 are around $31.40.
As the rehabilitation provider, your rate may not be the same rate that the insurance company reimburses, leaving the client to pay out of pocket. However, if you accept insurance, you agree to the reimbursement rate dictated by each insurance company and can only charge your patient the agreed upon rate.
Reimbursement rates vary between insurance companies and between individual insurance plans. Most insurance companies will send you a fee schedule to make things easier. This schedule is important because it is the legally agreed amount the insurance company will pay for services rendered.
Before signing a contract with an insurance company to become an in-network provider, it’s important to know these rates.
Knowing the reimbursement rate for occupational therapy CPT codes is also important for your clients so they know how much they may owe.
Finding out about CPT code reimbursement rates before seeing your client can be important. You may need to contact each insurance company directly to get the correct answer and fee schedule. This way, there are no surprises for you or your client.
Be aware that fee schedules are confidential.
It is important to use the correct CPT codes for reimbursement, as using the incorrect code can lead to delayed or denied payments.
The 8-minute rule for Medicare
In 2000, Medicare introduced the 8-minute rule for rehab professionals. When billing for units of service, the guidelines state that if you have treated the patient directly for at least eight minutes, you can bill for one unit (15 minutes) of service.
This also applies to additional time up to 22 minutes. So, if you see a patient from 8 to 22 minutes, you can bill for one 15-minute unit of service. If, for example, you saw a patient for 25 minutes, you can bill for two units for service. This is an important rule to be aware of to ensure you are properly billing for services rendered.
The 8-minute rule applies to the 97110 CPT code for occupational therapy.
Other important CPT codes for occupational therapy
There are many CPT codes you may use as an occupational therapy practitioner. The American Occupational Therapy Association lists the most widely used occupational therapy CPT codes, which includes the 97110 CPT code.
A few other popular timed-based codes include:
- 97129: Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem-solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact.
- 97140: Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction) 1 or more regions, each 15 minutes.
- 97530: Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes.
- 97535: Self-care/home management training (e.g., activities of daily living [ADLs] and compensatory training, meal preparation, safety procedures, and instructions in using assistive technology devices/adaptive equipment), direct one-on-one contact, each 15 minutes.
It is important to note that there are two types of CPT codes occupational therapists can bill for: service-based and time-based codes.
Service-based occupational therapy CPT codes are untimed, whereas time-based codes are based on time, usually 15-minute increments.
Navigating CPT codes for occupational therapy and reimbursement rates is a complex task. Understanding individual CPT codes for occupational therapy, like the frequently used 97110 code, can help you accurately reflect what occurs in session with clients. Keeping updated with changes, such as reimbursement rates, can also help streamline your billing process.
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